丹参热蒸治疗对血瘀型腰椎间盘突出症患者疼痛症状评分和血液流变学指标的影响

Effect of hot-steaming therapy with danshen on symptomatic score and hemorheological indexes in patients with lumbar disc protrusion of blood-stasis type

目的:观察具有明确的镇痛、镇静、抗炎功效的丹参热蒸治疗对血瘀型腰椎间盘突出症患者症状、疼痛程度和血流变学指标的影响,并与非血瘀型患者作对照。方法:①选择2002-06/2005-06解放军总医院理疗科门诊就诊或住院治疗的腰椎间盘突出症患者91例,男47例,女44例。患者均对检测项目知情同意。②参照1993年卫生部《中药新药临床研究指导原则》关于“治疗腰椎间盘突出症的临床研究指导原则”所确定的辨证标准,并结合临床实际,初步拟设为4个证型:血瘀型(n=33)、寒湿型、湿热型、肝肾亏虚型;后3个证型统称为非血瘀型(n=58)。③全部患者接受丹参袋熏蒸治疗。用法为丹参(由有本院中药房提供)碾碎,装入布袋入入锅中蒸30min后取出,放于腰部和臀部热敷,温度以能耐受为度。药凉后取下,1次/d,每剂用20～30d,30d为1个疗程,同时接受包括腰椎牵引和中频电治疗的物理治疗。④临床症状评估采用日本骨科学会推荐的下腰痛评估量表,包括14项内容:下腰痛;腿酸或麻木;步行能力;直腿抬高试验;感觉障碍;运动障碍;日常生活能力测评;卧位转身;站立试验;洗漱;长久坐(1h);身体前倾试验;举物和持物;膀胱功能。每项内容按3级或4级计分法评估,得分越高代表损伤程度越重。⑤疼痛评估采用1980年世界卫生组织推荐的主诉分级法:0分为无痛;1分为轻度疼痛,但可耐受,不影响睡眠,并可正常生活;2分为中度疼痛,较为明显,睡眠受干扰,需要一般性止痛、镇静和安眠药物;3分为重度,疼痛剧烈,难以忍受,常伴有植物神经功能紊乱,睡眠受到严重干扰,需要麻醉性药物。⑥治疗前1周和疗程结束后1周内进行症状及疼痛评估并应用LBY-N6B型全自动模块式血流变仪(北京普利生科贸贪集团)测定血液流变学指标变化。⑦计量资料差异比较采用t检验。结果:腰椎间盘突出症患者91例均进入结果分析。①血瘀型和非血瘀型患者治疗前下腰痛评估量表评分接近(P>0.05);治疗后除下腰痛评估量表中的运动障碍和膀胱功能项外,其余项目评分均明显低于治疗前(P<0.05)。治疗后血瘀型腰椎间盘突出症患者下腰痛评估量表中下腰痛、腰酸和麻感、步行能力、直腿抬高试验、感觉障碍、站立试验、长久坐、总分明显低于非血瘀型患者(P<0.05)。②治疗前血瘀型和非血瘀型腰椎间盘突出症患者主诉分级法疼痛评分接近(1.93±0.38,1.96±0.41,P>0.05),治疗后血瘀型腰椎间盘突出症患者明显低于非血瘀型患者(1.55±0.40,1.60±0.36,t=1.966,P<0.05);血瘀型腰椎间盘突出症患者治疗后明显低于治疗前(t=2.352,2.407,P<0.05)。③治疗前血瘀型和非血瘀型患者各项血流变学指标接近(P>0.05)。治疗后血瘀型患者全血黏度、血浆黏度、红细胞压积、血沉、全血还原黏度、血沉方程K值、红细胞聚集指数明显低于治疗前(P<0.05);非血瘀型患者治疗后全血低切和中切黏度、红细胞压积、血沉、全血还原中切和高切黏度、血沉方程K值、红细胞聚集指数明显低于治疗前(P<0.05)。血瘀型患者治疗后全血黏度、血浆黏度、血沉、全血还原黏度、红细胞聚集指数明显低于非血瘀型患者(P<0.05)。结论:丹参热蒸可明显改善血瘀型腰椎间盘突出症患者症状、疼痛程度及血流变学指标,作用效果优于非血瘀型患者。

