针刺治疗慢性非特异性腰痛的临床研究  

A clinical study of acupuncture therapy for treatment of chronic nonspecific low back pain

作　　者：袁启令 刘亮[1] 马江涛[2] 武文韬[1] 叶茂林[2] 张银刚[1] 

机构地区：[1]西安交通大学第一附属医院,陕西西安710061 [2]河南中医药大学,河南郑州450008

出　　处：《中医正骨》2016年第6期12-17,共6页The Journal of Traditional Chinese Orthopedics and Traumatology

基　　金：国家自然科学基金项目1371987;81171761);陕西省科技计划项目(2013K12-14-04)

摘　　要：目的：探讨针刺对于慢性非特异性腰痛的特异性治疗作用。方法：采用前瞻性、随机、单盲、安慰对照、平行、多中心研究。共纳入150例慢性非特异性腰痛患者,随机分配至针刺组、安慰针刺组和等待治疗组,每组50例。治疗时针刺组选择肾俞、大肠俞、委中、腰阳关、环跳5个穴位为固定针刺点,同时在腕骨、带脉、阳陵泉、足临泣、地仓、足三里、命门、悬枢、神庭、水沟10个穴位中灵活选取几个穴位进行针刺治疗,进针5～20 mm,得气后留针20 min。隔2 d治疗1次,共治疗6周。安慰针刺组选取与针刺组相同的5个固定穴位用安慰针灸针进行治疗,疗程与针刺组相同;等待治疗组在本试验期间不接受治疗,待本试验结束后再接受针刺治疗。所有患者在必要的情况下,允许口服非甾体类抗炎药缓解腰痛。主要观察指标包括腰部疼痛视觉模拟评分量表（visual analogue scale,VAS）评分和Oswestry功能障碍指数（Oswestry disability index,ODI）,观察时点设为针刺组和安慰针刺组治疗前和治疗结束后1、4、12周。同时观察并发症发生率,评价试验的盲法质量。结果：共有14例患者未完成试验观察,其中针刺组4例、安慰针刺组4例、等待治疗组6例。针刺组和安慰针刺组共有17例患者报告了24次小至中度的与治疗有关的不良反应,不良反应持续时间均不超过1周。2组不良反应发生率比较,差异无统计学意义（χ^2=0.071,P=0.790）。治疗结束后,针刺组和安慰针刺组患者均接受了盲法评估。2组患者的评估结果比较,差异无统计学意义（χ^2=0.230,P=0.891）。治疗前后不同时间腰痛VAS评分的差异有统计学意义,即存在时间效应（F=34.590,P=0.000）;除等待治疗组外（P=0.054）,治疗结束后1周针刺组和安慰针刺组腰痛VAS评分均小于治疗前（P=0.000,P=0.000）;治疗结束后4、12周,针刺组、安慰针刺组和等待治疗组的�Objective： To explore the specific therapeutic effect of acupuncture therapy on chronic nonspecific low, back pain. Methods ： A prospective, randomized, single-blinded, placebo-eontrolled, parallel, multicenter trial was carried out. One hundred and lifty patients with chronic nonspecific low back pain were included and randomly divided into acupuncture group, placebo-acupuncture group and wait-to-treat group ,50 cases in each group. The patients in acupuncture group were treated with acupuncture therapy and five acupoints in- cluding Shenshu （ BI23 ） , Dachangshu （ BL25 ） , Weizhong （ BIA0 ） , Yaoyangguan （ GV3 ） and Huantiao （ GB30 ） were selected as fixed acu- puncture points. Meanwhile, several points were selected for acupuncture treatment from 10 acupoints including Wangu （SI4）, Daimai （ GB26 ）, Yanglingquan （ GB34 ）, Zulinqi （ GB41 ）, Dicang （ ST4 ）, Zusanli （ ST36 ）, Mingmen （ GV4 ）, Xuanshu （ GV5 ）, Shenting （ GV24 ） and Shuigou （GV26） according to the specific conditions. The depth of needle insertion was 5 - 20 mm and the needles were retained for 20 min- tues at a time after DEQI（ GETTING QI）. The acupuncture was performed every 3 days for consecutive 6 weeks. The patients in placebo-ac- upuncture group were treated with placebo-acupuncture therapy by selecting the same 5 acupoints as that of acupuncture group and the course of treatment was also same as that of acupuncture group. The patients in wait-to-treat group were not treated until the end of this trial. All of the patients were permitted to take nonsteroidal anti-inflammatory drugs （NSAID） for relieving low back pain if necessary. Low back pain visual analogue scale （VAS）scores and Oswestry disability index （ODI）were used as main indexes for measuring the treatment ef- fectiveness before the treatment and at 1,4 and 12 weeks after the end of the treatment. Meanwhile, the complication rates were observed and the quality of blind method used in the trail was evaluate

关 键 词：腰痛 针刺疗法 安慰针刺 临床试验 

分 类 号：R246.9[医药卫生—针灸推拿学]