世界中医药
文章摘要
引用本文:赵小秋,杨苹,黄国艳.针刺养老穴联合康复锻炼对中风后肩手综合征生命质量的影响及其部分机制[J].世界中医药,2019,(07):.  
针刺养老穴联合康复锻炼对中风后肩手综合征生命质量的影响及其部分机制
Study on Effects of Acupuncture at Yanglao(SI 6)Combined with Rehabilitation Exercise on Life Quality of Shoulder-hand Syndrome After Stroke and Its Partial Mechanism
投稿时间:2018-11-28  
DOI:10.3969/j.issn.1673-7202.2019.07.052
中文关键词:  针刺  养老穴  康复锻炼  中风后肩手综合征  炎性反应递质  内皮功能  疗效  生命质量  血液循环
English Keywords:Acupuncture  Yanglao(SI 6)  Rehabilitation exercise  Shoulder-hand syndrome after stroke  Inflammatory factors  Endothelial function  Efficacy  Quality of life  Blood circulation
基金项目:四川省卫生计生委科研立项课题(17PJ370)
作者单位
赵小秋,杨苹,黄国艳 四川省达州市中心医院中医康复科达州635000 
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中文摘要:
      目的:探讨针刺养老穴联合康复锻炼对中风后肩手综合征生命质量的影响,并对其作用机制进行探讨,以期提高疗效。方法:选取2016年4月至2018年1月达州市中心医院收治的符合纳入条件中风后肩手综合征患者86例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组43例。对照组常规治疗,调控血压、血脂、抗血小板聚集等基础治疗,并健康宣教和电针治疗。观察组在对照组基础上加用针刺养老穴联合康复锻炼,连续治疗8周,观察2组治疗前、治疗后降钙素基因相关肽(CGRP)、一氧化氮(NO)、血浆内皮素-1(ET-1)、缓激肽(BK)、P物质(SP)水平变化并比较;观察2组治疗前、治疗后在血液流变学指标全血还原黏度、血浆黏度、血细胞比容、血小板聚集率变化并比较;观察治疗前、治疗后在视觉模拟评分法(VAS)、简化Fugl-Meyer运动功能评定法(FMA)、改良Barthel指数(MBI)变化并比较;治疗过程中进行不良反应监测,检测血常规、肝肾功能等血液学指标;治疗完成后进行疗效总结。结果:2组患者治疗前CGRP、NO、ET-1、BK、SP比较,差异无统计学意义(P>0.05),治疗后2组CGRP、NO含量较治疗前均显著升高,ET-1、BK、SP色较治疗前显著下降,差异有统计学意义(P<0.05),治疗后观察组患者CGRP、NO显著高于对照组、ET-1、BK、SP显著低于对照组,差异有统计学意义(P<0.05)。2组患者治疗前全血还原黏度、血浆黏度、血细胞比容、血小板聚集率比较,差异无统计学意义(P>0.05),治疗后2组以上各指标较治疗前均显著下降,差异有统计学意义(P<0.05),治疗后观察组患者以上指标显著优低于对照组,差异有统计学意义(P<0.05)。2组患者治疗前VAS、FMA、MBI评分比较,差异无统计学意义(P>0.05),治疗后2组VAS、FMA较治疗前显著下降,MBI评分显著升高,差异有统计学意义(P<0.05),治疗后观察组VAS、FMA显著低于对照组,MBI评分显著高于对照组,差异有统计学意义(P<0.05)。治疗后观察组患者治疗有效率明显高于对照组,差异有统计学意义(P<0.05)。对照组不良反应发生率11.63%,观察组为9.3%,2组不良反应发生率比较,差异无统计学意义(P>0.05)。结论:针刺养老穴联合康复锻炼能提高中风后肩手综合征生命质量和疗效,抑制炎性反应,改善内皮功能,促进血液循环。
English Summary:
      To explore the effects of acupuncture at Yanglao(SI 6)combined with rehabilitation exercise on the quality of life of shoulder-hand syndrome after stroke,and to explore the mechanism of action in order to improve the efficacy.Methods:From April 2016 to January 2018,86 patients with post-stroke shoulder-hand syndrome admitted in Dazhou Central Hospital and eligible for inclusion were selected as research subjects.They were randomly divided into control group(43 cases)and observation group(43 cases)according to the order of treatment.The control group received routine treatment:basic treatment such as regulating blood pressure,blood lipid and anti-platelet aggregation,health education and electroacupuncture.On the treatment basis of the control group,the observation group was given acupuncture at Yanglao(SI 6)combined with rehabilitation exercise for 8 weeks.Levels of calcitonin gene-related peptide(CGRP),nitric oxide(NO),plasma endothelin-1(ET-1),bradykinin(BK)and substance P(SP)in the 2 groups were observed and compared before and after the treatment.Before and after the treatment,the changes of hemorheology indexes like whole blood reduced viscosity,plasma viscosity,hematocrit and platelet aggregation rate in the 2 groups were observed and compared.VAS score,FMA score and MBI score in the 2 groups were observed and compared before and after the treatment.Adverse reactions were monitored during the treatment.Hematological indexes of blood routine test and liver and kidney function were detected.The efficacy was summarized after the treatment.Results:There was no significant difference in CGRP,NO,ET-1,BK and SP between the 2 groups before the treatment(P>0.05).After the treatment,the content of CGRP and NO in the 2 groups was significantly higher than that before the treatment,while the content of ET-1,BK and SP was significantly lower than that before the treatment(P<0.05).After the treatment,the content of CGRP and NO in the observation group was significantly higher than that in the control group,while the content of ET-1,BK and SP was significantly lower than that in the control group(P<0.05).(2)There was no significant difference in the whole blood reduction viscosity,plasma viscosity,hematocrit and platelet aggregation rate between the 2 groups before the treatment(P>0.05).After the treatment,the above indexes in the 2 groups were significantly lower than those before the treatment(P<0.05).After the treatment,the above indexes in the observation group were significantly lower than those in the control group(P<0.05).(3)The VAS,FMA and MBI scores of the 2 groups were not statistically significant before the treatment(P>0.05).After the treatment,the VAS and FMA scores of the 2 groups were significantly lower than those before the treatment,and the MBI scores were significantly higher(P<0.05).After the treatment,the VAS and FMA scores of the observation group were significantly lower than those of the control group,and the MBI score was significantly higher than that of the control group(P<0.05).(4)After the treatment,the effective rate and total effective rate of the observation group were significantly higher than those of the control group(P<0.05).(5)The incidence of adverse reactions was 11.63 in the control group and 9.3 in the study group.There was no significant difference in the incidence of adverse reactions between the 2 groups(P>0.05).Conclusion:Acupuncture at Yanglao(SI 6)combined with rehabilitation exercise can improve the quality of life and efficacy of shoulder-hand syndrome after stroke,inhibit inflammatory reaction,improve endothelial function and promote blood circulation.
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