皮肤针与体针对腰肌劳损和增生性脊柱炎患者疼痛症状的改善作用

背景：疼痛症在临床上极为常见,目前应用针灸治疗具有较好的效果.然而针灸疗法方法甚多,各有所长,认识不同针法对疼痛症治疗的疗效差异,在临床上具有重要意义.1999年,应厄瓜多尔医学疼痛学会的要求,开展此项观察.目的：观察不同针法对不同疾病疼痛症的疗效差异.设计：随机对照观察.单位：厄瓜多尔三军总医院疼痛科,成都军区总医院中医科、外一科.对象：选择1999-05/2000-11厄瓜多尔三军总医院疼痛科门诊腰肌劳损、增生性脊柱炎患者360例,其中腰肌劳损179例,增生性脊柱炎181例.随机对两类疾病患者进行分组,即腰肌劳损皮肤针组88例,体针组91例;增生性脊柱炎皮肤针组92例,体针组89例.方法：分别运用皮肤针、体针对上述疾病患者进行治疗,并同时对治疗前后患者症状加以观察.隔日治疗1次,腰肌劳损5次为基本疗程,增生性脊柱炎则为7次.治疗结果按Budzynski疼痛分级标准进行评定,统计方法采用MEPS统计软件处理数据.主要观察指标：皮肤针、体针组对腰肌劳损、增生性脊柱炎治疗前后患者疼痛症状缓解情况,并对同种疗法治疗异病、不同疗法治疗同病的疗效、疗程进行相关分析.结果：观察病例366例,剔除病例6例,实际完成完整病例360例.①皮肤针、体针疗法治疗后患者的疼痛分级均较治疗前减轻（P＜0.01）.②皮肤针对腰肌劳损、增生性脊柱炎治疗,以腰肌劳损疗效明显（P＜0.01）;皮肤针对腰肌劳损治疗疗效优于体针组（P＜0.05）.③体针组增生性脊柱炎疼痛分级Ⅰ级者明显高于皮肤针组,但总疗效差异不显著（P＞0.05）.④两组患者疼痛分级减少1个等级时,平均治疗次数皮肤针组少于体针组（P＜0.05）.结论：皮肤针与体针对增生性脊柱炎、腰肌劳损两类疾病疼痛症的治疗上,均有较好疗效,其中,以皮肤针对软组织损伤疗效明显,且起效迅速;体针对增生性脊柱炎患者疼痛改善上较皮肤针更为彻底.     

中药熏蒸疗法配合康复训练对强直性脊柱炎患者疼痛及关节状态影响

目的探讨中药熏蒸疗法配合康复训练对强直性脊柱炎患者疼痛及关节的作用.方法强直性脊柱炎患者102例,分为观察组68例和对照组34例,均口服柳氮磺砒啶,观察组同时外用中药熏蒸疗法配合康复训练.结果治疗20 d后,观察组关节功能Keitel积分明显低于治疗前及对照组(P＜0.01);观察组显效率及总有效率均优于对照组(P＜0.01).结论中药熏蒸疗法及康复训练能明显改善强直性脊柱炎患者的疼痛程度及关节活动度,提高临床疗效.     

“复康牌”药磁腰托疗法治疗腰椎间盘突出症的临床研究

目的观察"复康牌"药磁腰托疗法对腰椎间盘突出症的临床疗效并探讨其作用机理.方法按纳入标准将60例腰椎间盘突出症患者随机分为试验组和对照组各30例.对照组采用①腰椎牵引;②中频电疗法;③推拿按摩.试验组在此基础上增加"复康牌"药磁腰托疗法(腰托内含磁片和中药).治疗前及治疗后一周、两周、四周分别进行疼痛及腰椎功能评估.所有结果均进行统计学分析(t检验).结果治疗后两组患者疼痛及腰椎功能较治疗前都有改善(P＜0.05或P＜0.001);但随时间推移试验组的疗效逐渐优于对照组(组间比较P＜0.05或P＜0.001).结论"复康牌"药磁腰托疗法能有效缓解腰椎间盘突出症患者的疼痛,改善腰椎功能,因而是一种治疗腰椎间盘突出症的安全有效的方法,值得进一步研制和推广.     

