本文關(guān)鍵詞：開(kāi)四關(guān)聯(lián)合腹針治療腰椎間盤(pán)突出癥的臨床觀察　出處：《廣州中醫(yī)藥大學(xué)》2017年碩士論文　論文類(lèi)型：學(xué)位論文

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【摘要】：目的:腰椎間盤(pán)突出癥(LDH)是一種常見(jiàn)疾病,在針灸科和骨科中就診率高,青壯年多發(fā),且逐漸呈現(xiàn)年輕化。除有明確手術(shù)指征的病人外,保守治療為本病的主要治療手段,但復(fù)發(fā)率高。腹針療法臨床應(yīng)用廣泛,已經(jīng)證實(shí)對(duì)多種疾病療效顯著,具有其他療法所無(wú)法替代的優(yōu)點(diǎn)。開(kāi)四關(guān)調(diào)和氣血陰陽(yáng),對(duì)多種疾病均有效。本文通過(guò)設(shè)計(jì)隨機(jī)對(duì)照試驗(yàn),探討開(kāi)四關(guān)聯(lián)合腹針治療LDH的臨床療效,為開(kāi)四關(guān)聯(lián)合腹針治療LDH提供臨床依據(jù),并進(jìn)一步明確開(kāi)四關(guān)的早期鎮(zhèn)痛效果。方法:嚴(yán)格根據(jù)納入條件,選取2016年5月至2017年2月在廣東省中醫(yī)院及廣州中醫(yī)藥大學(xué)第一附屬醫(yī)院針灸科或骨科門(mén)診就診的60例病人;將其隨機(jī)分為兩組,治療組、對(duì)照組各30例病人。治療組先在四關(guān)穴上行提插捻轉(zhuǎn)瀉法后留針,隨后開(kāi)始腹針治療,而對(duì)照組只給予腹針治療。兩組均要求病人臥硬板床休息2周,每次治療留針30分鐘,前3次每日1次,之后2日1次,6-10次為1療程。采用腰椎功能評(píng)分(下腰痛評(píng)分系統(tǒng))、直觀疼痛模擬量表(VAS評(píng)分)作為療效評(píng)價(jià)指標(biāo),分別于首次治療30分鐘后、前3次治療后、1個(gè)療程治療的前后各進(jìn)行一次VAS評(píng)分,于1個(gè)療程治療的前后進(jìn)行JOA評(píng)分,并根據(jù)治療前后JOA下腰痛評(píng)分的改善率來(lái)評(píng)定最后的臨床療效。將所得數(shù)據(jù)由專(zhuān)人在excel上建立數(shù)據(jù)庫(kù),使用SPSS22.0軟件對(duì)數(shù)據(jù)進(jìn)行比較分析。結(jié)果:1.首次治療后30min,兩組VAS評(píng)分與治療前比較均具有明顯差異(P0.01),而兩組間的VAS評(píng)分比較提示具有顯著性差異(P0.01),但治療組治療前后的差值明顯大于對(duì)照組。治療3次后,兩組VAS評(píng)分與治療前比較均具有顯著性差異(P0.01),兩組組間VAS評(píng)分比較具有顯著性差異(P0.01),但兩組治療前后差值經(jīng)統(tǒng)計(jì)學(xué)分析,無(wú)明顯差異性。2.1個(gè)療程后,兩組的JOA及VAS評(píng)分與治療前比較,差異具有統(tǒng)計(jì)學(xué)意義(P0.01)。3.1個(gè)療程后,兩組間JOA及VAS評(píng)分比較,VAS評(píng)分的差異不具有統(tǒng)計(jì)意義(P0.05),JOA評(píng)分的差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。4.療效評(píng)價(jià):治療組30例病例中,臨床治愈9例,顯效13例,有效6例,無(wú)效2例,臨床總有效率達(dá)93.33%。對(duì)照組30例病例中,臨床治愈5例,顯效8例,有效13例,無(wú)效4例,臨床總有效率達(dá)86.67%。經(jīng)秩和檢驗(yàn)z=-2.129,P0.05,兩組結(jié)果具有顯著性差異。結(jié)論:開(kāi)四關(guān)聯(lián)合腹針及單純腹針療法均可在一定程度上改善LDH患者的腰椎功能及減輕疼痛癥狀,結(jié)果提示治療組的臨床療效優(yōu)于對(duì)照組。同時(shí)通過(guò)分析兩組在不同治療次數(shù)后VAS評(píng)分的差異可得知,開(kāi)四關(guān)聯(lián)合腹針?lè)椒ㄔ诰徑馓弁捶矫鎯?yōu)于單純腹針?lè)椒?且即時(shí)止痛效果顯著。本次研究的治療方法表明開(kāi)四關(guān)鎮(zhèn)痛起效迅速,且具有患者痛苦少、操作簡(jiǎn)單易行等優(yōu)點(diǎn),也進(jìn)一步明確了腹針治療LDH的臨床療效,值得臨床進(jìn)一步推廣應(yīng)用。
[Abstract]:Objective: Lumbar disc herniation (LDH) is a common disease, in acupuncture and orthopedic departments, the rate of medical treatment is high, young adults more, and gradually showing younger, except for patients with clear indications of surgery. Conservative treatment is the main treatment of this disease, but the recurrence rate is high. Abdominal acupuncture therapy has been widely used in clinical practice, has been proved to be effective in many diseases. It has the advantage that other therapies can not be replaced. It is effective for many diseases by combining Qi-Xin-yang with Kaisiguan. This article discusses the clinical effect of Kaisiguan combined with abdominal acupuncture in the treatment of LDH by designing a randomized controlled trial. To provide the clinical basis for the treatment of LDH with the combination of open four customs and abdominal acupuncture, and to further clarify the early analgesic effect of opening four customs. Methods: strictly according to the condition of inclusion. From May 2016 to February 2017, 60 patients were selected from the Department of Acupuncture or Orthopaedics, Department of Acupuncture or Orthopedics, Guangzhou University of traditional Chinese Medicine and the first affiliated Hospital of Guangzhou University