【目的】观察温针经筋刺法联合Bobath康复手法治疗脑卒中后肩手综合征 （SHS） Ⅰ期的临床疗效。 【方法】将90例脑卒 中后SHS Ⅰ期患者随机分为观察组和对照组，每组各45例，对照组给予Bobath康复手法治疗，观察组在对照组治疗的基础 上，联合温针经筋刺法治疗。2组均治疗8周。治疗2个月后，评价2组临床疗效，观察2组患者治疗前后疼痛视觉模拟量表 （VAS） 评分的变化情况，以及关节肿胀程度的情况。比较2组患者治疗前后Fugl-Meyer运动功能量表 （FMA） 评分、Barthel指 数 （BI） 评分以及中医证候积分的变化情况。 【结果】（1） 治疗后，2组患者的VAS评分均明显改善 （P＜0.05） ，且观察组在改善 VAS评分方面明显优于对照组，差异有统计学意义 （P＜0.05） 。 （2） 治疗后，2组患者的关节肿胀程度均明显改善 （P＜0.05） ， 且观察组在改善关节肿胀程度方面明显优于对照组，差异有统计学意义 （P＜0.05） 。 （3） 治疗后，2组患者的FMA、BI评分均 明显改善 （P＜0.05） ，且观察组在改善FMA、BI评分方面明显优于对照组，差异有统计学意义 （P＜0.05） 。 （4） 观察组总有效率 为93.33% （42/45） ，对照组为77.78% （35/45） 。观察组疗效优于对照组，差异有统计学意义 （P＜0.05） 。 【结论】温针经筋刺法 联合Bobath康复手法治疗脑卒中后SHS Ⅰ期患者，能明显改善患者的疼痛症状，改善关节肿胀程度，提高患者运动功能与 日常生活能力，提高患者生活质量，疗效显著。

Objective To observe the clinical effect of warm-needle meridian sinew acupuncture combined with Bobath rehabilitation manipulation in the treatment of post-stroke shoulder-hand syndrome （SHS） stage I. Methods A total of 90 patients with post-stroke SHS stage I were randomly divided into observation group and control group，45 cases in each group. The control group was treated with Bobath rehabilitation manipulation，and the observation group was treated with warm-needle meridian sinew acupuncture on the basis of the control group. Both groups were treated for eight weeks. After two months of treatment，the clinical efficacy of the two groups was evaluated，and the changes of Visual Analogue Scale （VAS） pain score and the degree of joint swelling were observed before and after treatment. The changes of Fugl-Meyer motor function scale （FMA） score，Barthel Index （BI） score and traditional Chinese medicine （TCM） symptom score were compared before and after treatment between the two groups. Results （1） After treatment，the VAS scores of the two groups were significantly improved （P＜0.05），and the improvement of VAS score in the observation group was significantly superior to that in the control group，the difference was statistically significant （P＜0.05） . （2）After treatment，the degree of joint swelling in the two groups was significantly improved （P＜0.05），and the observation group was significantly superior to the control group in improving the degree of joint swelling，the difference was statistically significant （P＜0.05） . （3） After treatment，the FMA and BI scores of the two groups were significantly improved （P＜0.05） ， and the improvement of FMA and BI scores in the observation group was significantly superior to that in the control group，the difference was statistically significant （P＜0.05） . （4） The total effective rate was 93.33%（42/45） in the observation group and 77.78%（35/45） in the control group. The curative effect of the observation group was superior to that of the control group，and the difference was statistically significant （P＜0.05） . Conclusion Warm- needle meridian sinew acupuncture combined with Bobath rehabilitation manipulation can significantly improve the pain symptoms of patients with post-stroke SHS in stage I，improve the degree of joint swelling，improve the motor function and daily living ability of patients，and improve the quality of life of patients.

R246.9

国家自然科学基金资助项目 （编号：82374565）