微创医学

目的探讨B超引导下星状神经节阻滞（SGB）联合激痛点温针灸在脑卒中后肩手综合征（SHS）患者中的应用效果。方法选取96例脑卒中后SHS患者作为研究对象，采用随机数字表法将患者分为A组、B组、C组，每组32例。A组采用常规治疗联合B超引导下SGB治疗，B组采用常规治疗联合激痛点温针灸治疗，C组采用常规治疗联合B超引导下SGB治疗及激痛点温针灸治疗。3组均治疗2个月。治疗后，比较3组的临床疗效；治疗前后，比较3组疼痛程度［疼痛视觉模拟评分法（VAS）评分］、上肢运动功能［Fugl-Meyer上肢运动功能评定量表（FMA-UE）评分］、日常生活能力（改良Barthel指数评分），以及3组治疗后的不良反应发生情况。结果 3组总有效率比较差异具有统计学意义（P<0.05），其中C组总有效率高于A组和B组（P<0.05）。治疗后，3组疼痛VAS评分较治疗前降低，且C组低于A组和B组（P<0.05）；3组FMA-UE评分较治疗前升高，且C组高于A组和B组（P<0.05）；3组改良Barthel指数评分较治疗前升高，且C组高于A组和B组（P<0.05）。3组总不良反应发生率比较，差异无统计学意义（P>0.05）。结论 B超引导下SGB联合激痛点温针灸治疗脑卒中后SHS患者可提高疗效、缓解疼痛，并促进上肢功能恢复，且安全性良好。

Objective To investigate the appliaction effect of ultrasound-guided stellate ganglion block (SGB) combined with warm needling moxibustion at trigger points in patients with post-stroke shoulder-hand syndrome (SHS). Methods A total of 96 patients with post-stroke SHS were enrolled as subjects and divided into group A, group B and group C by the random number table method, with 32 cases in each group. Group A received routine treatment combined with ultrasound-guided SGB; group B received routine treatment combined with warm needling moxibustion at trigger points; group C received routine treatment plus ultrasound-guided SGB and warm needling moxibustion at trigger points. All three groups were treated for 2 months. After treatment, the clinical efficacy of the three groups was compared. Before and after treatment, the pain degree (visual analogue scale [VAS] score), upper limb motor function (Fugl-Meyer assessment of upper extremity [FMA-UE] score) and activities of daily living (modified Barthel index score) were compared among the three groups. The occurrence of adverse reactions after treatment was also compared among the three groups. Results There was a statistically significant difference in the overall effective rate among the three groups (P<0.05), and the overall effective rate of group C was higher than that of group A and group B (P<0.05). After treatment, the VAS scores for pain in all three groups decreased compared with those before treatment; the scores in group C were lower than those in group A and group B (P<0.05). The FMA-UE scores of the three groups increased after treatment, with higher scores observed in group C relative to group A and group B (P<0.05). The modified Barthel index scores were elevated in all three groups after treatment, and group C achieved higher scores than group A and group B (P<0.05). No statistically significant difference was found in the total incidence of adverse reactions among the three groups (P>0.05). Conclusion For patients with post-stroke SHS, ultrasound-guided SGB combined with warm needling moxibustion at trigger points can enhance therapeutic effects, alleviate pain, facilitate the recovery of upper limb function, with satisfactory safety.