of Chinese Medicine. It was randomly divided into two groups, treatment group, control group of 30 patients. The patients in the control group were only treated with abdominal acupuncture. The patients in both groups were required to rest in a hard bed for 2 weeks for 30 minutes each time, once a day for the first three times, and once after 2nd. The lumbar function score (low back pain scoring system) and visual pain simulation scale (VAS) were used to evaluate the efficacy of the treatment for 30 minutes after the first treatment. After the first three treatments, one VAS score was performed before and after one course of treatment, and the JOA score was performed before and after one course of treatment. According to the improvement rate of low back pain score under JOA before and after treatment, the final clinical curative effect was evaluated. SPSS22.0 software was used to compare and analyze the data. Results: 1. 30 minutes after the first treatment, the VAS scores of the two groups were significantly different from those before treatment (P 0.01). The comparison of VAS scores between the two groups indicated that there was a significant difference between the two groups, but the difference before and after treatment in the treatment group was significantly higher than that in the control group. After 3 times of treatment, the difference was significantly higher in the treatment group than in the control group. The VAS scores of the two groups were significantly different from those before treatment (P 0.01), and the VAS scores between the two groups were significantly different (P 0.01). However, the difference between the two groups before and after treatment had no significant difference. 2.1 courses later, the JOA and VAS scores of the two groups were compared with those before treatment. The difference was statistically significant (P 0.01). After 3.1 courses of treatment, the difference of JOA and VAS scores between the two groups was not statistically significant (P 0.05). The difference of JOA score was statistically significant (P 0.05). Evaluation of curative effect: in the treatment group, 9 cases were clinically cured, 13 cases were markedly effective, 6 cases were effective and 2 cases were ineffective. The total clinical effective rate was 93.33. In the control group, 5 cases were cured, 8 cases were effective, 13 cases were effective, and 4 cases were ineffective. The total clinical effective rate was 86.67%. Conclusion: the combination of abdominal acupuncture and abdominal acupuncture can improve the lumbar spine function and relieve pain in LDH patients to some extent. The results suggest that the clinical efficacy of the treatment group is better than that of the control group. At the same time, by analyzing the difference of VAS score between the two groups after different treatment times, we can know. The treatment method of this study shows that the analgesic effect of open four customs combined with abdominal acupuncture is rapid and the pain is less in patients than in simple abdominal acupuncture. The advantages of simple operation and easy operation also confirmed the clinical effect of abdominal acupuncture on LDH, which is worthy of further clinical application.
【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類(lèi)號(hào)】：R246.9

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