益气健脾中药对强直性脊柱炎的疗效及焦虑抑郁的影响

目的:观察新风胶囊(XFC)治疗强直性脊柱炎(ankylosing spondylitis,AS)患者临床疗效及对焦虑、抑郁情绪的影响,探讨其治疗AS的相关机制.方法:①采用焦虑自评量表(SAS)、抑郁自评量表(SDS)、疼痛目测类比法(VAS法)、Bath强直脊柱炎功能指数(BASFI)、Bath强直脊柱炎疾病活动指数(BASDAI)、Bath强直脊柱炎整体指数(BAS-G)、症状分级评分等评分.②将60例AS患者按随机数字表分成2组,治疗组40例采用XFC,对照组20例采用柳氮磺吡啶(SASP),观察2组的主要症状体征、焦虑、抑郁情绪、急性时相反应物(血沉,ESR,C-反应蛋白,CRP)等的变化及疗效评价.结果:临床疗效采用ASAS20、BASFI50比较,XFC组分别为75%、70%,SASP组分别为20%、10%,XFC临床疗效明显优于SASP(P＜0.01或P＜0.05);2组治疗后SAS、SDS积分分别为42.03±8.40、53.80±9.64和41.38±9.16、52.70±6.88,XFC明显优于SASP(P＜0.01或P＜0.05);XFC组在疼痛评估VAS、症状体征、急性时相反应物、BASDAI、BASFI、BAS-G和BASMI在治疗前后及与SASP组相比,改善明显(P＜0.01或P＜0.05).结论:XFC临床疗效优于SASP,其显著降低SAS、SDS积分;可改善AS患者临床症状及相关指标.     

动静脉内瘘拔针及止血方法的探讨

目的 探讨动静脉内瘘拔针及止血方法.方法 选取在厦门市某三甲医院血透室行血液透析患者60例,共行拔针3 600次,随机分为观察组和对照组各30例,每组各行拔针1 800次.对照组给予快出拔针及常规压迫止血,观察组给予缓出拔针及内瘘动脉端加压止血.治疗达标后使用数字疼痛分级法及Wong-Banker面部表情量表法[1]对两组患者的疼痛针次数、疼痛程度及内瘘动脉端渗血针次数进行调查比较.结果 观察组患者拔针疼痛发生率为19.06％,对照组疼痛发生率为40.28％,两组比较差异有统计学意义(P＜0.05),观察组疼痛程度明显轻于对照组(P＜0.05),观察组内瘘动脉端渗血针次数显著少于对照组(P＜0.05).结论 缓出拔针及内瘘动静脉端加压止血法可减轻患者疼痛程度,减少动脉端渗血,有利于动脉内瘘的保护,提高患者血液透析舒适度.     

温针在基孔肯雅热患者疼痛中的应用及护理

目的:温针在基孔肯雅热患者疼痛中的应用效果及护理方法.方法:将46例基孔肯雅热患者随机分为观察组和对照组各23例,对照组采用常规方法护理关节(保暖加按摩),观察组在此基础上采用物理疗法(温针).观察两组的治疗效果和时间.结果:两组患者疼痛缩短时间和治愈率比较差异有统计学意义(P＜0.01,P＜0.05).结论:对基孔肯雅热患者采用温针治疗可减轻关节疼痛、缩短治疗时间.     

刃针疗法配合推拿治疗颈源性头痛的临床疗效

目的:分析颈源性头痛采用刃针疗法配合推拿治疗的临床疗效。方法:选取2014年8月～2017年12月我社区收治的颈源性头痛患者110例,随机分为观察组与对照组各55例。对照组予以推拿治疗,观察组采用刃针疗法配合推拿治疗。比较两组治疗效果。结果:观察组治疗后头痛发作次数、VAS与ROM评分均低于对照组(P0.05);观察组治疗总有效率高于对照组(P0.05)。结论:颈源性头痛采用刃针疗法配合推拿治疗的效果显著,能有效缓解患者疼痛症状,值得临床推广。     

