通督活血汤结合刺络放血治疗退行性腰椎管狭窄症疗效观察  

Clinical Effect of Tongdu Huoxue Decoction(通督活血汤)Combined with Collateral-Pricking and Bloodletting Method in Treatment of Degenerative Lumbar Spinal Stenosis

作　　者：熊雨墨 李梓宸 李瑛 肖强兵 王丽华 胡昊 丰瑞兵 乔杰 胡彦 XIONG Yumo;LI Zichen;LI Ying;XIAO Qiangbing;WANG Lihua;HU Hao;FENG Ruibing;QIAO Jie;HU Yan(Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430074,Hubei,China;Affiliated Hospital of Hubei University of Chinese Medicine,Wuhan 430074,Hubei,China;Hubei Research Institute of Traditional Chinese Medicine,Wuhan 430074,Hubei,China;School of Acupuncture and Moxibustion and Orthopaedics,Hubei University of Chinese Medicine,Wuhan 430074,Hubei,China;Honghu Hospital of Traditional Chinese Medicine,Honghu Hospital of Traditional Chinese Medicine Affiliated to Hubei University of Chinese Medicine,Jingzhou 433200,Hubei,China)

机构地区：[1]湖北省中医院,湖北武汉430074 [2]湖北中医药大学附属医院,湖北武汉430074 [3]湖北省中医药研究院,湖北武汉430074 [4]湖北中医药大学针灸骨伤学院,湖北武汉430074 [5]洪湖市中医医院,湖北中医药大学附属洪湖中医医院,湖北荆州433200

出　　处：《中华中医药学刊》2024年第11期218-221,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：湖北省中医药管理局中医药面上项目(ZY2023 M005);湖北省中医药管理局中医药青年人才项目(ZY2023 Q004,ZY2023 Q006)。

摘　　要：目的观察通督活血汤结合刺络放血治疗退行性腰椎管狭窄症临床效果及对患者腰椎功能影响。方法将医院收治的90例退行性腰椎管狭窄症患者(2020年1月—2023年2月收治)纳入实验研究,将患者以随机数字表法分为中医组与对照组,每组45例。对照组患者西医治疗,中医组患者在对照组治疗基础上结合中医方案(通督活血汤结合刺络放血)治疗,治疗过程中对照组患者脱落1例,中医组患者脱落2例,观察各组数据:临床治疗效果、治疗前后患者中医证候总积分以及步行距离变化、日本骨科学会腰椎功能评分(Japanese Orthopaedic Association Scores,JOA)及腰痛奥斯威斯指数量表(Oswestry Disability Index,ODI)评分变化、血清肿瘤坏死因子α(Tumour necrosis factor-α,TNF-α)及白细胞介素-1α(Interleukin-1α,IL-1α)水平变化、血液流变学指标(血细胞比容、纤维蛋白原、血浆黏度、全血低切黏度以及全血高切黏度)变化、治疗不良反应。结果中医组患者治疗总有效率为95.35%(41/43),对照组患者治疗总有效率为81.82%(36/44),前者更高,P<0.05;治疗前,各组患者中医证候总积分、步行距离、JOA评分、ODI评分、TNF-α水平、IL-1α水平、血液流变学指标(血细胞比容、纤维蛋白原、血浆黏度、全血低切黏度以及全血高切黏度)比较,差异无统计学意义(P>0.05),各组患者经治疗后中医证候总积分、步行距离、JOA评分、ODI评分、TNF-α水平、IL-1α水平、血液流变学指标(血细胞比容、纤维蛋白原、血浆黏度、全血低切黏度以及全血高切黏度)均明显改善,而中医组患者治疗后中医证候总积分以及步行距离、JOA评分以及ODI评分、TNF-α水平及IL-1α水平、血液流变学指标(血细胞比容、纤维蛋白原、血浆黏度、全血低切黏度以及全血高切黏度)均优于对照组(P<0.05);中医组与对照组患者不良反应率分别为4.66%(2/43)、2.27%(1/44),且症状轻微(PObjective To observe the clinical effect of Tongdu Huoxue Decoction(通督活血汤)combined with collateral-pricking and bloodletting method in the treatment of degenerative lumbar spinal stenosis and its influence on the function of lumbar spine.Methods Ninety patients with degenerative lumbar spinal stenosis treated in the hospital(from January 2020 to February 2023)were included in this experimental study,and the patients were divided into the traditional Chinese medicine group and the control group by random number table method,with 45 cases in each group.The patients in the control group were treated with Western medicine,and those in the traditional Chinese medicine group were treated with traditional Chinese medicine(Tongdu Huoxue Decoction combined with collateral-pricking and bloodletting method)on the basis of the treatment in the control group.In the course of treatment,1 case of patients in the control group and 2 cases in the traditional Chinese medicine group fell off.Clinical treatment results,changes in the total scores of TCM symptoms and walking distance of patients before and after treatment,the changes in the Japanese orthopaedic society lumbar function score(JOA)and low back pain Osweis Index scale(ODI)scores,the levels in serum tumor necrosis factorα(TNF-α)and interleukin-1α(IL-1α),hemorheological indicators(hematocrit,fibrinogen,plasma viscosity,whole blood low shear viscosity,and whole blood high shear viscosity)and treatment adverse reactions were compared.Results The total effective rate was 95.35%(41/43)in the traditional Chinese medicine group and 81.82%(36/44)in the control group,and the former was higher(P<0.05).Before treatment,the total scores of TCM symptoms,walking distance,JOA score and ODI score,levels of TNF-αand IL-1αand hemorheology indexes(hematocrit,fibrinogen,plasma viscosity,whole blood low shear viscosity,and whole blood high shear viscosity)were not significant(P>0.05).After treatment,the total TCM syndrome scores,walking distance,JOA score,ODI score,the levels

关 键 词：退行性腰椎管狭窄症 刺络放血 通督活血汤 治疗效果 腰椎功能 血液流变学 

分 类 号：R274.981.5[医药卫生—中西医结合] R245-0[医药卫生—中医骨伤科学]