针刺联合常规疗法治疗脊髓损伤临床研究  

Clinical Study on Acupuncture Combined with Routine Therapy for Spinal Cord Injuries

作　　者：王玉辉 杨雪 马虎升 WANG Yuhui;YANG Xue;MA Husheng(Huoyang Orthopedic Traumatological Hospital of Henan Province(Henan Provincial Orthopedic Hospital),Zhengzhou Henan 450000,China)

机构地区：[1]河南省洛阳正骨医院(河南省骨科医院),河南南郑州450000

出　　处：《新中医》2024年第9期180-185,共6页New Chinese Medicine

基　　金：河南省中医药研究专项课题(2022ZY1114)。

摘　　要：目的:观察针刺联合常规疗法治疗脊髓损伤的疗效。方法:选取94例脊髓损伤患者,按随机数字表法分为常规组及针刺组各47例。常规组给予常规治疗,针刺组在常规组基础上给予针刺治疗。比较2组临床疗效,比较2组治疗前后24 h漏尿次数、每次排尿量、24 h排尿次数、残余尿量、尿失禁问卷简表(ICI-Q-SF)、疼痛视觉模拟评分法(VAS)评分、尿失禁生活质量问卷(I-QOL)评分、膀胱顺应性、最大尿道闭合压、腹部漏尿点压、最大膀胱容量、胫前肌的运动诱发电位(MEP)、静息运动阈值(RMT)、单核趋化蛋白-1(MCP-1)、核因子-κB(NF-κB)、热休克蛋白70(HSP70)水平的变化。结果:针刺组总有效率为97.87%,常规组为82.98%,2组比较,差异有统计学意义(P<0.05)。治疗后,2组每次排尿量均较治疗前增加(P<0.05),24 h漏尿次数、残余尿量、24 h排尿次数均较治疗前减少(P<0.05);针刺组每次排尿量大于常规组(P<0.05),24 h漏尿次数、残余尿量、24 h排尿次数少于常规组(P<0.05)。治疗后,2组ICI-Q-SF、VAS评分均较治疗前下降(P<0.05),I-QOL评分较治疗前升高(P<0.05);针刺组ICI-Q-SF、VAS评分均低于常规组(P<0.05),I-QOL评分高于常规组(P<0.05)。治疗后,2组膀胱顺应性、最大尿道闭合压、腹部漏尿点压、最大膀胱容量均较治疗前增加(P<0.05),针刺组上述4项指标值均高于常规组(P<0.05)。治疗后,2组MEP波幅均治疗前增加(P<0.05),RMT均较治疗前降低(P<0.05);针刺组MEP波幅高于常规组(P<0.05),RMT低于常规组(P<0.05)。治疗后,2组MCP-1、NF-κB水平均较治疗前下降(P<0.05),HSP70水平均较治疗前升高(P<0.05);针刺组MCP-1、NF-κB水平均低于常规组(P<0.05),HSP70水平高于常规组(P<0.05)。结论:针刺联合常规疗法治疗脊髓损伤疗效较好,可调节尿流动力学及神经电生理指标值,改善患者急迫性尿失禁、神经性疼痛状态,抑制机体微环境炎症反应。Objective:To observe the curative effect of the therapy of acupuncture combined with routine therapy on spinal cord injuries.Methods:A total of 94 patients with spinal cord injuries were selected and divided into the routine group and the acupuncture group according to the random number table method,with 47 cases in each group.The routine group was given'routine therapy,and the acupuncture group was additionally treated with acupuncture based on the treatment of the routine group.The clinical effects,and the changes in 24-hour leakage of urine frequency,voided volume each time,24-hour urination frequency,residual urine volume,the scores of Incontinence Questionnaire-Urinary Incontinence Short Form(ICl-Q-SF),Visual Analogue Scale(VAS)and Incontinence Quality of Life Scale(l-QOL),bladder compliance,maximum urethral closure pressure,abdominal leak point pressure,maximum cystometric capacity,motor evoked potentials(MEP)of tibialis anterior,resting motor threshold(RMT),monocyte chemotactic protein-1(MCP-1),nuclear factor-kB(NF-kB),and heat shock protein 70(HSP70)were compared before and after treatment between the two groups.Results:The total effective rate was 97.87%in the acupuncture group,and 82.98%in the routine group,the difference being significant(P<0.05).After treatment,the voided volume each time in the two groups was increased when compared with that before treatment(P<0.05),the 24-hour leakage of urine frequency,residual urine volume and 24-hour urination frequency were decreased when compared with those before treatment(P<0.05);the voided volume each time in the acupuncture group was higher than that in the routine group(P<0.05),and the 24-hour leakage of urine frequency,residual urine volume and 24-hour urination frequency were less than those in the routine group(P<0.05).After treatment,the scores of ICl-Q-SF and VAS in the two groups were decreased when compared with those before treatment(P<0.05),and the I-QOL scores were increased when compared with those before treatment(P<0.05);the scores of ICl-Q-S

关 键 词：脊髓损伤 针刺 急迫性尿失禁 神经性疼痛状态 调节神经电生理 微环境炎症反应 

分 类 号：R246.2[医药卫生—针灸推拿学]