AIM： To observe the effect of the hot-steaming therapy with danshen characterized by analgesia, sedation and ant±inflammation on symptomatic score and hemorheological indexes in patients with lumbar disc protrusion （LDP） of blood-stasis type and compare with LDP patients of non-bloodstaais type. METHODS： ① Totally 91 LDP patients including 47 males and 44 females were selected from the Department of Physiotherapy of General Hospital of Chinese PLA between June 2002 and June 2005. All cases were known the fact. ② According to clinical criteria of LDP diagnosed by Traditional Chinese Medicine ＆ New Medicine Clinical Research in 1993, 4 types were determined firstly： blood stasis （n=33）, cold-damp, damp-heat and deficiency of liver-yin and kidney-yin, and the last three were named as non-blood-stasis types （n=58）.③ All patients received hot-steaming therapy with danshen. Medication： Danshen （provided by dispensary of the hospital） was crushed, put into jute bag, steamed for 30 minutes, and stayed at waist and buttock. The temperature of bag was suitable for tolerance. Patients were treated once a day for 30 days as a course. Each potion was used for 20-30 days. Meanwhile, traction at lumbar vertebrae and electric therapy with moderate frequency were also used. ④ Clinical symptom was evaluated with Evaluated criteria of low back pain recommended by Japanese Orthopaedics and Tranmstology Academy. The criteria included 14 items： low back pain, soreness or numbness of leg, walking ability, straight-leg raising test, sensory disturbance, motor disorder, measurement of daily living ability, turning around at decubitus, standing test, washing, prolonged sitting （1 hour）, body anteversion test, lifting and holding things, and bladder function. Each item was evaluated as grade Ⅲ and grade Ⅳ, and the scores were higher, the injury was severer. ⑤ Pain evaluation was performed with chief grading method recommended by WHO in 1980：0 point as painless; 1 as mild pain, being suffering, non-effect on sleeping, having normal living; 2 as moderate pain, obvious, effect on sleeping, needing general drugs of relieving pain, sedation and soporific; 3 as severe pain, intensive pain, not suffering, combining with vegetative nerve function disorder, severe effect on sleeping, needing anesthesia drugs. ⑥ Evaluations of symptom and pain were performed 1 week before treatment and 1 week after treatment, and hemorheological indexes were assayed with LBY-N6B automatic die-block hemorheological meter （provided by Beijing Pulisheng Kemaotan Group）. ⑦ Measurement data were compared with t test. RESULTS： Totally 91 LDP patients entered the final analysis. ① Scores of low back pain of LDP patients were similar between of blood-stasis type and of non-bloed-stasis type （P 〉 0.05）, scores of other items except motor disorder and bladder function were lower after treatment as compared with those before treatment （P 〈 0.05）. Total scores including low back pain, soreness or numbness of waist, walking ability, straight-leg raising test,sensory disturbance, standing test and prolonged sitting were lower in blood-stasis type than those in non-blood-stasis type after treatment （P 〈 0.05）. ② Scores of chief grading method were similar between of blood-stasis type and of non-blood-stasis type before treatment （1.93±0.38, 1.96±0.41, P 〉 0.05）, but scores of LDP patients of blood-stasis type were lower than those of non-blood-stasis type after treatment （1.55±0.40, 1.60±0.36, t=1.966, P 〈 0.05）, and scores of blood-stasis type were decreased after treatment as compared with those before treatment （t=2.352, 2.407, P 〈 0.05）. ③ hemorheological indexes were similar between of blood-stasis type and of non-blood-stasis type before treatment （P 〉 0.05）. After treatment, indexes of blood-stasis type including whole blood viscosity, plasma viscosity, hematocrit, erythrecyte sedimentation, whole blood recovery viscosity, K value of erythrocyte sedimentation equation, erythrocyte aggregation index were decreased as compared with those before treatment （P 〈 0.05）; and indexes of non-blood-stasis type including whole blood viscosity of high and middle shear rates, hematocrit, erythrocyte sedimentation, whole blood recovery viscosity of high and middle shear rates, K value of erythrocyte sedimentation equation and erythrocyte aggregation index were decreased after treatment as compared with those before treatment （P 〈 0.05）. Indexes of blood-stasis type including whole blood viscosity, plasma viscosity, erythrocyte sedimentation, whole blood recovery viscosity and erythrocyte aggregation index were lower than those of non-blood-stasis type （P 〈 0.05）. CONCLUSION： Hot-steaming therapy with danshen can obviously improved symptomatic score, pain degree and hemorheological indexes in LDP patients of blood stasis type, and the effect is superior to those of nonblood-stasis type.