腺苷钴胺联合康复疗法治疗急性腰椎间盘突出症的临床观察

目的:观察腺苷钴胺联合康复疗法治疗急性腰椎间盘突出症引起的肢体麻木和疼痛的疗效.方法:将130例腰椎间盘突出症患者随机分为联合康复组和单纯康复组,各65例.单纯康复组采用腰椎牵引和中频电疗,联合康复组在前述治疗基础上给予腺苷钴胺肌肉注射治疗,治疗2个疗程后对两组患者肢体疼痛、麻木情况进行评定和疗效评价.结果:联合康复组VAS评分低于单纯康复组,差异具有显著性(P＜0.05).130例患者中86例有麻木症状,治疗后比较两组间麻木感改善总有效率(联合康复组和单纯康复组分别为88.64％、59.52％),差异具有显著性(P＜0.05).联合康复组有效率96.92％,单纯康复组有效率76.92％,差异具有显著性(P＜0.05).治疗过程中无1例患者出现腺苷钴胺药物不良反应.结论:腺苷钴胺配合康复疗法对于减轻急性腰椎间盘突出症麻痛症状效果确切.     

不同针刺方法治疗脑卒中偏瘫疼痛的效果分析

目的：观察针刺治疗脑卒中偏瘫疼痛的临床分析。方法：通过头针组64例,体针组58例,头针体针并用组72例,将疼痛分为Ⅰ,Ⅱ,Ⅲ级,分别进行疗效分析。结果：头针组总有效率87．5％,体针组总胶82\76%, 针体针并用组总有效率94．44％,头针体针并用组总有效率显优于头针组（P＜0．05）和体针组（P＜0．05）。结论：头针体针并用镇痛效果优于单纯头针或体针止痛。     

健康教育对急性腰椎间盘突出症患者疼痛改善的影响

目的 探讨健康教育对门诊治疗急性腰椎间盘突出症（LDH）患者疼痛改善的影响.方法 将80例急性腰椎间盘突出症患者随机分为2组,对照组（40例）采用常规康复治疗和常规教育,观察组（40例）在常规康复治疗基础上进行有计划的健康教育.采用简化McGILL疼痛评分进行疗效评定.结果 治疗7 d后,观察组在简化McGILL疼痛评分的疼痛分级指数（PRI）、目测类比定级法（VAS）、现有疼痛强度（PPI）上均优于对照组,差异有统计学意义（P＜0.05）.结论 有计划的健康教育有益于急性腰椎间盘突出症疼痛的改善.     

针刺、穴位注射对原发性帕金森病患者中枢神经肽和一氧化氮的影响

背景针灸治疗原发性帕金森病(Parkinson disease,PD)已经取得了一定的疗效,但其作用机制尚不清楚.目的研究针刺、穴注治疗原发性帕金森病的疗效及可能途径.设计随机对照单盲研究.地点和对象1998-06/2000-10在南京脑科医院神经外科住院的PD患者,均符合1984-10全国锥体外系疾病讨论会确定的<帕金森病及帕金森综合征的诊断与鉴别诊断>,并己停止药物治疗3周以上.按就诊顺序221随机分为针刺组21例,穴位注射组23例,对照组10例.干预针刺组采用毫针针刺治疗,1次/d,治疗15 d;穴位治疗组进行穴位注射脉络宁注射液[南京金陵制药(集团)有限公司,苏卫药准字(1985)第177601号],2 mL/穴,2穴/次,1次/d,治疗15 d;对照组不作针刺和穴注治疗.以改良Webster症状评分表评定治疗效果.在治疗前后检测患者脑脊液β-内啡肽、LEK和一氧化氮的含量.主要观察指标各组PD患者疗效,脑脊液中β-内啡肽、亮氨酸脑啡肽(1eucine enkephalin,LEK)、一氧化氮含量.结果针刺组和穴注组的总有效率分别为71%和65%.穴注组LEK含量降低[(1.81 ±0.29)xg/],β-内啡肽含量升高[(184.13±9.94)μg/L],一氧化氮的含量的升高[(10.45±0.53)μmol/L];针刺组β-内啡肽含量上升[(144.73±12.72)μg/L],LEK含量降低[(4.18±0.56)μg/L],一氧化氮的含量的升高[(8.46±0.55)μmol/L],与治疗前比较,差异均有显著性意义(t=5.74～9.47,P均＜0.001).针刺组一氧化氮含量的升高与疗效的相关有显著性意义(t=3.019,P＜0.01).对照组在此期间3种物质含量的变化无显著性意义.结论针刺和穴位注射脉络宁对于原发性帕金森病具有一定的疗效,其作用可能与中枢LEK、β-内啡肽和一氧化氮的含量变化有关.     

