CAJ | 학술논문

目的观察经皮电神经刺激(TENS)治疗脑卒中后肩手综合征(SHSAS)的疗效及对患者交感神经皮肤反应(SSR)的影响.方法采用随机数字表法将68例脑卒中后肩手综合征患者分为治疗组及对照组.2组患者均给予常规康复训练,治疗组在此基础上辅以TENS治疗,治疗3周为1个疗程.于治疗前、治疗3周后采用视觉模拟评分法(VAS)评定患者偏瘫侧肢体疼痛及水肿程度,同时对偏瘫侧上肢进行交感神经皮肤反应(SSR)检查.结果 2组患者分别经3周治疗后,发现治疗组偏瘫侧肢体疼痛及水肿VAS评分均较治疗前及对照组明显改善(P＜0.05).治疗前2组患者SSR潜伏期、波幅、异常率组间差异均无统计学意义(P＞0.05),分别经3周治疗后,发现2组患者SSR潜伏期、异常率均较治疗前明显改善(P＜0.05),并且上述指标均以治疗组的改善幅度较显著(P＜0.05)；2组患者SSR波幅治疗前、后均无显著变化(P＞0.05).通过相关性分析发现,2组患者SSR潜伏期、异常率与VAS评分具有正相关性(p＜0.05),SSR波幅与VAS评分无明显相关性(P＞0.05).结论在常规康复训练基础上辅以TENS治疗,能进一步改善SHSAS患者偏瘫侧肢体疼痛及肿胀程度,降低SSR异常率,同时本研究结果还提示SSR可作为SHSAS患者的疗效评定指标之一.
목적 관찰경피전신경자격(TENS)치료뇌졸중후견수종합정(SHSAS)적료효급대환자교감신경피부반응(SSR)적영향.방법 채용수궤수자표법장68례뇌졸중후견수종합정환자분위치료조급대조조.2조환자균급여상규강복훈련,치료조재차기출상보이TENS치료,치료3주위1개료정.우치료전、치료3주후채용시각모의평분법(VAS)평정환자편탄측지체동통급수종정도,동시대편탄측상지진행교감신경피부반응(SSR)검사.결과 2조환자분별경3주치료후,발현치료조편탄측지체동통급수종VAS평분균교치료전급대조조명현개선(P＜0.05).치료전2조환자SSR잠복기、파폭、이상솔조간차이균무통계학의의(P＞0.05),분별경3주치료후,발현2조환자SSR잠복기、이상솔균교치료전명현개선(P＜0.05),병차상술지표균이치료조적개선폭도교현저(P＜0.05)；2조환자SSR파폭치료전、후균무현저변화(P＞0.05).통과상관성분석발현,2조환자SSR잠복기、이상솔여VAS평분구유정상관성(p＜0.05),SSR파폭여VAS평분무명현상관성(P＞0.05).결론 재상규강복훈련기출상보이TENS치료,능진일보개선SHSAS환자편탄측지체동통급종창정도,강저SSR이상솔,동시본연구결과환제시SSR가작위SHSAS환자적료효평정지표지일.
Objective To observe any therapeutic effect of transcutaneous electric nerve stimulation (TENS) on patients with shoulder-hand syndrome after stroke (SHSAS) and to examine the influence of TENS on sympathetic skin response (SSR).Methods Sixty-eight patients with SHSAS were randomly divided into a treatment group (35 cases) treated with routine rehabilitation training and TENS therapy and a control group (33 cases)treated with routine rehabilitation training only.The therapy for both groups lasted 3 weeks.The severity of pain and edema of the affected upper limb was assessed with a visual analogue scale (VAS) while sympathetic skin response was recorded from the affected upper limb before and after treatment.Results VAS scores improved significantly in the treatment group,and significantly more than in the control group.There was no significant difference in the SSR latencies,amplitudes or abnormality rates between the two groups before treatment.The latencies and abnormality rates of both groups improved significantly after treatment,but the improvement in the treatment group was more obvious.The SSR amplitudes did not change significantly after treatment in either group.There was a positive correlation between the SSR latencies and abnormality rates and the VAS scores,but no significant correlation between SSR amplitude and the VAS scores.Conclusions TENS therapy combined with routine rehabilitation training showed not only good clinical results,but also significant changes in SSR among patients with SHSAS.This indicates that SSR could be used to evaluate therapeutic effects in SHSAS patients.