加味蠲痹汤综合疗法治疗中风后风痰瘀阻证肩手综合征

Modified Juanbitang on Shoulder-hand Syndrome with Wind Phlegm Stasis After Stroke

摘要:

目的：探讨加味蠲痹汤内服、泡洗治疗对中风后肩手综合征（SHS）风痰瘀阻证患者康复的疗效及对降钙素基因相关肽（CGRP），P物质（SP），血浆缓激肽（BK），一氧化氮（NO），内皮素-1（ET-1）等因子的影响。方法：将146例SHS患者以入院情况，随机按数字表法分为对照组和观察组各73例。对照组除内科治疗外，给予良肢位摆放，上肢被动活动训练、上肢主动活动训练等康复措施。观察组采用加味蠲痹汤内服和泡洗，1剂/d。两组疗程均为4周。肩手综合征评估量表（SHSS），水肿程度、疼痛视觉模拟评分（VAS），风痰瘀阻证、神经功能缺损（NIHSS）评分、功能独立性评定量表（FIM）和上肢Fugl-Meyer功能量表（U-FMA），治疗前后各评价1次。检测治疗前后CGRP，SP，BK，NO和ET-1水平。结果：观察组临床疗效总有效率为91.3%，对照组为79.41%，观察组高于对照组（χ²=3.885，P<0.05）；治疗后观察组SHS量表感觉、自主神经、运动3个维度评分及总分均低于对照组（P<0.05，P<0.01）；治疗后观察组U-FMA评分高于对照组（P<0.05），VAS评分低于对照组（P<0.01）；治疗后观察组患者FIM评分高于对照组，NIHSS和风痰瘀阻证评分均低于对照组（P<0.05或P<0.01）；治疗后观察组CGRP和NO水平均高于对照组，SP，BK和ET-1均低于对照组（P<0.01）；治疗后观察组全血黏度、血浆黏度、血沉和血小板聚集率均低于对照组（P<0.01）。结论：采用加味蠲痹汤内服、泡洗治疗SHS风痰瘀阻证能减轻患者的疼痛、肿胀和感觉异常等，改善了神经功能缺损，提高了患者上肢运动能力和独立生活的能力，临床疗效显著，并能调节CGRP，NO，SP，BK和ET-1等细胞因子。

Abstract:

Objective: To discuss the effect of modified Juanbitang for oral and bath therapy on shoulder-hand syndrome (SHS) with wind phlegm stasis after stroke, and its impact on calcitonin gene related peptide (CGRP), substance P (SP), plasma bradykinin, nitric oxide (NO) and endothelin-1 (ET-1). Method: One hundred and forty-six patients with SHS were divided into control group and observation group by random number table. All of their normal limbs were kept in a good position, and all of the patients got passive upper limb motion training and active upper limb motion training. Patients in control group got modified Juanbitang for oral, 1 dose/day. In addition to the therapy of control group, patients in observation group was also given Modified Juanbi decoction for bath therapy, 30 min/time, 2 times/day. The course of treatment was 4 weeks. Shoulder-hand syndrome assessment scale (SHSS), edema degree, pain visual analogue scale (VAS), wind phlegm stasis, neurological deficit (NIHSS), functional Independence rating scale (FIM) and upper extremity Fugl-Meyer functional scale (U-FMA) were scaled once before and after treatment. And levels of CGRP, SP, plasma bradykinin, NO and ET-1 were detected before and after treatment. Result: The total efficiency in observation group was 91.3%, which was higher than 79.41% in control group (χ²=3.885, P<0.05). After treatment, SHS scores of feeling, autonomic nerve, movement and the total score were lower than those in control group (P<0.05 or P<0.01). Score of U-FMA was higher than that in control group (P<0.05), and VAS score was lower than that in control group (P<0.01). And score of FIM was higher than that in control group, scores of NIHSS and wind phlegm stasis were higher than those in control group (P<0.05 or P<0.01). Levels of CGRP and NO were higher than those in control group, and levels of SP, bradykinin and ET-1 were lower than those in control group (P<0.01). After treatment, whole blood viscosity (high, low), plasma viscosity and platelet aggregation rate in observation group were superior to those in control group (P<0.01). Conclusion: Modified Juanbitang for oral and bath therapy can relieve patients' pain, swelling and paresthesia, ameliorate neurological deficit, improve patients' upper limb motion ability and independent living ability, and regulate levels of CGRP, NO, SP, bradykinin and ET-1, with a significant clinical effect.