Acupuncture and chronic pain mechanisms.

Forty patients with chronic pain below the waist level not amenable to conventional medical and/or surgical treatment were randomly assigned to one or two different methods of acupuncture, after studying the underlying pain mechanisms using a Multidisciplinary Pain Clinic approach and the differential spinal block (DSB). One group received acupuncture needling in the classical acupuncture points referred to as meridian loci needling (MLN) and the other group received tender area needling (TAN) with needles inserted in the dermatomal distribution of the painful areas. The responses between the two groups showed no significant difference. Results were then related to the predetermined somatopsychological basis of the individual's pain problems as classified by the DSB. A group of patinets in whom pain relief occurred upon subarachnoid injection of 0.25% procaine followed by sympathetic blockade or 0.5% procaine injection followed by hypalgesia without motor loss, also reported maximum subjective improvement in their pain level following acupuncture therapy performed at a later time. The other group of patients in whom pain persisted despite sensory and motor blockade (1% procaine) responded very poorly to acupuncture therapy. DSB was found to be complimentary to acupuncture therapy in that it facilitated patient selection for the therapy.     

经皮神经电刺激与电针刺激穴位治疗纤维肌痛综合征的疗效对比

背景纤维肌痛是一种非关节性风湿病,表现为身体多处疼痛与发僵,伴有睡眠障碍,疲乏无力等,常规治疗疗效不佳.目的通过经皮神经电刺激和电针刺激穴位治疗,并与常规用药治疗进行对比.探讨其对纤维肌痛综合征的疗效.设计以患者为观察对象的随机对照实验.单位新乡医学院第一附属医院,新乡医学院第三附属医院.对象选择1994-06/2001-05在新乡医学院第一附属医院康复中心门诊就诊的纤维肌痛综合症患者66例,均为随访病例.随机分为经皮神经电刺激组、电针组、药物组,每组22例.年龄42～55岁,病程7～13个月.方法①电刺激组采用FZ-1型程控低频脉冲治疗仪,将2对电极分别贴敷于压痛点最明显的邻近2对主穴上,另1对电极贴敷于1对配穴.通连续波,输出脉冲宽度为6～150 ms,高频100 Hz,刺激15 min,再转为低频2 Hz,刺激15 min,强度约(14±3)mA,1次/d,连续治疗20 d,为1个疗程,共治疗2个疗程,疗程间休息4 d.②电针组用28号毫针刺入应刺深度得气后,接G-6805电疗仪.取穴、操作、治疗时间均同电刺激组.③药物组口服谷维素和维生素B130 mg/片,3次/d;阿米替林片从每日10 mg开始,每10天增加10 mg至20～30 mg时止,睡前1次口服.共服药45 d.主要观察指标①各组患者镇痛疗效比较.②治疗后6,12,24个月痊愈显效者的随访结果比较.结果66例患者均进入结果分析.①镇痛的总有效率比较电刺激组和电针组明显高于药物组(100%,95.5%,68.2%;X2=18.03,17.27,P＜0.01).②复发率比较治疗后24个月电刺激组、电针组明显低于药物组(7.1%,6.1%,50.0%;X2=7.01,6.91;P＜0.05).结论经皮电刺激或电针刺激穴位治疗均有较强的镇痛作用,且复发率低.经皮神经电刺激穴位治疗纤维肌痛综合征是一种无创痛的方法.     

