不同频率电针治疗脑卒中偏瘫肩痛的临床观察  

Clinical observation of electroacupuncture with different frequencies in treatment of hemiplegic shoulder pain after stroke

作　　者：丁玉菊 刘照勇 肖荣 张波[2] DING Yu-ju;LIU Zhao-yong;XIAO Rong;ZHANG Bo(Department of Rehabilitation,Eighth People's Hospital of Hefei,Hefei 238000,Anhui Province,China;Department of Encephalopathy,First Affiliated Hospital of Anhui University of CM,Hefei230038)

机构地区：[1]合肥市第八人民医院康复科,安徽合肥238000 [2]安徽中医药大学第一附属医院脑病科,合肥230038

出　　处：《中国针灸》2023年第8期899-903,共5页Chinese Acupuncture & Moxibustion

基　　金：“十四五”合肥市中医优势专科建设项目:合卫中医秘[2021]167号。

摘　　要：目的:观察不同电针频率对脑卒中偏瘫肩痛(HSP)临床疗效的影响。方法:将105例脑卒中HSP患者随机分为手针组(35例,脱落2例)、电针连续波组(35例,脱落3例)和电针疏密波组(35例)。三组均予常规康复治疗,手针组穴取患侧肩髃、肩贞、肩髎、肩前等针刺治疗,电针连续波组和电针疏密波组在手针组基础上于肩髃-肩髎、曲池-手三里加用电针,参数分别为15 Hz连续波、2 Hz/100 Hz疏密波。每天1次,一周5次,连续治疗4周。观察各组患者治疗前、治疗2周和治疗4周患肩视觉模拟量表(VAS)评分,治疗前后肩前屈被动关节活动度(PROM)、肩外展PROM、上肢肌力、改良Barthel指数(MBI)评分、Fugl-Meyer量表(FMA)评分。结果:与治疗前比较,各组患者治疗2、4周VAS评分降低(P<0.05),治疗4周VAS评分低于治疗2周(P<0.05);治疗2、4周,电针连续波组、电针疏密波组患者VAS评分低于手针组(P<0.05);治疗4周,电针疏密波组患者VAS评分低于电针连续波组(P<0.05)。与治疗前比较,各组患者治疗后肩前屈、外展PROM增大(P<0.05),上肢肌力增强(P<0.05),MBI和FMA评分升高(P<0.05);治疗后,电针连续波组、电针疏密波组肩前屈PROM大于手针组、上肢肌力强于手针组(P<0.05),电针疏密波组MBI、FMA评分高于手针组(P<0.05)。结论:电针对脑卒中偏瘫肩痛患者的止痛效应和综合康复疗效优于手针,2 Hz/100 Hz疏密波电针优于15 Hz连续波电针。Objective To observe the clinical efficacy on hemiplegic shoulder pain(HSP)after stroke treated with electroacupuncture(EA)under different frequencies.Methods A total of 105 patients with HSP after stroke were randomly divided into a manual acupuncture group(35 cases,2 cases dropped off),an EA continuous wave group(35 cases,3 cases dropped off)and an EA disperse-dense wave group(35 cases).The conventional rehabilitation therapy was delivered in the three groups.Additionally,acupuncture was applied to Jianyu(LI 15),Jianzhen(SI 9),Jianliao(TE 14)and Jianqian(Extra)etc.on the affected side in the manual acupuncture group.In the EA continuous wave group and the EA disperse-dense wave group,besides the treatment as the manual acupuncture group,the electric stimulation was attached to two pairs of acupoints,i.e.Jianyu(LI 15)and Jianliao(TE 14),and Quchi(LI 11)and Shousanli(LI 10),with 15 Hz continuous wave,and 2 Hz/100 Hz disperse-dense wave,respectively.The treatment was given once daily,5 times a week,for 4 weeks consecutively.The score of visual analogue scale(VAS)before treatment and after 2 and 4 weeks of treatment,as well as the passive range of motion(PROM)of shoulder forward flexion and PROM of shoulder abduction,muscle strength of the upper limb,the score of modified Barthel index(MBI)and the score of Fugl-Meyer assessment(FMA)before and after treatment were observed in each group.Results Compared with before treatment,VAS scores were reduced after 2 and 4 weeks of treatment in each group(P<0.05);and VAS scores after 4 weeks of treatment were lower than those after 2 weeks of treatment(P<0.05).After 2 and 4 weeks of treatment,VAS score in either the EA continuous wave group or the EA disperse-dense wave group was lower compared with the manual acupuncture group(P<0.05).After 4 weeks of treatment,VAS score in the EA disperse-dense wave was lower than that of the EA continuous wave group(P<0.05).Compared with before treatment,PROM of the shoulder forward flexion and abduction on the affected side after treatment

关 键 词：脑卒中 偏瘫肩痛 电针 手针 连续波 疏密波 

分 类 号：R246.6[医药卫生—针灸推拿学]