食管、胃十二指肠疾病牵涉痛与穴位敏化的研究  

Study on Referred Pain and Acupoint Sensitization in Esophageal and Gastroduodenal Diseases

作　　者：王渊 王健[2] 章薇[3] 施静[4] 何勋[1] 孙建华[6] 赵吉平[7] 吴媛媛[8] 赵君 朱兵[1] WANG Yuan;WANG Jian;ZHANG Wei;SHI Jing;HE Xun;SUN Jian-hua;ZHAO Ji-ping;WU Yuan-yuan;ZHAO Jun;ZHU Bing(China Academy of Chinese Medical Sciences Institute of Acupuncture and Moxibustion,Beijing 100700,China;Shandong University of Traditional Chinese Medicine School of Acupuncture and massage,Jinan 250355,China;Hunan University of traditional Chinese Medicine First Hospital,Changsha 410000,China;Yunnan Hospital of Traditional Chinese Medicine,Kunming 650000,China;Shaanxi University of Traditional Chinese Medicine School of Acupuncture and massage,Xianyang 712046,China;Jiangsu Hospital of Traditional Chinese Medicine,Nanjing 210029,China;Beijing University of Traditional Chinese Medicine Dongzhimen Hospital,Beijing 100700,China;Zhejiang University of Traditional Chinese Medicine Third Hospital,Hangzhou 310053,China)

机构地区：[1]中国中医科学院针灸研究所,北京100700 [2]山东中医药大学针灸推拿学院,济南250355 [3]湖南中医药大学第一附属医院,长沙410000 [4]云南省中医医院,昆明650000 [5]陕西中医药大学针灸推拿学院,咸阳712046 [6]江苏省中医院,南京210029 [7]北京中医药大学东直门医院,北京100700 [8]浙江中医药大学第三医院,杭州310053

出　　处：《上海针灸杂志》2020年第4期501-507,共7页Shanghai Journal of Acupuncture and Moxibustion

基　　金：中央公益性科研院所基本科研业务专项资金(ZZ10-006);国家重点研究发展计划(2018YFC1704600);国家自然科学基金项目(81674085)。

摘　　要：目的观察食管、胃十二指肠疾病牵涉痛的分布规律与穴位的关系。方法临床研究招募180例食管疾病和738例胃十二指肠溃疡患者,采用指压法在躯干四肢部位进行探查,观察压痛点的分布位置及其局部色泽形态变化并在人体神经皮节图上进行标记。采用感觉压痛仪测量30例胃十二指肠溃疡患者压痛阈值。动物研究采用SD大鼠胃炎模型(n=8)与对照组(n=3)进行比较,观察尾静脉注射Evans blue后体表蓝色渗出点的分布情况。结果食管疾病牵涉痛主要分布于胸骨处(88.69%)、上腹中部(84.52%)、背部颈椎到胸椎处(64.29%),颈部中间(32.14%),牵涉痛压痛点部位分布在C4-T9神经节段所支配的皮节内,顺着食管走形,多呈棒状,长条状,长约2~20 cm。胃十二指肠溃疡患者牵涉痛主要位于上腹部(88.65%)、背部(52.14%)、下肢部(34.46%)、下腹部(27.39%)、胸部(24.30%),以腹中部、左上腹部及左侧背部为主,主要对应着T5-10所支配的皮节区域,并不局限于穴位区,非穴区也有大量分布。压痛区域大小、形状各异,且牵涉痛区域的压痛阈值明显低于对侧相同正常部位的压痛阈值(P<0.001)。胃炎模型大鼠可以在T6-10观察到蓝色渗出点。结论食管疾病、胃十二指肠溃疡引起的牵涉痛主要分布在其相应的神经节段所支配的体表部位,而这些部位与穴位的形成有关。Objective To investigate the relationship between regularities in the distribution of referred pain and acupoints in esophageal and gastroduodenal diseases.Method One hundred and eighty patients with esophageal diseases and seven hundred and thirty-eight patients with gastroduodenal diseases were enrolled in this clinical study.The trunk and limbs were probed by finger-press method.The distributional positions of tender points with their local colors and shapes were observed and marked on the human dermatome map.The pressure pain threshold was measured using an esthesiometer in 30 patients with gastroduodenal ulcer.In an animal study,a comparison was made between SD rat models of gastritis(n=8)and a control group of rats(n=3)and the distribution of blue exudation points on the body surface was observed after caudal vein injection of Evans blue.Result Referred pain in esophageal diseases was mainly distributed in the sternum(88.69%),the middle of the upper abdomen(84.52%),the cervical to thoracic vertebrae of the back(64.29%)and the middle of the neck(32.14%).The tender points of referred pain were distributed in the dermatomes innervated by C4-T9 nerve segments and shaped along the esophagus,often like a stick or a long strip,about 2~20cm long.Referred pain in the patients with gastroduodenal ulcer was mainly situated in the upper abdomen(88.65%),the back(52.14%),lower limbs(34.46%),the lower abdomen(27.39%)and the chest(24.30%),especially in the middle abdomen,the left upper abdomen and the left back,mainly corresponded to T5-10 dermatomes,not limited to the acupoint area and also massively distributed in the non-acupoint area.The shapes and sizes of pressure points were different and the pain thresholds of referred pain region in patients were significantly lower than the same normal region from the opposite side.The tender area varied in size and shape and the pressure pain threshold was significantly lower in the referred pain area than in the contralateral normal part(P<0.001).Blue exudation points were obse

关 键 词：胃溃疡 十二指肠溃疡 消化性溃疡 食管疾病 牵涉痛 穴位敏化 压痛点 胃炎 大鼠 

分 类 号：R245.2[医药卫生—针灸推拿学]