銀質(zhì)針治療腦卒中肩手綜合征對(duì)患肢血液流速的影響.docx

1、?論著銀質(zhì)針治療腦卒中肩手綜合征對(duì)患肢血液流速的影響農(nóng)文軍，段朝霞，安平，吳玉花，陸蒸云，徐秀紅，李彥青,(廣西骨傷醫(yī)院內(nèi)科，廣西南寧530012)【摘要】目的探討銀質(zhì)針療法對(duì)腦卒中后肩手綜合征的效果。方法對(duì)80例腦卒中后肩手綜合征患者予以相同的基礎(chǔ)治療，按照就診前后順序隨機(jī)分為銀質(zhì)針治療組40例和體針對(duì)照組40例，比較兩組患者治療前后患側(cè)肢體血液流速的變化情況，治療3周后評(píng)定療效。結(jié)果治療后.治療組患者的患肢尺動(dòng)脈、梅動(dòng)脈、尺靜脈、梅靜脈和中指指間動(dòng)脈血流流速的改善高于對(duì)照組(P0.01)。結(jié)論銀質(zhì)針能促進(jìn)腦卒中后肩手綜合征患者的上肢動(dòng)脈血液流速及靜脈血流回流.改善微循環(huán)，從而明顯改善患者的

2、運(yùn)動(dòng)功能。.【關(guān)鍵詞】肩手綜合征;銀質(zhì)針療法;血液流速【中圖分類號(hào)】R245.3【文獻(xiàn)標(biāo)識(shí)碼】A【文章編號(hào)】10036350(2011)1400703Silverneedleinthetreatmentofshoulder-handsyndrome.NONGWen-jun,DUANGZao-xia,ANPing,etal.De/Hirtment,ofInternalMedicine,BoneInjuryHospitalofGuangxiProvince,Nanning,530012,Guangxi,CHINAAbstractObjectiveTbstudytheeffectofthesilve

3、rneedleonshoulder-handsyndrome(SHS)afterstroke.Methods80patientswithSHSafterstrokewereblindlyandrandomlydividedintotwogroups:thesilverneedlegroupandthebodyacupuncturegroup,witheachgroupof40patients.AUthepatientsweretreatedwiththesame基金項(xiàng)目：廣西科技廳科學(xué)基金項(xiàng)H(編號(hào):桂科fl2991229)；廣西衛(wèi)生廳計(jì)劃課題資金項(xiàng)目(ZOO8OI3)作者簡(jiǎn)介:農(nóng)文軍(I96

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8、rowmesenchymalstemcellsJ.SciChinaCLifeSci,2007.50(4):429-37.16 IwasakiM.NakataK,NakaharaH,ctal.Transforminggrowthfac-lor-betaIstimulateschondrogcncsisandinhibitsosteogenesisinhighdensitycultureofperiosteum-derivedcellsJ.Endocrinology.1993,132(4):1603-1608.17 OKeefeRJ.CrabbID,PuzasJE,etal.Effectsoftr

9、ansforminggrowthfactor-betaIandfibroblastgrowthfactoronDNAsynthesisingrowthplatechondrocytesareenhancedbyinsulin-likegrowthfacior-JJJ.JOrthopRes,1994,12(3):299-310.18 MaXH,GaoCQ,LiBJ,etal.TheempiricalstudyonparacrinecommunicationofbonemarrowmesenchymalstemcellsJ.Zhong-huaYiXueZaZhi,2010,90(7):496-49

10、8.19JWorstcrAA,NixonAJ,Brower-TolandBD,ctal.EffectoftransforminggrowthfactorbetaIonchondrogcnicdifferentiationofculturedequinemesenchymalstemcellsJ.AmJVetRes,2000.61(9):1003-1010.20 AttisanoL,WranaJL.SignaltransductionbytheTGF-betasuper-Science.2002,296(5573):1646-1647.21 KawamuraK,ChuCR.SobajimaS,e

11、tal.Adenoviral-mediatedtransferofTGF-betaIbutnotIGF-1induceschondrogenicdifferentiationofhumanmesenchymalstemcellsinpelletculturesJ,ExpHematol,2005,33(8):865-872.foundationtreatment,andwerecomparedtwovarietiesofbloodflowinfrontandbackofgettingtreatmentSHSjofyp-pcrlimb.Theresultswereperformedstatisti

12、calanalysisafter3weeks.ResultsTreatmentempress,thereweresignificantditterencesofvelocityofbloodflowoftheulnarvein,radialveinandmiddlq種gerditalartfrybetweenthetwogroups.Comparedthatofthebodyacupuncturegroup,theresultofthesilverneedlegroupsobviouslyimproved(P0.05），具有可比性。1.2治療方法1.2.1基礎(chǔ)治療兩組均進(jìn)行神經(jīng)內(nèi)科的基礎(chǔ)治療,

