發(fā)布時間：2018-01-14 03:04

  本文關鍵詞：開四關聯(lián)合腹針治療腰椎間盤突出癥的臨床觀察　出處：《廣州中醫(yī)藥大學》2017年碩士論文　論文類型：學位論文

  更多相關文章： 開四關 腹針 腰椎間盤突出癥

【摘要】：目的:腰椎間盤突出癥(LDH)是一種常見疾病,在針灸科和骨科中就診率高,青壯年多發(fā),且逐漸呈現(xiàn)年輕化。除有明確手術指征的病人外,保守治療為本病的主要治療手段,但復發(fā)率高。腹針療法臨床應用廣泛,已經(jīng)證實對多種疾病療效顯著,具有其他療法所無法替代的優(yōu)點。開四關調(diào)和氣血陰陽,對多種疾病均有效。本文通過設計隨機對照試驗,探討開四關聯(lián)合腹針治療LDH的臨床療效,為開四關聯(lián)合腹針治療LDH提供臨床依據(jù),并進一步明確開四關的早期鎮(zhèn)痛效果。方法:嚴格根據(jù)納入條件,選取2016年5月至2017年2月在廣東省中醫(yī)院及廣州中醫(yī)藥大學第一附屬醫(yī)院針灸科或骨科門診就診的60例病人;將其隨機分為兩組,治療組、對照組各30例病人。治療組先在四關穴上行提插捻轉瀉法后留針,隨后開始腹針治療,而對照組只給予腹針治療。兩組均要求病人臥硬板床休息2周,每次治療留針30分鐘,前3次每日1次,之后2日1次,6-10次為1療程。采用腰椎功能評分(下腰痛評分系統(tǒng))、直觀疼痛模擬量表(VAS評分)作為療效評價指標,分別于首次治療30分鐘后、前3次治療后、1個療程治療的前后各進行一次VAS評分,于1個療程治療的前后進行JOA評分,并根據(jù)治療前后JOA下腰痛評分的改善率來評定最后的臨床療效。將所得數(shù)據(jù)由專人在excel上建立數(shù)據(jù)庫,使用SPSS22.0軟件對數(shù)據(jù)進行比較分析。結果:1.首次治療后30min,兩組VAS評分與治療前比較均具有明顯差異(P0.01),而兩組間的VAS評分比較提示具有顯著性差異(P0.01),但治療組治療前后的差值明顯大于對照組。治療3次后,兩組VAS評分與治療前比較均具有顯著性差異(P0.01),兩組組間VAS評分比較具有顯著性差異(P0.01),但兩組治療前后差值經(jīng)統(tǒng)計學分析,無明顯差異性。2.1個療程后,兩組的JOA及VAS評分與治療前比較,差異具有統(tǒng)計學意義(P0.01)。3.1個療程后,兩組間JOA及VAS評分比較,VAS評分的差異不具有統(tǒng)計意義(P0.05),JOA評分的差異具有統(tǒng)計學意義(P0.05)。4.療效評價:治療組30例病例中,臨床治愈9例,顯效13例,有效6例,無效2例,臨床總有效率達93.33%。對照組30例病例中,臨床治愈5例,顯效8例,有效13例,無效4例,臨床總有效率達86.67%。經(jīng)秩和檢驗z=-2.129,P0.05,兩組結果具有顯著性差異。結論:開四關聯(lián)合腹針及單純腹針療法均可在一定程度上改善LDH患者的腰椎功能及減輕疼痛癥狀,結果提示治療組的臨床療效優(yōu)于對照組。同時通過分析兩組在不同治療次數(shù)后VAS評分的差異可得知,開四關聯(lián)合腹針方法在緩解疼痛方面優(yōu)于單純腹針方法,且即時止痛效果顯著。本次研究的治療方法表明開四關鎮(zhèn)痛起效迅速,且具有患者痛苦少、操作簡單易行等優(yōu)點,也進一步明確了腹針治療LDH的臨床療效,值得臨床進一步推廣應用。
[Abstract]:Objective: Lumbar disc herniation (LDH) is a common disease, in acupuncture and orthopedic departments, the rate of medical treatment is high, young adults more, and gradually showing younger, except for patients with clear indications of surgery. Conservative treatment is the main treatment of this disease, but the recurrence rate is high. Abdominal acupuncture therapy has been widely used in clinical practice, has been proved to be effective in many diseases. It has the advantage that other therapies can not be replaced. It is effective for many diseases by combining Qi-Xin-yang with Kaisiguan. This article discusses the clinical effect of Kaisiguan combined with abdominal acupuncture in the treatment of LDH by designing a randomized controlled trial. To provide the clinical basis for the treatment of LDH with the combination of open four customs and abdominal acupuncture, and to further clarify the early analgesic effect of opening four customs. Methods: strictly according to the condition of inclusion. From May 2016 to February 2017, 60 patients were selected from the Department of Acupuncture or Orthopaedics, Department of Acupuncture or Orthopedics, Guangzhou University of traditional Chinese Medicine and the first affiliated Hospital of Guangzhou University of Chinese Medicine. It was randomly divided into two groups, treatment group, control group of 30 patients. The patients in the control group were only treated with abdominal acupuncture. The patients in both groups were required to rest in a hard bed for 2 weeks for 30 minutes each time, once a day for the first three times, and once after 2nd. The lumbar function score (low back pain scoring system) and visual pain simulation scale (VAS) were used to evaluate the efficacy of the treatment for 30 minutes after the first treatment. After the first three treatments, one VAS score was performed before and after one course of treatment, and the JOA score was performed before and after one course of treatment. According to the improvement rate of low back pain score under JOA before and after treatment, the final clinical curative effect was evaluated. SPSS22.0 software was used to compare and analyze the data. Results: 1. 30 minutes after the first treatment, the VAS scores of the two groups were significantly different from those before treatment (P 0.01). The comparison of VAS scores between the two groups indicated that there was a significant difference between the two groups, but the difference before and after treatment in the treatment group was significantly higher than that in the control group. After 3 times of treatment, the difference was significantly higher in the treatment group than in the control group. The VAS scores of the two groups were significantly different from those before treatment (P 0.01), and the VAS scores between the two groups were significantly different (P 0.01). However, the difference between the two groups before and after treatment had no significant difference. 2.1 courses later, the JOA and VAS scores of the two groups were compared with those before treatment. The difference was statistically significant (P 0.01). After 3.1 courses of treatment, the difference of JOA and VAS scores between the two groups was not statistically significant (P 0.05). The difference of JOA score was statistically significant (P 0.05). Evaluation of curative effect: in the treatment group, 9 cases were clinically cured, 13 cases were markedly effective, 6 cases were effective and 2 cases were ineffective. The total clinical effective rate was 93.33. In the control group, 5 cases were cured, 8 cases were effective, 13 cases were effective, and 4 cases were ineffective. The total clinical effective rate was 86.67%. Conclusion: the combination of abdominal acupuncture and abdominal acupuncture can improve the lumbar spine function and relieve pain in LDH patients to some extent. The results suggest that the clinical efficacy of the treatment group is better than that of the control group. At the same time, by analyzing the difference of VAS score between the two groups after different treatment times, we can know. The treatment method of this study shows that the analgesic effect of open four customs combined with abdominal acupuncture is rapid and the pain is less in patients than in simple abdominal acupuncture. The advantages of simple operation and easy operation also confirmed the clinical effect of abdominal acupuncture on LDH, which is worthy of further clinical application.
【學位授予單位】：廣州中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.9

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