中药热奄包热敷足三里联合甲钴胺治疗老年糖尿病周围神经病变临床研究  

Clinical Study on Hot Compressing at Zusanli with Chinese Medicine Hot Packages Combined with Mecobalamine for Senile Diabetic Perineuropathy

作　　者：倪燕华 王舜 NI Yanhua;WANG Shun(Hangzhou Integrative Medicine Hospital,Hangzhou Zhejiang 310003,China)

机构地区：[1]杭州市红十字会医院,浙江杭州310003

出　　处：《新中医》2024年第20期200-206,共7页New Chinese Medicine

基　　金：浙江省中医药科技计划项目(2023ZL550)。

摘　　要：目的:观察中药热奄包热敷足三里联合甲钴胺治疗老年糖尿病周围神经病变(DPN)气虚血瘀证的临床疗效。方法:选取72例老年DPN气虚血瘀证患者,采用随机数字表法分为A组、B组、C组各24例。A组采用中药热奄包热敷足三里联合甲钴胺治疗,B组单独采用甲钴胺治疗,C组单独采用中药热奄包热敷足三里治疗,3组均连续治疗14 d。比较3组临床疗效、肱踝指数(ABI)值、疼痛数字评分法(NRS)评分、多伦多临床神经病变评分量表(TCSS)评分、健康调查简表(SF-36)评分、中医证候积分、运动神经传导速度(MCV)、感觉神经传导速度(SCV)、氧化应激指标和血液流变学指标。结果:治疗14 d (T3)时,A组总有效率91.67%,均高于B组66.67%、C组62.50%(P<0.05)。治疗3 d (T1)时,A组ABI值及SF-36评分均较治疗前(T0)时升高(P<0.05),NRS、TCSS评分均较T0时降低(P<0.05);B组、C组ABI值及NRS、TCSS、SF-36评分与同组T0时比较,差异均无统计学意义(P>0.05)。治疗7 d (T2)时,3组ABI值及SF-36评分均较T1时升高(P<0.05),NRS、TCSS评分均较T1时降低(P<0.05)。T3时,3组ABI值及SF-36评分均较T2时升高(P<0.05),NRS、TCSS评分均较T2时降低(P<0.05)。A组治疗后各时间点ABI值及SF-36评分均高于同期B组、C组(P<0.05),NRS、TCSS评分均低于同期B期、C期(P<0.05)。T3时,3组中医证候积分、血清纤溶酶原激活物抑制物-1 (PAI-1)水平及血细胞比容、血浆黏度、全血低切黏度、全血高切黏度水平均较T0时降低(P<0.05),MCV、SCV均较T0时提升(P<0.05),血清超氧化物歧化酶(SOD)、脑源性神经营养因子(BDNF)水平均较T0时升高(P<0.05);A组中医证候积分、血清PAI-1水平及上述4项血液流变学指标水平均低于B组、C组(P<0.05),血清SOD、BDNF水平均高于B组、C组(P<0.05)。结论:中药热奄包热敷足三里联合甲钴胺治疗老年DPN气虚血瘀证疗效较好,可改善氧化应激和血液流变学指标水平,有效缓解患者的疼痛感和�Objective:To observe the clinical effect of hot compressing at Zusanli(ST36)with Chinese medicine hot packages combined with Mecobalamine on senile diabetic perineuropathy(DPN)with qi deficiency and blood stasis syndrome.Methods:A total of 72 cases of senile DPN patients with qi deficiency and blood stasis syndrome were selected and divided into Group A,Group B,and Group C according to the random number table method,with 24 cases in each group.Group A was treated with hot compressing at Zusanliwith Chinese medicine hot packages combined with Mecobalamine,Group B was treated with Mecobalamin alone,and Group C was treated with hot compressing at Zusanli with Chinese medicine hot packages alone.All the three groups were treated for 14 days continuously.Compared the clinical efficacy,Ankle Brachial Index(ABI)values,Numerical Rating Scale(NRS)scores,Toronto Clinical Scoring System(TCSS)scores,36-item Short-Form healthy survey(SF-36)scores,traditional Chinese medicine(TCM)syndrome scores,motor nerve conduction velocity(MCV),sensory nerve conduction velocity(SCV),oxidative stress indexes,and hemorheological indexes in the three groups.Results:At 14 days of treatment(T3),the total effective rate was 91.67%in Group A,higher than that of 66.67%in Group B and 62.50%in Group C(P<0.05).At three days of treatment(T1),the ABI values and SF-36 score in Group A were increased when compared with those before treatment(T0)(P<0.05),and the NRS and TCSS scores were decreased when compared with those at T0(P<0.05);there was no significant difference in ABI values and scores of NRS,TCSS and SF-36 between Group B and Group C when compared with those in the same group at T0(P>0.05).At seven days of treatment(T2),all the three groups showed an increase in ABI values and SF-36 scores when compared with those at T1(P<0.05),a decrease in NRS and TCSS scores when compared with those at T1(P<0.05).At T3,all the three groups showed an increase in ABI values and SF-36 scores when compared with those at T2(P<0.05),a decrease in NRS and TCSS score

关 键 词：糖尿病周围神经病变 老年人 气虚血瘀证 中药热奄包 足三里 甲钴胺 氧化应激 血液流变学 

分 类 号：R587.2[医药卫生—内分泌] R248.1[医药卫生—内科学]