13、包括控制血壓、血糖、調(diào)節(jié)傾旨、防止血小板聚集、神經(jīng)營(yíng)養(yǎng)藥、對(duì)癥治療并防治并發(fā)癥，輔以必要的營(yíng)養(yǎng)支持C1.2.2治療組采用銀質(zhì)針治療。選擇患側(cè)肩胛區(qū)、肩區(qū)及上臂為治療區(qū)的針刺部位。首先.在疼痛明顯的針刺部位常規(guī)消毒皮膚，每個(gè)進(jìn)針點(diǎn)用0.5%利多卡因皮內(nèi)注射局麻,根據(jù)針刺部位選擇不同規(guī)格的無(wú)偏銀質(zhì)針（中國(guó)軟組織疼痛研究會(huì)監(jiān)制）,對(duì)準(zhǔn)針刺部位行垂直或斜針進(jìn)針，每針距約為1cm,直達(dá)肌膜附著的骨面，引出強(qiáng)烈針感為止。根據(jù)病-8情,布針1224針,留針時(shí)在每一根銀針的末端套上一個(gè)長(zhǎng)2.02.5cm的艾球，并點(diǎn)燃加熱，以病人能耐受為度待艾球燃盡,針身余溫消退后拔針,用2%碘酒涂針眼.覆蓋沙布,3d內(nèi)不接觸

14、水，以免感染。每周治療1次,共治療3周。1.2.3對(duì)照組采用針刺方法，以患者肩槌、曲池、外關(guān)、合谷穴為主，施以捻轉(zhuǎn)補(bǔ)瀉針?lè)?，留?0min,每日I次,3周1個(gè)療程。1.2.4觀察指標(biāo)及評(píng)定以彩色多普勒超聲測(cè)定患肢血液流速的變化來(lái)評(píng)估。主要觀察患肢的尺動(dòng)脈、尺靜脈、槎動(dòng)脈、橫靜脈、中指指問(wèn)動(dòng)脈的血液流速。1.2.5統(tǒng)計(jì)學(xué)分析等級(jí)資料采用秩和檢臆，計(jì)數(shù)資料采用義檢驗(yàn).治療前后用配對(duì)f檢驗(yàn)。2結(jié)果治療前后對(duì)照組的患側(cè)上肢尺動(dòng)脈、饒動(dòng)脈血液流速比較差異無(wú)統(tǒng)計(jì)學(xué)意義（P0.05）,而銀質(zhì)針治療組的患側(cè)上肢尺動(dòng)脈、梅動(dòng)脈血液流速比較差異有統(tǒng)計(jì)學(xué)意義（P0.01）,見(jiàn)表I、表2。治療后兩組間尺動(dòng)脈、梅動(dòng)脈血

15、液流速比較差異有統(tǒng)計(jì)學(xué)意義（P0.0Do治療前后兩組患側(cè)E肢的尺靜脈、梅靜脈和中指間動(dòng)脈血流流速比較差異均有統(tǒng)計(jì)學(xué)意義（治療組PV0.01,對(duì)照組P0.05）,治療后兩組間尺靜脈、槐靜脈、中指間動(dòng)脈血液流速比較差異有統(tǒng)計(jì)學(xué)意義（P0.01）o見(jiàn)表3、表4、表5。表1治療前后尺動(dòng)脈的血流流速比注:.治療后兩組間比較-3.904,P0.0絹別例數(shù)治療前治療后tP治療組4028.954.3432.684.23，3.8920.05*2治療前后梯動(dòng)豚血液流速比較任s,cm/s）ffi別例數(shù)治療前治療后1P治療組4021.384.1225.16i4.32*1.8850.05注:.治療后兩組間比較1=2.7

16、74.P0.01。衰3治療前后尺靜脈的血流流速比較(7,cm/s)組別例數(shù)治療前治療后1P治療組409.251.9616.251.4518.1580.01對(duì)照組409.4812.2310.562.562.0110.05注:.治療后兩組間比較=12.23l,P0.0Io表4治療前后橫部脈血液流速比較(7s,cm/s)祖別例數(shù)治療前治療后1P治療組408.432.9518.15i3.56*13.260.01對(duì)照組4093.452.4060.05注:.治療后兩組間比較$=10.537.0.01。衰5治療前后中指間動(dòng)脈血液流速比較(7j,cin/s)組別例散治療前治療后1P治療組

17、407.873.1215.75i2.72,12.0400.01對(duì)照組407.923.429.152.12*2.4630.05),兩組間治療后比較差異有統(tǒng)計(jì)學(xué)意義(PV0.01)。治療前后兩組的患側(cè)上肢尺靜脈、槎靜脈和中指間動(dòng)脈血流流速比較差異均有統(tǒng)計(jì)學(xué)意義(治療組PV0.01,對(duì)照組PV0.05)，治療后兩組間比較差異有統(tǒng)計(jì)學(xué)意義(PV0.01)。從以上資料表明，兩種方法治療均取得療效，但銀質(zhì)針治療組的療效更為明顯，它不僅能增加上肢動(dòng)脈血液的總供給雖以改善血液循環(huán).而且能夠促進(jìn)上肢的靜脈血液回流,使水腫減輕,并影響到遠(yuǎn)端指間動(dòng)脈血流速,使之相應(yīng)增加，從而提高患肢的運(yùn)動(dòng)功能，為銀質(zhì)針治療手綜合征提供理論依據(jù)C銀質(zhì)針治療腦卒中后肩手綜合征，療效快、效果明顯，為卒中患者運(yùn)動(dòng)康復(fù)增添-種安全、簡(jiǎn)便、快捷的新技術(shù)，同時(shí)對(duì)發(fā)揮中醫(yī)技術(shù)優(yōu)勢(shì)具有深遠(yuǎn)的意義。參考文獻(xiàn)1 李耿杵晃勇.4光耕,等.銀質(zhì)針熱灸療法治療腰腿痛的臨床觀察J.河北醫(yī)藥,2002.24(2):144-145.2 王新德.各類腦血管疾病診斷賽點(diǎn)J.中華神經(jīng)科雜志，1996.29(6):379-381