改良中药硬膏热贴敷联合BTA治疗中风后肩痛患者的临床疗效及对其神经功能的影响  

Hot Application of Improved Chinese Herbal Medicine Plaster Combined with Botulinum Toxin A Improves Nerve Function in the Patients with Shoulder Pain after Stroke

作　　者：李玉玲 郝娜 张明明 肖文霞 李洪梅 LI Yu-ling;HAO Na;ZHANG Ming-ming;XIAO Wen-xia;LI Hong-mei(Imaging Department,Hengshui Hospital of Traditional Chinese Medicine,Hengshui Hebei 053000;Department of Encephalopathy,Hengshui Hospital of Traditional Chinese Medicine,Hengshui Hebei 053000;Department of Pulmonary Diseases,Hengshui Hospital of Traditional Chinese Medicine,Hengshui Hebei 053000;Department of Digestive Diseases,Hengshui Hospital of Traditional Chinese Medicine,Hengshui Hebei 053000)

机构地区：[1]衡水市中医医院影像科,河北衡水053000 [2]衡水市中医医院脑病科,河北衡水053000 [3]衡水市中医医院肺病科,河北衡水053000 [4]衡水市中医医院脾胃科,河北衡水053000

出　　处：《世界中西医结合杂志》2024年第2期297-301,共5页World Journal of Integrated Traditional and Western Medicine

基　　金：河北省中医药管理局科研计划项目(2020535)。

摘　　要：目的 探究改良中药硬膏热贴敷配合A型肉毒毒素(Botulinum toxin A,BTA)治疗中风后肩痛(Hemiplegic shoulder pain, HSP)患者的临床疗效。方法 选取2021年1月—2022年9月期间衡水市中医医院脑病门诊就诊及住院的中风后肩痛患者200例,按随机数字表法分为对照组和观察组,每组各100例。对照组给予A型肉毒毒素治疗,观察组在对照组基础上给予改良中药硬膏热贴敷配合A型肉毒毒素治疗。持续治疗8周。观察比较两组患者临床疗效,治疗前后炎性因子[血清白细胞介素1β(Interleukin-1β,IL-1β)及一氧化氮(Nitric oxide, NO)]水平、扩展Barthel指数(Extended barthel index, EBI)量表评分、上肢简化Fugl-Meyer法(Fugl-Meyer assessment, FMA)评分、疼痛视觉模拟评分法(Visual analogue scale, VAS)评分、美国国立卫生研究院卒中量表(The national institutes of health stroke scale, NIHSS)评分、肩关节活动度评分。结果 治疗后观察组总有效率94.00%(94/100)高于对照组81.00%(81/100),差异有统计学意义(P<0.05)。治疗后两组患者炎症因子IL-1β、NO水平较治疗前降低,差异有统计学意义(P<0.05);且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者EBI、FMA评分较治疗前升高,差异有统计学意义(P<0.05);且观察组高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者VAS、NIHSS评分较治疗前降低,差异有统计学意义(P<0.05);且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后两组患者肩关节外展、外旋、屈曲活动度评分较治疗前升高,差异有统计学意义(P<0.05);且观察组高于对照组,差异有统计学意义(P<0.05)。结论 改良中药硬膏热贴敷配合BTA治疗能够改善中风后肩痛患者的上肢神经功能、肩关节活动度以及日常生活能力,缓解其疼痛,治疗效果显著优于单独BTA治疗。Objective To observe the clinical efficacy of hot application of improved Chinese herbal medicine plaster combined with botulinum toxin A(BTA)in the treatment of hemiplegic shoulder pain(HSP)after stroke.Methods A total of 200 patients hospitalized due to post-stroke HSP in the Department of Encephalopathy,Hengshui Hospital of Traditional Chinese Medicine from January 2021 to September 2022 were selected and assigned by the random number table method into a control group and an observation group,with 100 patients in each group.The control group was treated with BTA,while the observation group received BTA combined with hot application of improved Chinese herbal medicine plaster.The treatment lasted for 8 weeks,and the clinical efficacy was compared between the two groups of patients.The serum levels of inflammatory cytokines[interleukin-1β(IL-1β)and nitric oxide(NO)],Extended Barthel Index(EBI),Fugl-Meyer Assessment(FMA)score for upper limbs,Visual Analog Scale(VAS)score,The National Institutes of Health Stroke Scale(NIHSS)score,and shoulder range of motion score were determined before and after treatment.Results The total response rate(94.00%,94/100)in the observation group was higher than that(81.00%,81/100)in the control group(P<0.05).After treatment,the serum levels of IL-1βand NO decreased(P<0.05),and the decreases were more obvious in the observation group than in the control group(P<0.05).After treatment,the EBI and FMA scores increased and the VAS and NIHSS scores decreased(P<0.05).Moreover,the observation group had higher EBI and FMA scores and lower VAS and NIHSS scores than the control group(P<0.05).The treatment in both groups increased the score of shoulder joint abduction,external rotation,and flexion activity(P<0.05),and the observation group had higher scores than the control group(P<0.05).Conclusion The hot application of improved Chinese herbal medicine plaster combined with BTA can improve the upper limb nerve function,shoulder joint mobility,and daily living ability and alleviate the pain i

关 键 词：中风后肩痛 改良中药硬膏 热贴敷 A型肉毒毒素 神经功能 

分 类 号：R743.3[医药卫生—神经病学与精神病学]