加味黄芪桂枝五物汤联合醒脑开窍针刺法治疗脑卒中后肩手综合征的临床观察

目的:观察加味黄芪桂枝五物汤联合醒脑开窍针刺法治疗脑卒中后肩手综合征(SHS)的临床疗效及对神经源性炎症介质和血液流变学指标的影响。方法:将148例患者随机按数字表法分为对照组和观察组各74例。两组口服双氯芬酸钠缓释片,75 min/次,1次/d,连续2~4周;肿胀明显,口服醋酸泼尼松片,10 min/次,1次/d,连续1~2周。并采用醒脑开窍针刺法,1次/d,6次/周;对照组口服脑心通胶囊,4粒/次,3次/d,观察组内服加味黄芪桂枝五物汤,1剂/d。两组疗程均为连续治疗4周。进行对治疗前后肩手综合征评估量表(SHSS)评分,记录疼痛、肿胀消失时间;进行治疗前后Fugl-Meyer功能量表上肢部分评分(U-FMA),日常生活活动能力(ADL)评分和气虚血瘀证评分;检测治疗前后降钙素基因相关肽(CGRP),P物质(SP),缓激肽(BK)水平和血液流变学指标。结果:观察组患者的临床疗效优于对照组(Z=2.106,P<0.05);观察组SHSS量表的感觉、自主神经、运动3个维度评分和SHSS总分均低于对照组(P<0.01);观察组疼痛、肿胀消失时间均短于对照组(P<0.01);观察组患者U-FMA,ADL评分均高于对照组(P<0.01),气虚血瘀证评分低于对照组(P<0.01);观察组CGRP水平高于对照组(P<0.01),SP和BK水平均低于对照组(P<0.01);观察组的全血黏度(高切、低切)、血浆黏度、纤维蛋白原和血小板聚集率等均低于对照组(P<0.05)。结论:在西医常规治疗的基础上,内服加味黄芪桂枝五物汤配合醒脑开窍针刺疗法可减轻SHS严重程度和中医临床证候,缩短病程,改善上肢运动功能,并可抑制神经源性炎症反应,改善血液流性,提高患者的日常生活活动能力和临床疗效。

Clinical Efficacy of Jiwei Huangqi Guizhi Wuwutang Combined with Xingnao Kaiqiao Acupuncture on Shouder-hand Syndrome

Objective To observe the clinical efficacy of Jiwei Huangqi Guizhi Wuwutang combined with Xingnao Kaiqiao acupuncture on shouder-hand syndrome (SHS), and its effect on neurogenic inflammatory factors and hemorheology.Method One hundred and forty-eight patients were randomly divided into control group and observation group (74 cases). Both groups'' patients got rehabilitation measures, such as diclofenac sodium sustained release tablets for two to four weeks, 75 min/time, 1 time/day, and patients with apparent swelling got prednisone acetate tablets for one to two weeks, 10 min/time, 1 time/day. And patients in control group got Xingnao Kaiqiao acupuncture, 1 time/day, 6 times/week. Control grouporal Naoxintong capsule 4 tablets/time,3 times/day, patients in observation group were added with Jiwei Huangqi Guizhi Wuwutang, 1 dose/day. The courses of treatment were 4 weeks. Before and after treatment, shoulder hand syndrome scale (SHSS), the upperextremities of the Fugl-meyer movement assessment (U-FMA), ability of daily life activities (ADL), Qi deficiency and blood stasis syndrome and clinical efficacy were scored, disappearing time of pain and swelling were recorded, and levels of calcitonin gene related peptide (CGRP), substance P (SP), bradykinin (BK) and hemorheology were detected.Result The clinical efficacy in observation group was better than that in control group (Z=2.106, P<0.05). And scores of sensory, autonomic, motion according to SHSS scale and the total scale of SHSS were all lower than those in control group (P<0.01). Disappearing time of pain and swelling were shorten than those in control group (P<0.01). After treatment, scores of U-FMA and ADL were higher than those in control group (P<0.01), while score of syndrome of Qi deficiency and blood stasis was lower than that in control group (P<0.01). And level CGRP was higher than that in control group (P<0.01), and levels of SP and BK were lower than those in control group (P<0.01). After treatment, whole blood viscosity (high cut, low cut), plasma viscosity, fibrinogen and platelet aggregation rate were all lower than those in control group (P<0.05).Conclusion In addition to the conventional western medicine therapy, Jiwei Huangqi Guizhi Wuwutang combined with Xingnao Kaiqiao acupuncture can reduce the severity of SHS and clinical syndromes of traditional Chinese medicine, shorten the course of disease, improve the motor function of upper limbs, inhibit the neurogenic inflammatory reaction, and improve the blood flow, the ability of daily life and the clinical efficacy of patients..