经筋刺法治疗脑卒中后痉挛状态的疗效评估:随机分组的对照

背景脑卒中后痉挛状态与弛缓状态有质的区别,其针灸治疗方法亦应不同.目的探讨脑卒中后肢体痉挛状态的有效治疗方法.设计以患者为研究对象的随机对照观察.单位一所中医学院的针灸推拿系.对象全部病例均来源于2002-01/2003-12湖南中医学院第一附属医院针灸科病房收治的57例住院患者.方法按照患者住院的先后顺序编号,再查随机数字表分为两组.在关刺、恢刺、燔针劫刺的基础上形成经筋刺法,治疗脑卒中痉挛状态患者24例,设立独取阳明为对照组24例,并运用现代康复医学有关痉挛状态的评定方法SIASA、Ashworth和等力测时法等进行了疗效对比观察.主要观察指标①SIAS积分.②痉挛状态Ashworth分级.③等力测时法量化评定痉挛状态比较.结果根据康复评定的结果,其中经筋组SIAS积分治疗前后分别为(6.98±3.52),12.59±3.36)分,阳明组分别为(7.12±3.38),(8.75±3.42)分,差异有显著性意义(P＜0.01).两组痉挛状态Ashworth分析及等力测时法量化评定痉挛状态比较差异也有显著性意义(P＜0.05或P＜0.01).结论痉挛状态应归属于"十二经筋"病候,而不属于"十二正经"病候,宜从经筋论治.经筋刺法是针灸治疗脑卒中后痉挛状态一种疗效确切的针刺方法.     

电针配合温针治疗梨状肌综合征临床研究

目的:探讨电针配合温针治疗梨状肌综合征疗效肯定性和及时止痛确切性。方法:将60例梨状肌综合征病例随机分成治疗组和对照组,分别予电针配合温针和单纯电针治疗,观察两组患者治疗前后疼痛VAS评分、即时止痛效果和临床疗效。结果:两组治疗前后自身疼痛VAS评分比较,差异有统计学意义(均P<0.01);两组治疗后VAS评分比较,差异无统计学意义(P>0.05);治疗组即时显效率83.33%,对照组为46.67%,治疗组的即时显效率明显高于对照组;治疗组治愈率为66.67%,对照组为43.33%,治疗组的治愈率明显高于对照组。结论:电针配合温针治疗梨状肌综合征有较好疗效,即时显效率和治愈率均高于对照组,有临床使用价值。     

Relief of chronic neck and shoulder pain by manual acupuncture to tender points--a sham-controlled randomized trial

OBJECTIVES: To compare the effects of real acupuncture to tender points for neck and shoulder pain and stiffness (Japanese: katakori) with those of sham acupuncture. DESIGN: Randomized-controlled trial. METHODS: Thirty-four volunteers from an acupuncture school with complaints of chronic pain and stiffness, who had no arm symptoms and gave informed consent, were randomly allocated to acupuncture or sham groups. Acupuncture or sham acupuncture was applied to the tender points once a week for 3 weeks. In the acupuncture group the acupuncture needle was inserted to the muscle, then the sparrow pecking technique was applied five times. Sham acupuncture was done without insertion of the needle. Dull pain and stiffness were evaluated by visual analog scale (VAS) before, and every 2 days after the first needling for 1 month. Pressure pain threshold on the tender points was measured before and after each treatment. RESULTS: There was no statistical difference of VAS scores between acupuncture and sham groups 9 days after the last treatment. However, the acupuncture group showed significant reduction of VAS scores immediately after and/or 1 day after the real acupuncture treatments (P<0.01). The effect tended to be prolonged after repeated treatment. Pressure pain thresholds tended to increase after real acupuncture treatment but not after sham acupuncture. CONCLUSIONS: Acupuncture applied to tender points appears to have short-term effects on neck and shoulder pain and stiffness, but this study was unable to demonstrate any long-term superiority over sham acupuncture.     

