【摘要】：目的:觀察在中醫(yī)治則的指導下針刺療法結合TDP神燈照射治療腦卒中后肩手綜合征患者的臨床療效,探究其治療原則、安全性及有效性,為臨床治療腦卒中后肩手綜合征提供更多的臨床數(shù)據(jù)資料,用以更好發(fā)展針刺治療及經(jīng)絡腧穴理論在本病臨床治療上的應用。材料與方法:根據(jù)中西醫(yī)診斷標準,選取2014年3月至2015年12月遼寧中醫(yī)藥大學附屬醫(yī)院康復中心腦K1病房的腦卒中后肩手綜合征的患者共47例,采取隨機數(shù)字表法,將入選患者隨機分為2組,其中觀察組24例,對照組23例。2組均給予中西醫(yī)常規(guī)基礎藥物及康復治療,觀察組在此基礎上給予針刺治療結合TDP神燈照射。針刺治療均1次/日,每次留針30分鐘,4周為一療程,在針刺治療基礎上予TDP神燈照射。最后通過治療前及療程結束之后進行相關臨床功能評定:臨床神經(jīng)功能缺損程度評分(NDS)、肩手綜合征水腫程度評分、上肢簡化Fugl-Meyer運動功能評分(FMA)、上肢疼痛評定視覺模擬量表(VAS)、改良Barthel指數(shù)評分等,統(tǒng)計各項的觀察量表數(shù)據(jù),運用SPSS20.0統(tǒng)計軟件分別進行組內、組間比較,來系統(tǒng)的評價針刺結合神燈照射對腦卒中后肩手綜合征的療效。結果:1.臨床共收集符合納入標準病史47例,其中觀察組24例,對照組23例。治療前兩組患者在性別、年齡、病程、上肢運動功能評分、日常生活活動能力評分、疼痛、水腫程度評估上,均無顯著差異(P0.05),具有組間可比性。2.兩組治療前后相比統(tǒng)計差異均顯著(P0.05),癥狀均有明顯好轉。3.治療后兩組相比較,VAS評分顯示,治療后評分比較統(tǒng)計學差異顯著(P0.05),療效明顯;水腫程度評分、神經(jīng)缺損程度NDS評分、上肢FMA評分、生活能力Barthel評分顯示差異性不顯著(P0.05)。結論:1.針刺結合神燈照射康復療法與單純康復療法對腦卒中后肩手綜合征均有較好的改善作用。2.針刺結合神燈康復組在疼痛評分上,療效差異顯著,明顯優(yōu)于對照組;在神經(jīng)缺損程度評分、水腫程度評分、上肢運動功能評定和日常生活能力評分上,兩組療效均佳,觀察組于療效上略優(yōu)于對照組,但差異并不顯著。3.針刺結合神燈照射及康復訓練均為臨床治療常用方法,在改善患者臨床腫痛癥狀及活動能力均有極佳療效,具有良好的可行性,協(xié)同治療可發(fā)揮更好療效,值得臨床推廣應用。
[Abstract]:Objective: to observe the clinical effect of acupuncture combined with TDP lamp irradiation on patients with shoulder and hand syndrome after stroke under the guidance of traditional Chinese medicine, and to explore the principle, safety and effectiveness of the treatment. To provide more clinical data for the treatment of shoulder and hand syndrome after stroke, and to develop the application of acupuncture therapy and meridian acupoint theory in the clinical treatment of this disease. Materials and methods: according to the diagnostic criteria of traditional Chinese and western medicine, 47 patients with post-stroke shoulder-hand syndrome were selected from the brain K1 ward of the Rehabilitation Center of Liaoning University of traditional Chinese Medicine from March 2014 to December 2015. The patients were randomly divided into two groups: the observation group (n = 24) and the control group (n = 23) were treated with traditional Chinese and western medicine and rehabilitation therapy. The observation group was treated with acupuncture combined with TDP lamp irradiation. Acupuncture treatment was done once a day for 30 minutes and 4 weeks as a course of treatment. TDP lamp irradiation was performed on the basis of acupuncture therapy. Finally, the related clinical functions were evaluated before and after the treatment: clinical neurological deficit scale (NDS), edema degree of shoulder and hand syndrome, The simplified Fugl-Meyer motor function score (FMA), visual analogue scale (VAS) and modified Barthel index (Barthel index) for upper limb pain assessment were compared between groups by SPSS 20.0 statistical software. To systematically evaluate the efficacy of acupuncture combined with lamp irradiation in the treatment of shoulder-hand syndrome after stroke. The result is 1: 1. A total of 47 cases were collected, including 24 cases in the observation group and 23 cases in the control group. Before treatment, there was no significant difference in gender, age, course of disease, upper limb motor function score, ADL score, pain and edema evaluation between the two groups (P0.05). The statistical difference between the two groups before and after treatment was significant (P0.05), the symptoms were significantly improved. 3. After treatment, the scores of VAS were significantly different (P0.05), and the scores of edema, NDS, FMA and Barthel were not significant (P0.05). Conclusion 1. Acupuncture combined with Shenlantern irradiation rehabilitation therapy and simple rehabilitation therapy have better effects on shoulder and hand syndrome after stroke. The pain score of acupuncture combined with Shen-lantern rehabilitation group was significantly different and better than that of the control group, and the two groups had good curative effect on the scores of nerve defect, edema, upper limb motor function and daily living ability. The observation group was slightly better than the control group in curative effect, but the difference was not significant. Acupuncture combined with Shenlantern irradiation and rehabilitation training are common methods in clinical treatment. They have excellent curative effect in improving the symptoms and activities of clinical swelling and pain, and have good feasibility. The synergistic treatment can play a better effect and is worthy of clinical popularization and application.
【學位授予單位】：遼寧中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2016
【分類號】：R277.7
，

本文編號：2125000