四黃水蜜外敷對(duì)腦卒中患者偏癱上肢腫脹的療效研究

肖彬新　　王玫　　謝曉華

[關(guān)鍵詞] 四黃水蜜;腦卒中;上肢;腫脹;肩手綜合征

[中圖分類號(hào)] R473.6? ? ? ? ? [文獻(xiàn)標(biāo)識(shí)碼] B? ? ? ? ? [文章編號(hào)] 1673-9701（2021）20-0158-04

Effect of external application of Sihuang Hydromel on treatment of upper limb swelling in stoke patients with hemiplegia

XIAO Binxin? ?WANG Mei? ?XIE? Xiaohua

Department of Brain Disease， People′s Hospital of Fujian University of Traditional Chinese Medicine， Fuzhou? ?350004，China

[Abstract] Objective To explore the effect of external application of Sihuang hydromel on the treatment of hemiplegic side upper limb swelling after stroke. Methods Sixty patients with hemiplegic side upper limb swelling after stroke treated in the People′s Hospital of Fujian University of Traditional Chinese Medicine from March 2018 to October 2019 were selected and randomly divided into the control group and the intervention group. The control group were treated with routine care， good limb position and limb function training. The intervention group were given Sihuang hydromel in addition to the treatment of the control group. The interventions were given for 1 week. The upper limb wrist joint circumference， swelling score， and motor function were compared between the two groups before and after treatment. Results After 7 days of intervention， the upper limb wrist joint circumferences in the intervention group and the control group were（15.64±1.02） cm and （16.36±1.28） cm， respectively. The swelling scores in the intervention group and the control group were （0.40±0.91） and （1.24±0.83） points， respectively. The FMA scores in the intervention group and the control group were（21.51±4.96） and（15.78±6.49） points， respectively. The differences between before and after treatment were statistically significant in both groups（P<0.05）. The upper limb wrist joint circumference， swelling score and motor function in the intervention group after treatment were improved compared with those in the control group， with statistically significant differences（P<0.05）. Conclusion External application of Sihuang hydromel combined with routine rehabilitation nursing can relieve upper limb swelling in stroke patients with hemiplegia and promote limb function recovery.

[Key words] Sihuang hydromel; Stroke; Upper limb; Swelling; Shoulder-hand syndrome

約85%腦卒中患者存在不同程度的肢體癱瘓[1]。偏癱肢體腫脹發(fā)生率為20%，多發(fā)生于急性期[2]。腦卒中后肢體腫脹原因尚未明確，臨床上認(rèn)為卒中后神經(jīng)受損，血管調(diào)節(jié)功能障礙，靜脈血液回流受阻;同時(shí)因偏癱側(cè)主動(dòng)運(yùn)動(dòng)減少，肢體肌肉緊張度下降，肌肉泵的擠壓作用明顯減弱，導(dǎo)致血液回流不暢而瘀滯產(chǎn)生腫脹[3]。偏癱后機(jī)體營(yíng)養(yǎng)代謝功能緩慢引起水、電解質(zhì)紊亂，局部血管舒縮功能失調(diào)也是造成患肢水腫的高危因素[4-5]。若沒(méi)有重視，長(zhǎng)期肢體制動(dòng)和局部組織缺氧造成手部肌肉萎縮、掌指關(guān)節(jié)囊攣縮，腫脹滲出物纖維化引起的粘連和滑膜囊增厚，可導(dǎo)致肢體不可逆殘疾，影響患側(cè)上肢功能的康復(fù)[6]。肢體的腫脹程度可導(dǎo)致關(guān)節(jié)活動(dòng)度下降、慢性疼痛，甚至炎癥和感染，影響肢體功能康復(fù)。同時(shí)加重患者心理負(fù)擔(dān)，易出現(xiàn)焦慮、抑郁等不良情緒。因此，及早消除患肢腫脹將會(huì)增加手功能康復(fù)幾率。中西結(jié)合是臨床治療發(fā)展的主要方向。本研究通過(guò)四黃水蜜外敷對(duì)卒中后偏癱上肢腫脹，臨床效果顯著，現(xiàn)報(bào)道如下。