耳针、体针、耳体针结合治疗单纯性肥胖

目的探讨针灸减肥的机制和疗效.方法将1996-08/1999-07月间就诊的195例患者随机分为体针组(64例)、耳针组(55例)、耳体针结合组(76例).140例须体针治疗者分胃肠实热(88例)、脾虚湿阻(34例)、肾气不足(11例)、肝郁气滞(7例)4型治疗,视不同证型施与相应补泻手法.131例须耳针治疗者分胃肠实热(85例)、脾虚湿阻(31例)、肾气不足(9例)、肝郁气滞(6例)4型治疗.结果体针组总有效率81.3%、耳体针结合组总有效率93.4%、耳针组总有效率49.9%;体针组、耳体针结合组临床疗效明显优于耳针组(P＜0.05),体针组与耳体针结合组比较,差异无显著性意义(P＞0.05),但耳体针结合组总有效率明显高于体针组;体针组四型间总有效率差异无显著性意义(P＞0.05);耳针组胃肠实热型与脾虚湿阻、肾气不足、肝郁气滞三型比较P均＜0.05,疗效较好.结论针灸治疗肥胖病取效的关键是辨证取穴,应该多经脉多穴位结合起来考虑问题.有些穴位在不同证型看来似有重复,但由于配穴不同,手法有异,针刺治疗作用也就不同.耳针治疗肥胖对某些证型疗效较好,但若配合体针治疗则相得益彰.     

Randomised clinical trial comparing the effects of acupuncture and a newly designed placebo needle in rotator cuff tendinitis.

Acupuncture has gained increasing attention in the treatment of chronic pain. The lack of a satisfying placebo method has made it impossible to show whether needling is an important part of the method or whether the improvement felt by the patient is due to the therapeutic setting and psychological phenomena. Also, the effectiveness of acupuncture has not been demonstrated sufficiently. We treated 52 sportsmen with rotator cuff tendinitis in a randomised single-blind clinical trial using a new placebo-needle as control. Patients were treated for 4 weeks. The primary endpoint of the trial was the change in the modified Constant-Murley-score from the baseline. Assessment of the treatment outcome was made by experienced orthopaedists not informed of the treatment allocation. Acupuncture with penetration of the skin was shown to be more effective than a similar therapeutic setting with placebo needling in the treatment of pain. The acupuncture-group improved 19.2 Constant-Murley-score points (SD 16.1, range from -13 to 50), the control-group improved 8.37 points (SD 14.56, range from -20 to 41), (P=0.014; C.I. 2.3;19.4). This study showed that needling is an important part of the acupuncture effect in the treatment of chronic shoulder pain in athletes. No conclusions can be derived from this study concerning the importance of choosing points and the rules of Traditional Chinese Medicine. Using the new placebo method as control for other ailments could improve the evidence of specific acupuncture effects beyond pain treatment.     

Acupuncture for chronic shoulder pain in persons with spinal cord injury: a small-scale clinical trial

OBJECTIVE: To determine the efficacy of acupuncture in the treatment of chronic musculoskeletal shoulder pain in subjects with spinal cord injury (SCI). DESIGN: Randomized, double blind (participants, evaluator), placebo (invasive sham) controlled trial. SETTING: Clinical research center. PARTICIPANTS: Seventeen manual wheelchair-using subjects with chronic SCI and chronic musculoskeletal shoulder pain. INTERVENTIONS: Participants were randomly assigned to receive 10 treatments of either acupuncture or invasive sham acupuncture (light needling of nonacupuncture points). MAIN OUTCOME MEASURE: Changes in shoulder pain intensity were measured using the Wheelchair User's Shoulder Pain Index. RESULTS: Shoulder pain decreased significantly over time in both the acupuncture and the sham acupuncture groups (P=.005), with decreases of 66% and 43%, respectively. There was no significant difference between the 2 groups (P=.364). There was, however, a medium effect size associated with the acupuncture treatment. CONCLUSIONS: There appears to be an analgesic effect or a powerful placebo effect associated with both acupuncture and sham acupuncture. There was a medium treatment effect associated with the acupuncture, which suggests that it may be superior to sham acupuncture. This observation, along with the limited power, indicates that a larger, more definitive randomized controlled trial using a similar design is warranted.