基于“治未病”思想探析井荥合灸防治奥沙利铂周围神经毒性的临床研究  

A clinical study on the prevention and treatment of oxaliplatin peripheral neurotoxicity by moxibustion at Jing points and Ying points based on the thought of preventive treatment of isease

作　　者：刘玲玲 孙玺媛[1] 韩东 姜梅[1] 张杰 LIU Lingling

机构地区：[1]齐齐哈尔市第一医院,黑龙江齐齐哈尔161001

出　　处：《中医临床研究》2024年第16期50-54,共5页Clinical Journal Of Chinese Medicine

基　　金：齐齐哈尔市科技计划创新激励项目(CSFGG-2022023)。

摘　　要：目的:探究中医外治法防治奥沙利铂周围神经毒性发生的重要手段,为中医适宜技术的临床转化提供理论依据,为中医治未病思想提供证据支持。方法:选取2022年1月-10月收治于齐齐哈尔市第一医院南院中西医结合肿瘤科且符合纳入标准的胃肠道恶性肿瘤患者40例,根据随机数字表法分为试验组和对照组,每组209例对照组常规予含铂双药联合方案化疗,试验组于化疗基础上加用中医适宜技术隔丹参粉艾灸双侧涌泉穴、劳宫穴。观察治疗前后两组患者周围神经毒性发生情况、血清神经生长因子、运动及感觉神经传导速度的变化。结果:试验组治疗后周围神经毒性发生率明显低于对照组(P<0.05),以0级、1级不良反应为主,且无3级及以上周围神经毒性发生;试验组治疗后血清神经生长因子水平下降浮度较对照组小(P<0.01);试验组治疗后尺神经、桡神经运动神经传导速度及感觉神经传导速度下降水平均较对照组低(P<0.05)。结论:艾灸涌泉穴、劳宫穴可以防治胃肠道恶性肿瘤患者奥沙利铂周围神经毒性的发生,其机制可能是通过调节运动神经传导速度、感觉神经传导速度改善血清神经生长因子水平下降,从而减轻外周神经损伤。Objective:The important means of TCM external treatment to prevent and treat oxaliplatin peripheral neurotoxicity was explored to provide a theoretical basis for the clinical transformation of TCM appropriate techniques and evidence support for the idea of preventive treatment of disease in TCM.Methods:Forty patients with gastrointestinal malignant tumor who were admitted to the First Hospital of Qiqihar from January to October 2022 and met the inclusion criteria were selected and were randomly divided into the experimental group and the control group.The control group was routinely given platinum-containing dual drugs plus chemotherapy,while the experimental group was additionally treated by TCM appropriate techniques,moxibustion insulated by Danshen(Salvia miltiorrhiza)powder on Yongquan points(KI1)and Laogong points(PC8).The occurrence of peripheral neurotoxicity,serum nerve growth factor(NGF),motor nerve conduction velocity and sensory nerve conduction velocity in the two groups were observed before and after treatment.Results:After treatment,the incidence of peripheral neurotoxicity in the experimental group was significantly lower than that in the control group(P<0.05),with goade 0 and goade 1 adverse reactions as the main ones,and no peripheral neurotoxicity of grade 3 or above occurred.After treatment,the decrease of serum NGF in the experimental group was not significant compared with that in the control group(P<0.01).After treatment,the decline level of ulnar nerve,radial nerve movement nerve conduction velocity and sensory nerve conduction velocity in the experimental group was not obvious compared with the control group(P<0.05).Conclusion:Moxibustion at Yongquan points and Laogong points can prevent the occurrence of oxaliplatin peripheral neurotoxicity in patients with gastrointestinal malignant tumor.The mechanism may be to increase serum NGF level by regulating the conduction velocities of motor and sensory nerves,thus alleviating peripheral nerve injury.

关 键 词：治未病 艾灸 周围神经毒性 血清神经生长因子 奥沙利铂 

分 类 号：R273[医药卫生—中西医结合]