冷热交替漩涡浴对脑卒中后肩手综合征Ⅰ期的疗效观察

摘要

目的：探讨冷热交替漩涡浴治疗脑卒中后肩手综合征Ⅰ期的疗效。方法选取60例脑卒中后肩手综合征Ⅰ期患者随机分为对照组(n=30)和观察组(n=30)。对照组进行综合康复训练，包括运动疗法、向心性缠绕、关节松动术和意念性训练，30 min/次；观察组在此基础上给予温度分别为12~15℃和37~43℃的冷热交替漩涡浴治疗，20 min/次。两组均2次/d，5 d/周，共4周。治疗前及治疗4周后分别采用视觉模拟评分(VAS)、手排水体积差、改良Ashworth量表(MAS)、Fugl-Meyer量表(FMA)和Barthel指数(BI)评定上肢疼痛、水肿、肌张力、运动功能和日常生活活动能力。结果治疗前，两组上肢疼痛、水肿、肌张力、运动功能、日常生活活动能力均无显著性差异(P>0.05)。治疗4周后，两组以上指标均较治疗前改善(P<0.05)，且观察组明显均优于对照组(P<0.01)。结论冷热交替漩涡浴能进一步提高康复训练治疗脑卒中后肩手综合征Ⅰ期的治疗效果。%Objective To investigate the effect of alternating cooling and heating whirlpool bath on patients with shoulder-hand syn-drome in stage I after stroke. Methods 60 patients with shoulder-hand syndrome in stage I after stroke were randomly divided into control group (n=30) and observation group (n=30). The control group received comprehensive rehabilitation training including exercise therapy, concentric winding, joint mobilization and ideation training, 30 minutes every time, twice a day, 5 days a week for 4 weeks. The observation group received alternating cooling (12~15℃) and heating (37~43℃) whirlpool bath treatment 20 minutes every time in addition, twice a day, 5 days a week for 4 weeks. Visual Analogue Scale (VAS), hand drainage volume, modified Ashworth Scale (MAS), Fugl-Meyer Assess-ment (FMA) and Barthel Index (BI) were used to assess the upper limb pain, the degree of edema, muscle tension, motor function and activi-ties of daily living. Results Before treatment, there was no significant difference in the scores of VAS, MAS, FMA and BI, and the hand drainage volume between 2 groups (P>0.05). 4 weeks after treatment, all the indexes improved in both groups (P<0.05), and were better in the observation group than in the control group (P<0.01). Conclusion The effect of alternating cooling and heating whirlpool bath may fur-ther improve the symptoms of shoulder-hand syndrome in stage I after stroke.