中医综合康复方案治疗中风后关节活动障碍前瞻性队列研究  

Traditional Chinese Medicine Comprehensive Rehabilitation Scheme on Joint Movement Disorder after Stroke:A Prospective Cohort Study

作　　者：赵若男 宋瑞 何丽云[1] 李洪皎[1] 王启桢 苏同生 吕晓颖[1] ZHAO Ruonan;SONG Rui;HE Liyun;LI Hongjiao;WANG Qizhen;SU Tongsheng;LYU Xiaoying(Institute of Basic Research in Clinical Medicine,China Academy of Chinese Medical Sciences,Beijing,100700;Xi'an TCM Hospital of Encephalopathy;Shaanxi Traditional Chinese Medicine Hospital)

机构地区：[1]中国中医科学院中医临床基础医学研究所,北京市100700 [2]西安中医脑病医院 [3]陕西省中医医院

出　　处：《中医杂志》2022年第21期2060-2065,共6页Journal of Traditional Chinese Medicine

基　　金：国家自然科学基金(81703950);国家中医药管理局重大疑难疾病中西医临床协作试点(脑梗死)项目(国中医药办医政发[2018]3号);中国中医科学院科技创新工程中医临床基础学科创新团队项目(CI2021B003);中央级公益性科研院所基本科研业务费专项资金(ZZ14-YQ-037)。

摘　　要：目的评估中医综合康复方案在治疗中风后关节活动障碍方面的临床疗效。方法采用前瞻性队列研究,纳入2017年1月1日至2020年12月1日陕西省5所三级甲等医院1154例中风后关节活动障碍患者,根据是否接受中医综合康复方案分为治疗组和对照组。对照组给予西医基础治疗,治疗组在西医基础治疗的同时给予中医综合康复方案:阴偏盛(软瘫)者口服马海胶囊(每次0.3 g,每日3次),同时给予针刺患侧上肢肩三针、曲池、后溪、合谷、内关,针刺患侧下肢髀关、血海、阳陵泉、申脉、足三里、三阴交、太冲,均行补法,每次30 min,每周5次;阳偏盛(硬瘫)者口服柔筋胶囊(每次0.9 g,每日3次),同时针刺治疗,穴位同上,均行泻法,每次30 min,每周5次。两组共治疗3个月。分别于治疗前,治疗第1、3个月,随访期第6、12、18、24个月共7个访视点采用Fugl-Meyer关节活动度量表、Fugl-Meyer关节疼痛量表、改良Rankin量表进行评分。应用倾向性评分匹配控制两组队列的混杂因素,采用重复测量方差分析法,比较两组患者在7个访视点的治疗效果差异。结果最终纳入分析患者982例,其中治疗组686例,对照组296例。经倾向性评分匹配,两组各有292例匹配成功。重复测量数据主体内效应检验结果显示,不同访视点之间FuglMeyer关节活动度量表评分、Fugl-Meyer关节疼痛量表评分、改良Rankin量表评分差异均有统计学意义(P<0.01)。第5、6、7次访视时两组患者Fugl-Meyer关节活动度量表评分差异具有统计学意义(P<0.05)。第1、2、3、4次访视时两组患者Fugl-Meyer关节疼痛评分比较,治疗组得分显著低于对照组(P<0.05)。各访视点治疗组改良Rankin量表评分均显著高于对照组(P<0.01)。结论中医综合康复方案联合西医基础方案治疗中风后关节活动障碍,可显著改善关节活动情况和疼痛情况,效果优于单纯西医基础治疗。ObjectiveTo evaluate the effect of traditional Chinese medicine(TCM)comprehensive rehabilita-tion scheme on joint movement disorder after stroke.MethodsA multicenter,prospective cohort study was con-ducted in five tertiary hospitals in Shaanxi Province from January 1,2017 to December 1,2020,and 1154 patients with joint movement disorder after stroke were included.Patients were divided into the trial group and the control group according to whether they received the TCM comprehensive rehabilitation scheme.Patients in the control group received western medicine,while those in the trial group additionally took TCM comprehensive rehabilitation scheme.Patients of abnormal exuberance of Yin(soft paralysis)were treated oral Mahai Capsule(马海胶囊),0.3 g per time for three times daily,plus needling with supplementation manipulation at Jian San Zhen(肩三针,three shoulder points),Quchi(LI 11),Houxi(SI 3),Hegu(LI 4),Neiguan(PC 6)of the affected upper limbs,and at Biguan(S T 31),Xuehai(SP 10),Yanglingquan(GB 34),Shenmai(BL 62),Zusanli(ST 36),Sanyinjiao(SP 6),and Taichong(LV 3)of the affected lower limbs,30 min per time for five times weekly.For patients with abnormal exu-berance of yang(hard paralysis),Roujing Capsule(柔筋胶囊)was taken orally,0.9 g per time for three times daily,together with needling at mentioned above acupoints but with drainage manipulation,30min per time for five times weekly.Both groups received treatment for three months.Fugl-Meyer joint range of motion,Fugl-Meyer joint pain evaluation scale,and Modified Rankin scale were used to measure the joint activity of the patients at seven time points:before treatment,after 1-and 3-month treatment,and during 6-,12-,18-and 24-month follow-up.The pro-pensity score was used to match and control the confounding factors of the two groups.Analysis of variance of repeated measurements was used to compare the effect differences between two groups at multiple time points.ResultsTotal-ly,982 cases were finally included,with 686 cases in the trial group and 29

关 键 词：中风 关节活动障碍 中医综合康复治疗 针刺疗法 Fugl-Meyer关节活动度量表 Fugl-Meyer关节疼痛量表 改良Rankin量表 

分 类 号：R255.2[医药卫生—中医内科学]