温和灸配合推拿治疗中风后肩手综合征的疗效观察(硕士)

温和灸配合推拿治疗中风后肩手综合征的疗效观察(硕士)(论文14500字)
摘    要
目的：
观察温和灸配合推拿疗法对脑卒中后肩手综合征的影响，了解温和灸配合推拿疗法对治疗脑卒中后肩手综合征的临床效果｡
通过此研究方案，对比温和灸结合推拿疗法配合现代康复技术与单纯现代康复技术对治疗脑卒中后肩手综合征的治疗效果，以期建立一种新的中西医结合治疗方案｡
方法：
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｡
另外，两组患者于治疗前后均接受心电图、胸片等检査，记录整个治疗过程中的副作用和不良反应，以对两种治疗方法的安全性进行评价｡用统计软件包 SPSS22.0进行数据管理和统计分析研究｡
统计方法：治疗前两组间计数资料比较采用卡方检验，符合正态分布的计量资料组内治疗前后的比较采用配对ｔ检验，而组间治疗前后的比较则行两个独立样本ｔ检验，用 ±s表示；偏态分布的计量资料不符合ｔ检验使用条件时则行秩和检验，用`R（P25，P50,P75）表示，等级资料采用秩和检验。
成果：
共纳入符合标准的病例60例，实验组30例，对照组30例，过程中无脱落或死亡病例。实验组的总有效率为100%，对照组的总有效率为76.70%，对两组的疗效进行对比，经Wilcoxon秩和检验，P<0.05（见表6）。表明在本研究课题中，实验组对于脑卒中后肩手综合征的治疗效果优于对照组｡��
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｡��
结论：
两种治疗方案对脑卒中后肩手综合征患者的临床表现和功能改善均有积极影响，而且在治疗过程中两组患者都没有出现明显的副作用或者不良反应；实验组对治疗中风中后肩手综合征的疗效优于对照组，说明温和灸配合推拿疗法对于研究脑卒中后肩手综合征患者的临床治疗是有意义的，适用于临床使用。
关键词：脑卒中；肩手综合征；温和灸；推拿
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
Abstract
Objective
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.
Methods
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.
Results
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. ��
Conclusion
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

目    录
摘    要    I
Abstract    III
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
一、研究内容    7
二、研究对象    7
三、样本计算    8
四、治疗方案    8
五、观察内容    9
六、疗效判定标准    9
七、统计学处理    9
八、技术保证    9
九、技术路线    10
十、研究结果    10
结    语    15
参考文献    16
附    录    18
致    谢    26