电针夹脊穴治疗腰椎间盘突出症的镇痛时效及对血浆相关因子的干预  

Time-dependent analgesic effect of electroacupuncture at Jiaji acupoint in patients with lumbar disc herniation and its intervention on related factors of plasma

作　　者：黄国付[1] 张红星[1] 张唐法[1] 余芳[1] 

机构地区：[1]华中科技大学同济医学院附属中西医结合医院针灸科,湖北省武汉市430022

出　　处：《中国临床康复》2006年第43期1-6,共6页Chinese Journal of Clinical Rehabilitation

基　　金：武汉市卫生局资助项目(武卫2000148)~~

摘　　要：目的:观察电针夹脊穴对腰椎间盘突出症的镇痛时效及其对血浆β-内啡肽、一氧化氮和自由基代谢的影响。方法:①选择2003-05/2006-05华中科技大学同济医学院附属中西医结合医院针灸科腰椎间盘突出症住院患者68例。均对治疗方案知情同意。按编码随机抽取方法分为2组:治疗组36例和对照组32例。②治疗组:选取突出部位相对应的双侧夹脊、患侧环跳,L4～5配患侧阳陵泉,L5～S1配患侧委中。各穴以触电感向下肢传导为得气征象,并接以韩氏穴位神经刺激仪,刺激参数均为调频波、刺激强度(恒流输出)为患者所能接受而不引起痛苦的最大强度,一般为10～20mA。1次/d,每次30min,10d为1疗程,疗程之间间隔3d,共观察2个疗程。对照组:参照《针灸学》选取患侧肾俞、大肠俞、秩边、环跳、承扶、殷门、委中、阳陵泉,刺激参数和疗程同治疗组。③采用国际公认的疼痛询问量表进行疼痛综合评定;观察两组的镇痛起效时间、首次治疗后维持时间,并通过目测类比定级法比较治疗开始前、首次治疗后(代表即刻效应)及最后一次治疗前(代表远期效应)的平均疼痛分数;采用杨氏评分法评定疗效。④于入院第2天、治疗1次后、治疗1疗程后及治疗2疗程后采用放射免疫分析法测定患者血浆β-内啡肽;于入院第2天及疗程结束后用硝酸还原酶法测定血浆中一氧化氮含量,羟胺氧化法测定超氧化物歧化酶活性,硫代巴比妥酸法测定丙二醛含量。结果:68例病例全部进入结果分析。①两组在选词阳性项目数、疼痛分级指数感觉分、疼痛分级指数总分、视觉模拟尺度、疼痛强度上差异均有显著性意义(t=4.52～6.64,P<0.01)。②治疗组的镇痛起效时间短、镇痛维持时间长,与对照组比较差异有显著性意义(t=36.63～75.93,P<0.01)。③治疗组首次治疗后疼痛评分下降48%,治疗结束时共下降88%;同时,对照组首次�AIM： To observe the analgesic effect of electroacupuncture （EA） at Jiaji （Extra） in patients with lumbar disc herniation （LDH）, and the therapeutic effect on the levels of plasma β-endorphin （β-EP）, nitric oxide （NO）, superoxide dismutase （SOD） and malondialdehyde （MDA） by EA. METHODS： ① Totally 68 inpatients with LDH selected from the Department. of Acupuncture and Moxibustion, Institute of Integrated Traditional Chinese and Western Medicine Affiliated to Tongji Medical College, Huazhong University of Science and Technology between May 2003 and May 2006 were randomly divided into treatment group （n=36） and eontrnl group （n=32）, with their informed consents of the treatment scheme.②The following acupoints were selected： Jiaji （Extra） of double side corresponding to the protrusion and Huantiao （GB 30） on the affected side of protrusion as well as Yanglingquan （GB 34） L4-5 and Weizhong（BL 40） L5-S1 in the treatment group. After deqi sign featured as electric shock conducted to lower limb, HANS acupoint neurostimulator was connected in wave of modulated frequency. The general electric intensity ranged from 10 to 20 mA in current constant which could be accepted by patients. Thirty minutes every day, ten days for a treatment course and at interval of three days. Acupoints such as Shenshu （BL 23）, Dachangshu （BL 25）, Zhibian （BL 54）, Huantiao （GB 30）, Chengfu （BL 36）, Yinmen （BL 37）, Weizhong （BL 40） and Yanglingquan （GB 34） were selected in the control group according to Acupucture and Moxibustion, the stimulation parameter and course were the same as those of treatment group. ③The improvement of pain was rated comprehensively using the internationally recognized Multiple Pain Quantity which described and measured pain. The acting time of analgesic effect and the effect-lasting time after the first treatment were observed, and visual analogue scale was adopted to examine and compare the mean pain score before treatment

关 键 词：电针 穴 夹脊 椎间盘移位 镇痛 Β内啡肽 一氧化氯 超氧化物歧化酶 

分 类 号：R681.5[医药卫生—骨科学]