Clinical Study Of Acupuncture Combined With Manual Lymphatic Drainage On Edema Of The Hemiplegic Upper Limbs In Stroke Patients

Objective: Therapy of acupuncture combined with manual lymphatic drainage(MLD)is used to treat the upper limb of hemiplegic edema after stroke.We aim to further reveal the mechanisms of hemiplegic upper limb edema after stroke and explore the possible mechanisms of acupuncture combined with MLD in the treatment of hemiplegic upper limb edema by observing the changes of edema,pain and motor function before and after treatment and analyzing the therapeutic effect,so as to provide a new idea and new direction for the effective prevention and treatment of hemiplegic upper limb edema.Methods: 120 inpatients with the upper limbs edema after stroke were enrolled in the study.They were randomly divided into four groups,including routine rehabilitation group(A),acupuncture group(B),manual lymphatic drainage group(C)and acupuncture combined with manual lymphatic drainage group(D),with 30 cases in each group.Group A was treated with routine rehabilitation therapy for 40 minutes each time,group B was treated with acupuncture for 30 minutes each time on the basis of routine rehabilitation therapy,group C was treated with MLD for 30 minutes each time on the basis of routine rehabilitation therapy.For group D,acupuncture therapy and MLD treatment were both used for 30 minutes each time on the basis of routine rehabilitation treatment.All the four groups were treated five times/week for four weeks.The circumferences on the point of the first web space and wrist striation of hemiplegic upper limb were measured before and after treatment,and the changes of edema of hemiplegic upper limb were compared and evaluated.Visual analogue pain score(VAS),upper limb motor function test of Fugl-Meyer movement assessment scale(U-FMA)and modified Barthel index were used to evaluate hemiplegic upper limb pain,upper limb motor function and activity of daily living(ADL),respectively.Results: After 4 weeks of treatment,the circumferences of hemiplegic upper limbs with edema in the four groups were shorter than that before treatment,and the decrease of the circumferences of upper limbs treated with acupuncture combined with manual lymphatic drainage were the greatest(P < 0.05).The VAS scores of hemiplegic upper limbs in the four groups were lower than those before treatment.Compared with the other three groups,the greatest difference of VAS scores before and after treatment in acupuncture combined with manual lymphatic drainage group was observed,and the difference was statistically significant(P < 0.05).The scores of U-FMA were higher than those before treatment,especially in the acupuncture combined with manual lymphatic drainage group.There was significant difference between group D and the other three groups(P<0.05).After treatment,the modified Barthel index in group D was significantly higher than that before treatment,especially in the acupuncture combined with manual lymphatic drainage group,which was significantly higher than that in the other three groups(P < 0.05).Conclusion: Acupuncture combined with manual lymphatic drainage can effectively reduce the edema and pain of the hemiplegic upper limbs after stroke,improve the motor function of the upper limbs,and thus improve the activity of daily living of patients.The therapeutic effect of this method is better than that of acupuncture or manual lymphatic drainage alone.