基于主客配穴的针刺对脑卒中后肩痛及上肢运动功能障碍的影响及相关性分析

关键词：主客配穴  原络配穴  脑卒中后肩痛  上肢  运动功能障碍  相关性分析

Keywords:host-guest point selection  yuan-source and luo-connecting point selection  shoulder pain after stroke  upper extremity  motor dysfunction  correlation

摘要：

      摘要 目的：观察基于主客配穴的针刺疗法对脑卒中后肩痛及上肢运动功能障碍的影响，并探索疼痛改善与上肢运动功能的恢复是否具有相关性。 方法：将60例符合纳入标准的患者随机分成治疗组（主客配穴组）和对照组（传统取穴组），各30例。对照组取穴：肩髃、臂臑、曲池、手三里、外关、合谷，治疗组取穴：太渊、偏历、合谷、列缺 、腕骨、通里、阳池、内关（两组均患侧），两组均接受常规内科基础治疗及综合康复治疗，留针30min，每隔10min行针1次，治疗每日1次，每周治疗5次，周末双休，共治疗4周。观察两组患者治疗前及治疗4周后疼痛视觉模拟评分（Visual analogue score，VAS）、上肢运动功能评分量表（Simplified Fugl-Meyer motor function assessment ，FMA）及两者之间的关联。 结果：治疗后两组VAS评分较治疗前均降低（均P＜0.01），FMA评分较治疗前均升高（均P＜0.01）；治疗组治疗后VAS评分及FMA评分改善程度优于对照组（均P＜0.05）。VAS的变化与FMA的变化呈正相关。 结论：主客配穴法缓解脑卒中后肩痛的疗效优于传统取穴法。主客配穴法与传统取穴法相比在疼痛改善程度相同时，上肢运动功能恢复更好，但其仅针对于部分患者。主客配穴疗法有待进一步探索，以期更广泛的适用于各类脑卒中后肩痛的患者。

Abstract:

      Abstract Objective: To observe effect of acupuncture on shoulder pain after stroke and upper extremity motor dysfunction based on host-guest point selection, and to explore if relationship between improvement in pain and recovery of upper extremities function exist. Method: Sixty patients who met the inclusion criteria were randomly divided into treatment group (host-guest point selection) and control group (traditional point selection), 30 cases in each group. Points chosen in control group: JianYu (LI15), BiNao (LI14), QuChi (LI11), ShouSanLi (LI10), WaiGuan (SJ5), HeGu (LI4), points chosen in treatment group: TaiYuan (LU9), PianLi (LI6), HeGu (LI4), LieQue (LU7), WaiGuan (SI4),TongLi (HT5), YangChi (SJ4), NeiGuan (PC6), all points in effected side. Both two groups were given routine medical treatment and comprehensive rehabilitation training. Needle retaining time is 30min, hand manipulating of needle were done every 10 minutes, for once a day, 5 times a week, free on weekend, 4 weeks were required in two groups. Visual analogue score(VAS), Simplified Fugl-Meyer motor function assessment (FMA) and the correlation of the two scales of both two group were observed and explored before and after 4 weeks’ treatment. Result: The scores of VAS in both groups reduced after the treatment (both P<0.01), scores of FMA rose after the treatment (both P<0.01); after treatment, the improvement of VAS and FMA in treatment group was better than that in control group (both P<0.05). There was positive correlation between the change of VAS and FMA. Conclusion: The effect of host-guest point selection therapy is superior to that of traditional point selection therapy on relieve shoulder pain after stroke. For the two therapies, when the degree of pain improvement is simultaneous, Host-guest point selection therapy make upper extremity motor function recover better, but only for partial patients. This therapy remain to be explored, in order to be applied to all kinds of patients with shoulder pain after stroke.