四黄水蜜外敷对脑卒中患者偏瘫上肢肿胀的疗效研究

肖彬新　　王玫　　谢晓华

[关键词] 四黄水蜜;脑卒中;上肢;肿胀;肩手综合征

[中图分类号] R473.6          [文献标识码] B          [文章编号] 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

约85%脑卒中患者存在不同程度的肢体瘫痪[1]。偏瘫肢体肿胀发生率为20%，多发生于急性期[2]。脑卒中后肢体肿胀原因尚未明确，临床上认为卒中后神经受损，血管调节功能障碍，静脉血液回流受阻;同时因偏瘫侧主动运动减少，肢体肌肉紧张度下降，肌肉泵的挤压作用明显减弱，导致血液回流不畅而瘀滞产生肿胀[3]。偏瘫后机体营养代谢功能缓慢引起水、电解质紊乱，局部血管舒缩功能失调也是造成患肢水肿的高危因素[4-5]。若没有重视，长期肢体制动和局部组织缺氧造成手部肌肉萎缩、掌指关节囊挛缩，肿胀渗出物纤维化引起的粘连和滑膜囊增厚，可导致肢体不可逆残疾，影响患侧上肢功能的康复[6]。肢体的肿胀程度可导致关节活动度下降、慢性疼痛，甚至炎症和感染，影响肢体功能康复。同时加重患者心理负担，易出现焦虑、抑郁等不良情绪。因此，及早消除患肢肿胀将会增加手功能康复几率。中西結合是临床治疗发展的主要方向。本研究通过四黄水蜜外敷对卒中后偏瘫上肢肿胀，临床效果显著，现报道如下。