【作者】 谢芹；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸学， 2010， 博士

【摘要】 目的：观察针刺结合康复训练对脑卒中肩手综合征患者神经功能、上肢运动功能、疼痛及综合功能的影响,探讨针刺结合康复训练对脑卒中肩手综合征的治疗作用,为其在脑卒中肩手综合征临床治疗中的应用提供循证医学证据。方法：在广州中医药大学第一附属医院住院病人中选取符合纳入标准的病例90例,按照随机化原则分为3组,依次为针刺组(A组)30例、康复训练组(B组)30例、针刺结合康复训练组(C组)30例,三组均每周治疗5天,休息2天后继续下一周治疗,共治疗4周,疗程28天。针刺组(A组)治疗日每天给予单纯针刺治疗一次、康复训练组(B组)治疗日每天给予单纯康复训练一次,针刺结合康复训练组(C组)治疗日每天给予针刺治疗与康复训练各一次。治疗期间三组均给予常规基础药物治疗28天。治疗前、治疗14天后及疗程结束后进行相关临床功能评定：神经功能评定采用临床神经功能缺损程度评分(NDS)、上肢运动功能评定采用上肢简化Fugl-Meyer评分(FMA)、上肢疼痛评定采用视觉模拟量表(VAS)、综合功能评定采用功能综合评定量表(FCA),疗程结束后进行肩手综合征综合疗效评定。结果：各组患者年龄、性别及治疗前临床神经功能缺损程度评分、上肢简化Fugl-Meyer运动功能评分、上肢疼痛VAS评分、综合功能FCA评分比较,差异无统计学意义(P>0.05)。1.NDS评分结果：各组治疗14天后、28天后NDS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后NDS评分下降值从高到低依次为针刺结合康复训练组(C组)、针刺组(A组)、康复训练组(B组),其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.01)。2.上肢简化FMA评分结果：各组治疗14天后、28天后上肢简化FMA评分均明显提高,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后上肢简化FMA评分升高值从高到低依次为C组、A组、B组,治疗14天后三组评分提高值之间比较差异无统计学意义(P>0.05),治疗28天后C组评分提高值显著高于B组(P<0.01),A组评分提高值也显著高于B组(P<0.05),C组与A组之间比较差异无统计学意义(P>0.05)。3.VAS评分结果：各组治疗14天后、28天后VAS评分均明显下降,与治疗前比较均有显著性差异(P<0.01)。治疗14天后、28天后VAS评分下降值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P<0.05或P<0.01)。4.FCA评分结果：各组治疗14天后、28天后FCA评分均明显提高,与治疗前比较均有显著性差异。治疗14天后、28天后FCA评分升高值从高到低依次为C组、A组、B组,其中C组与A组之间比较差异无统计学意义(P>0.05),C组与B组、A组与B组之间比较差异有统计学意义(P＜0.01)。5.肩手综合征综合疗效评定结果：A组显效率为26.7%,B组显效率为3.3%,C组显效率为36.7%,A组总有效率为90.0%,B组总有效率为83.3%,C组总有效率为96.7%,治疗效果由优到差依次为C组、A组、B组。C组与A组之间比较差异无统计学意义(P>0.05),C组与B组比较有显著性差异(P<0.01)、A组与B组比较有显著性差异(P<0.05)。结论：对脑卒中肩手综合征患者采取针刺结合康复训练、单纯针刺、单纯康复训练的方法均能有效促进其神经功能的恢复、减轻其疼痛程度、改善其上肢运动功能及综合功能。针刺结合康复训练组疗效明显优于康复训练组,针刺结合康复训练组各项指标改善优于针刺组,虽然差异不显著,但两组之间的疗效差异有随治疗时间延长而放大的趋势。针刺与康复训练在脑卒中肩手综合征的治疗中具有良好的协同作用。更多还原

【Abstract】 Objective To observe the effects of acupuncture combined with rehabilitation training on neurological function, upper limb motor function, pain degree, comprehensive function in the patients with shoulder-hand syndrome(SHS) after stroke. To study the therapeutic effects of acupuncture combined with rehabilitation training on SHS after stroke and to supply the evidence of its clinical application.Methods All the cases were the inpatients of The First Affiliated Hospital of Guangzhou University of Chinese Medicine.90 cases of shoulder-hand syndrome after stroke enrolled according to inclusion criteria were randomized into three groups:the acupuncture group(group A), the rehabilitation training group (group B) and the acupuncture combined with rehabilitation training group (group C),30 cases in each group. Patients in the acupuncture group (group A) were treated only with acupuncture, patients in the rehabilitation training group (group B) were treated only with rehabilitation training, and the patients in acupuncture combined with rehabilitation training group (group C) were treated with both acupuncture and rehabilitation training. The treatment course lasted for 28 days, acupuncture and rehabilitation training were given five days a week, and basic drug therapy was given throughout the whole course in all the three groups. The three groups were evaluated before treatment,14 days after the treatment and after the whole treatment course. Neurological function was evaluated by Neural Dysfunction Scale (NDS), upper limb motor function was evaluated by Simplified Fugl-Meyer Assessment (FMA), pain degree was evaluated by Visual Analogue Scale (VAS), and comprehensive function was evaluated by Functional Comprehensive Assessment (FCA). The comprehensive effect was evaluated after the treatment course.Results Before the treatment, there was no significant difference of age, sex, NDS score, Simplified FMA score, VAS score and FCA score between three groups (P>0.05)1. Results of NDS:Compared with before treatment, the NDS scores decreased significantly both after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of NDS after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:the acupuncture combined with rehabilitation training group (group C), the acupuncture group (group A) and the rehabilitation training group (group B). There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B, as well as between group A and group B (P<0.01).2. Results of Simplified FMA:Compared with before treatment, the Simplified FMA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of Simplified FMA after 14 days of treatment and after the whole treatment course from higher to lower, three groups were sorted as:group C, group A and group B. There was no significant difference between three groups after 14 days of treatment (P>0.05). The increased scores of group C was significantly higher than group B (P<0.01), and the increased scores of group A was also significantly higher than group B (P<0.05). There was no significant difference between group C and group A (P>0.05).3. Results of VAS:Compared with before treatment, the VAS score decreased significantly after 14 days of treatment and after the whole treatment course in all the three groups (P<0.01). By the reduced scores of VAS after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05). The difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).4. Results of FCA:Compared with before treatment, the FCA score increased significantly both after 14 days of treatment and after the whole treatment course in all three groups (P<0.01). By the increased scores of FCA after 14 days of treatment and after the whole treatment course from higher to lower, the three groups were sorted as:group C, group A and group B. There was no significant difference between group C and group A (P>0.05), the difference was significant between group C and group B, as well as between group A and group B (P<0.01).5. Results of the comprehensive effect evaluation:Apparent rate of the three groups was:group A 26.7%, group B 3.3% and group C 36.7%. Total effective rate of the three groups was:group A 90.0%, group B 83.3%, and group C 96.7%. By the effect of therapy from better to worse three groups were sorted as: group C, group A and group B. There was no significant difference between group C and group A (P>0.05), and the difference was significant between group C and group B (P<0.01), as well as between group A and group B (P<0.05).Conclusion Acupuncture, rehabilitation training and acupuncture combined with rehabilitation training can all improve the neurological function, upper limb motor function and comprehensive function and release pain of patients with shoulder-hand syndrome after stroke. Acupuncture combined with rehabilitation training is significantly more effective than simple rehabilitation training. Although the difference was not significant, acupuncture combined with rehabilitation training improved the condition better than simple acupuncture, and the difference was more obvious as the treatment course extended. There is a synergetic effect of acupuncture and rehabilitation training in the therapy of SHS after stroke.更多还原