热敏灸联合腰大肌肌间沟神经阻滞对腰椎间盘突出症患者MRI影像特征及血清P物质、β-内啡肽水平的影响  

Effects of Heat-Sensitive Moxibustion Combined with Intermuscular Nerve Block of Psoas Major on MRI Features and Serum Substance P andβ-endorphin Levels in Patients with Lumbar Disc Herniation

作　　者：顾敦星 孙翾[1] 陈常玉 陈云飞[2] 李鑫[3] 孟朋民[4] 苏心镜[5] GU Dun-xing;SUN Yi;CHEN Chang-yu;CHEN Yun-fei;LI Xin;MENG Peng-min;SU Xin-jing(Department of Imageology,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Anesthesiology,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Acupuncture and Moxibustion,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Rehabilitation,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China;Department of Pain,The Second Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075100,China)

机构地区：[1]河北北方学院附属第二医院影像科,河北张家口075100 [2]河北北方学院附属第二医院麻醉科,河北张家口075100 [3]河北北方学院附属第二医院针灸科,河北张家口075100 [4]河北北方学院附属第二医院康复科,河北张家口075100 [5]河北北方学院附属第二医院疼痛科,河北张家口075100

出　　处：《河北北方学院学报（自然科学版）》2020年第10期27-31,共5页Journal of Hebei North University:Natural Science Edition

基　　金：张家口市重点研发计划项目(No.1921018D)。

摘　　要：目的探讨热敏灸联合腰大肌肌间沟神经阻滞对腰椎间盘突出症(lumbar disc herniation,LDH)患者磁共振成像(magnetic resonance imaging,MRI)影像特征及血清P物质、β-内啡肽水平的影响。方法选取LDH患者64例随机分为实验组与对照组各32例。对照组采用腰大肌肌间沟神经阻滞治疗,实验组在对照组的基础上联合热敏灸治疗,连续治疗4周。比较2组治疗后临床疗效,治疗前后视觉模拟量表(visual analogue scale,VAS)、日本骨科协会评估量表(Japanese Orthopaedic Association scores,JOA)及健康状况调查问卷(the MOS item short from health survey,SF-36)评分、MRI影像特征改变及血清P物质、β-内啡肽水平变化,并比较2组治疗过程中不良反应总发生率。结果实验组总有效率(96.87%)显著高于对照组(75.00%)(P<0.05);治疗后2组VAS评分、膨出程度、椎间隙高度、硬膜外压痕矢径、硬膜外压痕纵轴及血清P物质水平均降低,且实验组显著低于对照组(P<0.05),JOA、SF-36评分及血清β-内啡肽水平均升高,且实验组显著高于对照组(P<0.05);治疗期间实验组不良反应总发生率为4.92%,对照组不良反应总发生率为6.56%,组间比较差异无统计学意义(P>0.05)。结论热敏灸联合腰大肌肌间沟神经阻滞可显著改善LDH患者临床症状,疗效确切,其机理可能与调节血清P物质及血清β-内啡肽水平有关。MRI影像特征改变可有效评定LDH的临床治疗效果。Objective To investigate the effects of heat-sensitive moxibustion combined with psoas muscle intermuscular nerve block on magnetic resonance imaging(MRI)imaging features,serum substance P andβ-endorphin levels in patients with lumbar disc herniation.Methods A total of 64 LDH patients were randomly divided into experimental group and control group with 32 cases each.The control group was treated with psoas muscle intermuscular nerve block,and the experimental group was treated with heat-sensitive moxibustion on the basis of the control group for 4 consecutive weeks.We compared the clinical efficacy of the two groups,visual analogue scale(VAS)before and after treatment,Japanese Orthopaedic Association scores(JOA)and health status survey(the MOS item short from health survey,SF-36)score,changes in MRI imaging characteristics and changes in serum substance P andβ-endorphin levels,and also compared the total incidence of adverse reactions in the two groups during treatment.Results The total effective rate of the experimental group(96.87%)was significantly higher than that of the control group(75.00%)(P<0.05);after treatment,the VAS score,bulging degree,intervertebral space height,epidural indentation vector diameter,the longitudinal axis of external indentation and serum substance P levels decreased,and the data of experimental group were significantly lower than those of control group(P<0.05).JOA,SF-36 scores and serumβ-endorphin levels increased,and the data of experimental group were significantly higher than those of control group(P<0.05).During the treatment,the total incidence of adverse reactions in the experimental group was 4.92%,and that in the control group 6.56%.There was no significant difference between the groups(P>0.05).Conclusion The combination of heat-sensitive moxibustion and intermuscular nerve block of the psoas major can significantly improve the clinical symptoms of patients with LDH with a definite effect.The mechanism may be related to the regulation of serum substance P and serumβ-endor

关 键 词：腰椎间盘突出症 腰大肌肌间沟神经阻滞 热敏灸 MRI P物质 Β-内啡肽 

分 类 号：R681.5[医药卫生—骨科学]