采用隨機對照研究，收集符合納入標準的患者共60例，并隨機分為實驗組和對照組，每組30例。實驗組和對照組分別按照預先制定的方案進行治療。于治療前及治療后，分別通過視覺疼痛量表（VAS）、簡化Fugl- Meyer上肢運動功能評分法（FMA）、改良 Barthel指數（MBI）以及總有效率的評估對比，以綜合判斷兩組的治療效果｡
實驗組和對照組治療前后 VAS評分､ FMA評分及 MBI指數比較均有顯著差異，并且實驗組各項指標改善情況明顯優于對照組（見表7-9）。說明兩組治療方法均可減輕患者的疼痛癥狀，改善患者的上肢運動功能和日常行為活動能力，即在現代康復治療技術基礎上配合溫和灸與推拿療法對于腦卒中后肩手綜合征患者具有積極的臨床治療意義｡治療過程未出現燙傷、皮膚肌肉損傷、病情加重等不良反應｡
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 錄 V
引 言 1
第一章 文獻研究 3
第一節 中醫古代文獻 3
第二節 現代臨床研究 4
第三節 現代基礎研究 5
第二章 臨床研究 7
第一節 研究目的 7
第二節 研究方法 7
結 語 15
附 錄 18
致 謝 26