温针电针配合运动疗法与经皮电神经刺激治疗卒中后偏瘫肩痛临床研究  

The clinical study on warm needling and electroacupuncture combined with exercise and TENS treating patients of hemiplegia after stroke with shoulder pain

作　　者：文怡川[1] 李娜[1] 伍祥容 Wen Yichuan;Li Na;Wu Xiangrong(Department of Rehabilitation,People's Hospital of Guang'an,Guang'an 638000,China)

机构地区：[1]四川省广安市人民医院康复医学科,638000

出　　处：《国际中医中药杂志》2020年第3期226-230,共5页International Journal of Traditional Chinese Medicine

摘　　要：目的探讨温针电针配合运动疗法和经皮电神经刺激(transcutaneous electrical nervestimulation,TENS)治疗缺血性卒中后偏瘫肩痛的疗效。方法选取本院2016年5月-2019年3月符合入选标准的68例卒中后偏瘫肩痛患者,按随机数字表法分为2组,每组34例。2组均按指南给予西医常规疗法治疗,在此基础上对照组给予运动疗法和TENS,观察组在对照组治疗基础上加用温针电针。2组均治疗4周。采用VAS量表评估肩痛程度,采用Fugl-Meyer运动量表评估上肢运动功能,采用改良Barthel指数评估日常生活活动能力,采用肩手综合征评估量表(Shoulder Hand Syndrome Score,SHSS)评估患者感觉、远端水肿及运动情况,采用角度尺测量法测评肩关节前屈、后伸、外展、内旋、外旋的活动度,采用ELISA法检测hs-CRP、IL-6水平,评价临床疗效。结果治疗后,观察组VAS评分低于对照组(t=5.778,P<0.01),上肢Fugl-Meyer运动量表、改良Barthel指数评分高于对照组(t值分别为10.933、14.493,P值均<0.01);肩关节前屈、后伸、外展、内旋、外旋活动度均大于对照组(t值分别为16.251、12.006、29.001、16.008、24.003,P值均<0.01);感觉、远端水肿、运动评分均低于对照组(t值分别为5.331、5.172、6.221,P值均<0.01)。观察组总有效率为94.1%(32/34)、对照组为67.7%(23/34),2组比较差异有统计学意义(χ^2=6.087,P=0.014)。治疗后观察组血清hs-CRP[(10.55±1.72)mg/L比(13.81±2.79)mg/L,t=6.551]、IL-6[(9.31±1.56)μg/L比(11.78±1.90)μg/L,t=7.149]水平均低于对照组(P<0.01)。结论温针电针配合运动疗法与TENS可改善卒中后偏瘫肩痛患者的肩痛症状,降低炎性细胞因子水平,提高疗效。Objective To investigate the efficacy of warm needling and electroacupuncture combined with exercise and transcutaneous electrical nervestimulation(TENS)treating patients of hemiplegia after stroke with shoulder pain.Methods A total of 68 patiens of hemiplegia after ischemic stroke patients with shoulder pain who were admitted in our hospital from May 2016 to March 2019,were randomly divided into control group and observation group by random number table method,with 34 patients in each group.Two groups were given with regular western treatment according to the guidelines.The control group was treated with excercise and TENS;while the observation group was treated with warm needling and electroacupuncture based on the control group.Both groups were treated for 4 weeks.Use Visual Analogue Scale(VAS)to assesse the shoulder pain;use Fugl-Meyer Scale(FMA)to evaluated upper limb movement function;use Barthel index(MBI)to assesse daily life ability;use the Shoulder Hand Syndrome Score(SHSS)to assess the feeling of patients,proneness,stretch,outreach,and internal rotation,outside activity of shoulder joint.The ELISA were employed to detect levels of high sensitivity to C-reactive protein(hs-CRP)and IL-6,to evaluate the clinical efficacy.Results After the treatment,the VAS score of the observation group was significantly lower than the control group(t=5.778,P<0.01),while socres of FMA and MBI and shoulder range of motion were significantly higher than that of control group(t=10.933,14.493,all Ps<0.01).The activity of flexion,extension,abduction,internal rotation,and external rotation of the shoulder joint were significantly higher than the control group(t=16.251,12.006,29.001,16.008,24.003,all Ps<0.01).Scores of sensory,the distal edema and motor of the scale of shoulder and hand syndrome in the observation group were significantly lower than the control group(t=5.331,5.172,6.221,all Ps<0.01).The total effective rate of the observation group was 94.1%(32/34),significantly higher than that of the control group 67.7%(23/34)

关 键 词：卒中 偏瘫 肩痛 温针疗法 电针疗法(中医) 运动疗法 

分 类 号：R246[医药卫生—针灸推拿学]