【摘要】：目的：觀察針灸陽明經(jīng)腧穴對(duì)糖尿病下肢周圍神經(jīng)病變的臨床療效,初步討論其作用機(jī)理,以評(píng)估該方法在糖尿病周圍神經(jīng)病變治療中的臨床優(yōu)勢(shì)與應(yīng)用價(jià)值,為糖尿病引起的下肢周圍神經(jīng)病變提供有效的、進(jìn)一步的治療途徑。方法：本次課題全部病例來自于黑龍江中醫(yī)藥大學(xué)附屬第一醫(yī)院選取符合診斷標(biāo)準(zhǔn)及納入標(biāo)準(zhǔn)的糖尿病周圍神經(jīng)病變患者60例,采用隨機(jī)分組法,將全部病例分為治療組(即針刺陽明經(jīng)腧穴配合溫和灸)30例,對(duì)照組(即常規(guī)針刺)30例,兩組的基礎(chǔ)治療方案相同：監(jiān)控血糖；兩組均需控制日常飲食并通過降糖藥或注射胰島素降糖,使空腹血糖控制在8mmol/L,餐后血糖在11.1mmol/L以下并維持穩(wěn)定1星期；口服彌可保片一一成人一次1片(0.5mg),一日3次。治療組施以基礎(chǔ)治療,并行針刺陽明經(jīng)腧穴(主經(jīng)穴：足三里、上巨虛、豐隆、下巨虛、解溪、內(nèi)庭,依據(jù)辯證分型加穴：氣虛血瘀加三陰交、氣海、血海,陰虛血瘀加肝俞、腎俞、三陰交,痰瘀阻絡(luò)加脾俞、胃俞、三焦俞、三陰交,肝腎虧虛加肝俞、腎俞、太溪)加用溫和灸治療,觀察治療4個(gè)療程。對(duì)照組施以基礎(chǔ)治療,并行常規(guī)針刺,取穴參照新世紀(jì)第二版教材《針灸學(xué)》取穴。近年來有很多研究報(bào)道多倫多臨床神經(jīng)病變?cè)u(píng)分系統(tǒng)(TCSS),并將其作為D PN有效的篩查和療效評(píng)價(jià)工具廣泛應(yīng)用于臨床。本課題應(yīng)用TCSS評(píng)分、神經(jīng)傳導(dǎo)速度測(cè)定(NCV)評(píng)估,并運(yùn)用統(tǒng)計(jì)學(xué)處理軟件,比較兩組TCSS分值、神經(jīng)傳導(dǎo)速度的變化,以及臨床療效。結(jié)果：1.治療前后兩組糖尿病下肢周圍神經(jīng)病變患者的TCSS評(píng)分、神經(jīng)傳導(dǎo)速度均有變化,改善了患者臨床癥狀,經(jīng)統(tǒng)計(jì)學(xué)軟件分析,結(jié)果為：治療后治療組、對(duì)照組組內(nèi)比較(P0.01)；且組間比較存在顯著性差異(P0.05),具有統(tǒng)計(jì)學(xué)意義。2.治療前后兩組糖尿病下肢周圍神經(jīng)病變患者的總有效率比較,治療組優(yōu)于對(duì)照組(P0.05)。結(jié)論：1.針灸陽明經(jīng)腧穴對(duì)糖尿病下肢周圍神經(jīng)病變患者的神經(jīng)傳導(dǎo)速度、臨床癥狀和體征均有改善。2.針灸陽明經(jīng)腧穴是治療和改善糖尿病下肢周圍神經(jīng)病變的有效方法之一。
[Abstract]:Objective: to observe the clinical effect of acupuncture and moxibustion on diabetic peripheral neuropathy of lower extremities, and discuss its mechanism, so as to evaluate the clinical advantage and application value of this method in the treatment of diabetic peripheral neuropathy. To provide an effective and further treatment for peripheral neuropathy of lower extremities caused by diabetes. Methods: 60 patients with diabetic peripheral neuropathy were selected from the first affiliated Hospital of Heilongjiang University of traditional Chinese Medicine and randomly divided into groups. All cases were divided into treatment group (acupuncture Yangming acupoints combined with mild moxibustion) 30 cases, control group (that is, routine acupuncture) 30 cases, the two groups of basic treatment plan is the same: monitoring blood sugar; Both groups were required to control their daily diet and control fasting blood glucose at 8 mmol / L through hypoglycemic drugs or insulin injection. Postprandial blood glucose was below 11.1mmol/L and remained stable for 1 week. Take Mecobao tablets one by one adult 1 tablet (0.5mg), 3 times a day. The treatment group was treated with basic treatment and acupunctured at acupoints of Yangming Meridian (main meridian points: Zusanli, Shangjuxu, Fenglong, Xijuxu, Jiexi, inner atria, plus acupoints according to dialectical classification: Qi deficiency, blood stasis plus Sanyinjiao, Qi sea, blood sea, yin deficiency and blood stasis plus Gan Shu, Shenshu, Sanyinjiao, phlegm stasis blocking collaterals plus spleen, Weishu, Sanjiaoshu, Sanyinjiao, deficiency of liver and kidney plus Gansu, Shenshu, Taixi) were treated with mild moxibustion and observed for 4 courses of treatment. The control group was treated with basic treatment and routine acupuncture, and the acupoints were selected according to the second edition of the new century textbook of Acupuncture and moxibustion. In recent years, Toronto Clinical Neuropathy scoring system (TCSS),) has been widely used as an effective screening and therapeutic evaluation tool for D-PN. In this study, TCSS score, nerve conduction velocity (NCV) were used to evaluate (NCV), and statistical software was used to compare the changes of TCSS score, nerve conduction velocity (NCV) and clinical curative effect between the two groups. Results: 1. Before and after treatment, the TCSS score and nerve conduction velocity of the two groups of diabetic peripheral neuropathy of lower extremities were changed, which improved the clinical symptoms of the patients. The results were as follows: the treatment group after treatment, the clinical symptoms of the patients were improved by statistical software analysis. Comparison in the control group (P0.01); There was a significant difference between the two groups (P0.05), with statistical significance. 2. The total effective rate of diabetic peripheral neuropathy before and after treatment was better in the treatment group than in the control group (P0.05). Conclusion: 1. Acupuncture and moxibustion on acupoints of Yangming Meridian can improve nerve conduction velocity, clinical symptoms and signs of diabetic patients with peripheral neuropathy of lower limb. 2. Acupuncture and moxibustion Yangming Meridian acupoints is one of the effective methods to treat and improve peripheral neuropathy of diabetic lower limbs.
【學(xué)位授予單位】：黑龍江中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類號(hào)】：R246.1

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