肠道疾病相关的牵涉痛规律与穴位敏化的关系  

Correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases

作　　者：崔翔[1] 章薇 孙建华[3] 何勋[1] 付勇[4] 王健 王渊 赵吉平[7] 周竞[8] 徐天成[3] 曹乾安 杨有为 李杰 吴江昀 唐远伟 施茵[8] 朱兵[1] CUI Xiang;ZHANG Weir;SUN Jian-hua;HE Xun;FU Yong;WANG Jian;WANG Yuan;ZHO Ji-ping;ZHOU Jing;XU Tian-cheng;CAO Qian-an;YANG You-wei;LI Jie;WU Jiang-yun;TANG Yuan-wei;SHI Yin;ZHUBing(Institute of Acupuncture and Moxibustion,China Academy of Chinese Medical Sciences,Beijing 100700,China;First Affliated Hospital of Hunan University of CM;Department of Acupuncture-Moxibustion and Rehabilitation,Jiangsu Provincial Hospital of TCM;First Department of Acupuncture and Moxibustion,Affliated Hospital of Jiangxi University of TCM;SInstitute of Acupuncture-Moxibustion and Tuina,Shandong University of TCM;Innovation Research Center for Combination of Acupuncture and Chinese Materia Media,Shaanxi University of CM;Department of Acupuncture and Moxibustion,Dongzhimen Hospital of Beijing University of CM;Shanghai Research Institute of Acupuncture and Meridian,Shanghai 200030;Institute of Acupuncture-Moxibustion and Tuina,Shaanxi University of CM)

机构地区：[1]中国中医科学院针灸研究所,北京100700 [2]湖南中医药大学第一附属医院 [3]江苏省中医院针灸康复科 [4]江西中医药大学附属医院针灸一科 [5]山东中医药大学针灸推拿学院 [6]陕西中医药大学针药结合创新研究中心 [7]北京中医药大学东直门医院针灸科 [8]上海市针灸经络研究所,上海200030 [9]陕西中医药大学针灸推拿学院

出　　处：《中国针灸》2019年第11期1193-1198,共6页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金项目：81674085;中央级公益性科研院所基本科研业务费专项资金资助项目：ZZZD16001;国家重点研发计划资助项目：2018YFC1704600

摘　　要：目的:观察肠道疾病牵涉痛分布规律与穴位之间的关系。方法:临床研究部分,在全国8家医院门诊及病房招募克罗恩病(143例)、溃疡性结肠炎(108例)、慢性阑尾炎(87例)及其他肠道相关疾病(105例)患者共计443例,观察并记录患者体表的压痛敏感部位及局部皮肤形态学改变。采用感觉压痛仪测量60例溃疡性结肠炎(UC)患者敏化点的痛阈值。动物实验部分,以肠炎模型SD大鼠为肠炎组(n=8),与不做任何处理的对照组大鼠(n=3),观察尾静脉注射Evans blue(EB)后体表出现蓝色渗出点现象,并统计其分布规律。结果:肠道疾病患者的体表牵涉痛部位主要位于下腹部(93.9%,416/443)、腰部(70.9%,314/443)、小腿部(33.0%,146/443),压痛区域直径为1.5~2.5 cm;与非敏化点相比,UC患者敏化点的痛阈值显著降低(P<0.001)。阑尾炎患者体表牵涉痛部位主要位于右侧下腹部(97.7%,85/87)、腰背部(54.0%,47/87)及右侧下肢内侧面(71.3%,62/87),压痛区域直径为1~2 cm,形状不规则。大鼠肠炎造模后,可以在T12~L2节段观察到EB渗出点。结论:肠道疾病时引起体表与病变肠段相同或相近节段出现牵涉性疼痛,这些敏化部位与"穴位"形成相关。Objective To observe the correlation between referred pain distribution and acupoint sensitization in patients with intestinal diseases.Methods In clinical research,443 patients from 8 hospitals were recruited,including the outpatients and inpatients of Crohn’s disease(n=143),ulcerative colitis(n=108),chronic appendicitis(n=87)and other intestinal diseases(n=105).The site with tenderness on the body surface and the morphological changes of local skin were observed and recorded in the patients.Using a sensory tenderness instrument,the pain threshold at the sensitization point was measured in 60 patients with ulcerative colitis.In animal experiment,SD rats were used and divided into a enteritis group(n=8),in which the enteritis model were established,and a control group(n=3),in which noany intervention was given.After the injection of Evans blue(EB)at caudal vein,the blue exudation points on the body surface were observed and the distribution rule was analyzed statistically.Results The referred pain on the body surface in the patients with intestinal diseases was mainly located in the lower abdomen(93.9%,416/443),the lumbar region(70.9%,314/443)and the lower legs(33.0%,146/443).The diameter of tenderness region was 1.5 to 2.5 cm.Compared with the region without sensitization,the pain threshold of the sensitization point in the patients with ulcerative colitis was reduced significantly(P<0.001).The referred pain on the body surface in the patients with appendicitis was located in the right lower abdomen(97.7%,85/87),the waist and back(54.0%,47/87)and the right lower limbs on the medial side(71.3%,62/87).The tenderness region was 1 to 2 cm in diameter and was irregular in form.After modeling of enteritis in the rats,the EB exudation points were visible from T12 to L2.Conclusion Intestinal diseases induce referred pain on the body surface where is the same as or adjacent to the location of the spinal segment corresponding to the affected intestinal section.These sensitization regions are related to the locations of

关 键 词：穴位本态 结肠炎 阑尾炎 稳态 痛阈 穴位敏化 

分 类 号：R245[医药卫生—针灸推拿学]