中医定向透药疗法治疗偏瘫肩痛患者疗效的临床观察

发布时间：2018-12-17 16:47

【摘要】：目的:本文旨在通过随机对照性的临床研究,比较中医定向透药疗法和中频脉冲电刺激治疗偏瘫肩痛的疗效差异,为偏瘫肩痛提供新的有效治疗方法。方法:将经过筛查的61例偏瘫肩痛患者随机分至治疗组(31例)和对照组(30例),治疗组给予中医定向透药疗法,对照组给予中频脉冲电刺激,两组贴片均放置于冈上肌、三角肌中后束,治疗时间为每次25min,每天1次,每周5次,连续治疗4周,共20次,两组同时给予常规康复治疗。分别于入组后第0周(基线水平)、第2周、第4周、第8周进行视觉模拟评分(VAS)、Fugl-Meyer运动功能评定量表(FMA)、肩关节被动活动度(PROM)、主动活动度(AROM)、Barthel指数量表(BI)、9条目患者健康问卷(PHQ-9)和健康状况调查问卷(SF-36)相关量表评定,以第4周为主要评定时间,了解患者疼痛、上肢运动功能、肩关节活动度、生活自理能力、抑郁状态、生活健康状况的改善情况。结果:1.共有60例患者完成本临床研究,治疗组30例,对照组30例,1例患者因个人原因出院而退出试验,治疗过程中未发生不良反应。2.治疗组和对照组第4周的VAS评分同基线水平相比分别降低1.74和0.95,组内比较和组间比较均有显著差异(P=0.000,P=0.000,P=0.000)。3.治疗组和对照组第4周的FMA评分同基线水平相比均提高,组内比较和组间比较均有显著差异(P=0.000,P=0.000,P=0.017)。4.治疗组和对照组第4周PROM前屈、外展、内旋和外旋度数同基线水平相比均提高,组内比较有显著差异(治疗组:P=0.000,P=0.000,P=0.000,P=0.005;对照组:P=0.000,P=0.000,P=0.000,P=0.000)。组间比较PROM前屈有显著差异(P=0.031),PROM外展、内旋、外旋无显著差异(P=0.238,P=0.484,P=0.598)5.治疗组和对照组第4周AROM前屈、外展、内旋、外旋度数同基线水平相比均提高,除对照组AROM外旋数值无显著差异(P=0.184)外,其余方向AROM数值有显著差异(治疗组:P=0.000,P=0.000,P=0.001,P=0.003;对照组:P=0.012,P=0.001,P=0.023)。组间比较AROM数值有显著差异(P=0.045,P=0.045,P=0.028,P=0.035)。6.治疗组和对照组第4周BI、PHQ-9和健康调查问卷分值与基线相比均提高,数值有显著差异(治疗组:P=0.000,P=0.000,P=0.000;对照组:P=0.001,P=0.000,P=0.003)。组间比较BI、PHQ-9和健康调查问卷有显著差异(P=0.041,P=0.040,P=0.046)。结论:1.中医定向透药疗法和中频脉冲电刺均激能改善偏瘫肩痛,且中医定向透药疗法优于中频脉冲电刺激,其疗效持久性更突出。2.中医定向透药疗法和中频脉冲电刺激还有助于改善肩关节主动及被动活动度、上肢运动功能、生活自理能力、抑郁状态和健康生活质量,且前者优于后者。
[Abstract]:Objective: to compare the curative effect of directional permeation therapy and middle frequency pulse electric stimulation in treating shoulder pain of hemiplegia by randomized controlled clinical study, and to provide a new effective treatment method for shoulder pain of hemiplegia. Methods: 61 patients with shoulder pain of hemiplegia were randomly divided into treatment group (31 cases) and control group (30 cases). The posterior bundle of deltoid muscle was treated for 25 minutes, once a day, 5 times a week for 4 weeks, 20 times. The two groups were given routine rehabilitation treatment at the same time. Visual analogue scale (VAS), Fugl-Meyer) was performed at week 0 (baseline level), week 2, week 4 and week 8 after admission to the group. (VAS), Fugl-Meyer motor function rating scale (FMA),) was used to assess passive motion of shoulder joint (PROM), active activity degree (AROM),). Barthel index scale (BI), 9 items of patient health questionnaire (PHQ-9) and health status questionnaire (SF-36) related to the evaluation of the fourth week as the main assessment time, to understand the pain, upper limb motor function, shoulder motion, shoulder motion. Self-care ability, depression, health improvement. Results: 1. A total of 60 patients completed the clinical study, the treatment group of 30 cases, the control group of 30 cases, one patient discharged from the test for personal reasons, no adverse reactions occurred in the course of treatment. 2. The VAS scores of the treatment group and the control group decreased by 1.74 and 0.95 respectively compared with the baseline level at the 4th week, and there were significant differences between the two groups. 3. The FMA scores in the treatment group and the control group at the 4th week were higher than those in the baseline level, and there were significant differences between the two groups (P < 0. 000P 0. 000 P 0. 017). 4. In the treatment group and the control group, the number of PROM flexion, abduction, internal rotation and external rotation increased significantly compared with the baseline level at the 4th week, and there was significant difference in the treatment group (treatment group: P0. 000P0. 000P0. 000P0. 005; In the control group, the control group (P = 0.000, P = 0.000). There was significant difference in PROM forward flexion between groups (P0. 031), PROM outreaching, internal rotation and extroversion (P0. 238, P0. 484, P0. 598). In the treatment group and the control group, the number of AROM flexion, abduction, internal rotation and degree of rotation increased compared with the baseline level at the 4th week. Except for the control group, there was no significant difference in the value of AROM external rotation (P0. 184), but there were significant differences in the other directions of AROM (treatment group: P0. 000, P < 0. 000). P0. 000, P0. 001, P0. 003; In the control group: P 0. 012, P = 0. 001, P = 0. 023). There was significant difference in AROM values among groups (P0. 045, P0. 028, P0. 035). The scores of BI,PHQ-9 and health questionnaire in the treatment group and the control group in the 4th week were significantly higher than those in the baseline (treatment group: P0. 000, P0. 000; control group, P0. 001, P0. 000, P0. 003). There was significant difference between BI,PHQ-9 and health questionnaire (P0. 041, P0. 040, P0. 046). Conclusion: 1. Both Chinese medicine directed permeation therapy and intermediate frequency pulse electroacupuncture can improve shoulder pain of hemiplegia, and traditional Chinese medicine directional permeation therapy is superior to intermediate frequency pulse electric stimulation, and its curative effect is more persistent. 2. Traditional Chinese medicine directional permeation therapy and middle frequency pulse electric stimulation can also improve the active and passive motion of shoulder, upper limb motor function, life self-care ability, depression state and healthy quality of life, and the former is superior to the latter.
【学位授予单位】：蚌埠医学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.7

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