张世正 陈新新 黄建平 林菲菲 陈妙

[摘要] 目的 運用体针及夹脊刺、温针灸三者结合的疗法治疗脑卒中后肩痛，评价针灸在脑卒中后肩痛治疗中产生的疗效。 方法 采用随机、对照的临床研究方法，选取2017年10月至2019年3月于温州市中医院神经内科住院部及景山康复中心接受治疗的64例患者纳入研究，分为治疗组和对照组。治疗组采用颈段夹脊穴温针灸加常规体针治疗，对照组仅行常规体针治疗，共治疗4周。在治疗前、治疗后4周，对患者行疼痛评分量表（VAS）、改良Barthel指数评分（MBI）、简化Fugl-Meyer 运动功能评分、改良Ashworth量表（MAS）评估两组疗效。 结果 治疗4周后，治疗组的VAS评分较对照组显著降低（P<0.01），同时治疗组和对照组较各自治疗前均有显著降低（P<0.01），以治疗组疗效更为明显（P<0.01）;治疗组的MAS评分较对照组未见显著降低（P>0.05），同时治疗组和对照组较各自治疗前均有显著降低（P<0.01）;治疗组的MBI、简化Fugl-Meyer运动功能量表评分较对照组未见显著升高（P>0.05），同时上述治疗组和对照组较各自治疗前均有显著升高（P<0.01）。 结论 颈段夹脊穴温针结合体针相比较单纯的体针治疗能有效减轻脑卒中后的肩痛，为临床治疗脑卒中后肩痛提供新的思路和方法。

[关键词] 脑卒中;肩痛;夹脊穴;温针灸;体针

[中图分类号] R246.6          [文献标识码] B          [文章编号] 1673-9701（2021）36-0133-05

Observation on the clinical efficacy in the treatment of shoulder pain after stroke with warming needle moxibustion combined with body acupuncture at Jiaji Point of neck segment

ZHANG Shizheng1   CHEN Xinxin1   HUANG Jianping1   LIN Feifei2   CHEN Miao3

1.Department of Neurology， Wenzhou Central Hospital in Zhejiang Province， Wenzhou   325000， China; 2.Department of Traditional Chinese Medicine， Wenzhou Central Hospital in Zhejiang Province， Wenzhou   325000， China; 3.Department of Neurology， Wenzhou Traditional Chinese Medicine Hospital in Zhejiang Province， Wenzhou   325000， China

[Abstract] Objective To evaluate the therapeutic efficacy of acupuncture and moxibustion in the treatment of shoulder pain after stroke， and treat shoulder pain after stroke with body acupuncture， Jiaji Point acupuncture and warming needle moxibustion. Methods A total of 64 patients admitted to the inpatient department of neurology of Wenzhou Traditional Chinese Medicine Hospital and Jingshan Rehabilitation Center from October 2017 to March 2019 were selected and divided into the treatment group and the control group according to the randomized， controlled clinical research method. The treatment group was treated with warming needle moxibustion at Jiaji Point of neck segment combined with conventional body acupuncture， while the control group was only treated with conventional body acupuncture. The treatment lasted for 4 weeks. Before treatment and 4 weeks after treatment， the patients were evaluated by visual analogue scale （VAS） of pain， modified Barthel index （MBI） score， simplified Fugl-Meyer motor function score and modified Ashworth scale （MAS）. Results After 4 weeks′ treatment， the VAS score of the treatment group was significantly lower than that of the control group（P<0.01）， and both the treatment group and the control group were significantly lower than those before treatment（P<0.01）.Meanwhile，the therapeutic efficacy of the treatment group was more obvious（P<0.01）.Compared with the control group， the MAS score of the treatment group wasn′t decreased significantly（P>0.05）， while both the treatment group and the control group were decreased significantly before treatment， respectively（P<0.01）.The MBI and the simplified Fugl-Meyer motor function score in the treatment group were not significantly higher than those in the control group（P>0.05）， while the above-mentioned treatment group and the control group were all significantly higher than those before treatment，respectively（P<0.01）. Conclusion It is found that needle warming moxibustion combined with body acupuncture at Jiaji （EX-B2） of neck segment can effectively relieve shoulder pain after stroke， which provides new ideas and methods for clinical treatment of shoulder pain after stroke.

[Key words] Stroke; Shoulder pain; Jiaji Point; Warming needle moxibustion; Body acupuncture

脑卒中后肩痛是一种发生率很高且病因复杂的脑卒中后并发症，它不仅发生在中风早期阶段，而且可以持续到中风恢复期及后遗症期。患者静息状态下偏瘫肩痛的发生率约为30%，运动状态下发生率约为58%[1-2]。……