采用随机对照研究，收集符合纳入标准的患者共60例，并随机分为实验组和对照组，每组30例。实验组和对照组分别按照预先制定的方案进行治疗。于治疗前及治疗后，分别通过视觉疼痛量表（VAS）、简化Fugl- Meyer上肢运动功能评分法（FMA）、改良 Barthel指数（MBI）以及总有效率的评估对比，以综合判断两组的治疗效果｡
实验组和对照组治疗前后 VAS评分､ FMA评分及 MBI指数比较均有显著差异，并且实验组各项指标改善情况明显优于对照组（见表7-9）。说明两组治疗方法均可减轻患者的疼痛症状，改善患者的上肢运动功能和日常行为活动能力，即在现代康复治疗技术基础上配合温和灸与推拿疗法对于脑卒中后肩手综合征患者具有积极的临床治疗意义｡治疗过程未出现烫伤、皮肤肌肉损伤、病情加重等不良反应｡
Observation on the therapeutic effect of mild moxibustion combined with massage on post-stroke shoulder and hand syndrome
Specialty: Acupuncture and massage
Author: Zhang Tian
Tutor: Xu Nenggui
To observe the effect of mild moxibustion combined with massage on shoulder and hand syndrome after stroke and to understand the clinical effect of mild moxibustion combined with massage on shoulder and hand syndrome after stroke.
Through this research program, the therapeutic effects of mild moxibustion combined with massage combined with modern rehabilitation technology and simple modern rehabilitation technology on shoulder and hand syndrome after stroke were compared, so as to establish a new treatment program combining traditional Chinese and western medicine.
A total of 60 patients who met the inclusion criteria were collected and randomly divided into the experimental group and the control group with 30 patients in each group. The experimental group and the control group were treated according to the predetermined plan. Before and after treatment, visual pain scale (VAS), simplified fugl-meyer upper limb motor function score (FMA), modified Barthel index (MBI) and total effective rate were used to evaluate and compare the treatment effects of the two groups.
In addition, both groups of patients received electrocardiogram and chest X-ray before and after treatment, and recorded side effects and adverse reactions during the whole treatment process, so as to evaluate the safety of the two treatment methods.
Statistical methods: the chi-square test was used to compare the counting data between the two groups before and after treatment, and the paired t-test was used for the comparison before and after treatment in the measurement data group conforming to the normal distribution, while the t-test of two independent samples was used for the comparison between the two groups before and after treatment, denoted by ±s. When the measurement data of skewed distribution do not meet the use conditions of t test, the row rank sum test is used, which is expressed by `R (P25, P50,P75), and the rank sum test is used for the rank data.
A total of 60 cases that met the criteria were included, including 30 cases in the experimental group and 30 cases in the control group. No cases of shedding or death occurred in the process. The total effective rate of the experimental group was 100%, and that of the control group was 76.70%. The efficacy of the two groups was compared by Wilcoxon rank sum test, P<0.05 (see table 6). Show that in this study, the experimental group in the treatment of shoulder hand syndrome after stroke is better than the control group.
There were significant differences in VAS score, FMA score and MBI index between the experimental group and the control group before and after treatment, and the improvement of various indicators in the experimental group was significantly better than that in the control group (see table 7-9). Show two groups of treatment can reduce the patient's pain symptoms, improve the patient's upper limb motor function and ability to daily activities, namely on the basis of modern rehabilitation techniques with mild moxibustion and massage therapy for shoulder hand syndrome after stroke patients with positive clinical significance. Treatment process does not appear burns, skin and muscle damage, such as aggravation of adverse reactions.
Both treatment regimens had positive effects on the clinical manifestations and functional improvement of patients with post-stroke shoulder and hand syndrome, and no significant side effects or adverse reactions occurred in either group during the treatment. The experimental group was better than the control group in the treatment of middle and posterior shoulder and hand syndrome after stroke, indicating that mild moxibustion combined with massage therapy is significant for the study of clinical treatment of patients with post-stroke shoulder and hand syndrome and is applicable to clinical use.
Key words: Stroke; Shoulder hand syndrome; Mild moxibustion; The massage
摘 要 I
目 录 V
引 言 1
第一章 文献研究 3
第一节 中医古代文献 3
第二节 现代临床研究 4
第三节 现代基础研究 5
第二章 临床研究 7
第一节 研究目的 7
第二节 研究方法 7
结 语 15
附 录 18
致 谢 26