艾灸不同状态腧穴治疗膝骨性关节炎的临床疗效观察

Observation on Clinical Effects of Moxibustion Stimulation of Different Sensitive Status Acu-points for Knee Osteoarthritis

目的:观察同一组腧穴的热敏态与静息态对治疗膝骨性关节炎(KOA)的临床疗效的影响。方法:60例KOA患者以患侧内膝眼、外膝眼、鹤顶三穴区有无热敏灸感及热敏灸感发生的次数为标准,将其分成热敏组、静息组各30例,两组均对上三穴同时施灸,每天1次,治疗20d。采用视觉模拟评分(VAS)评价疼痛程度并评价临床疗效。结果:治疗后及治疗后半年随访,热敏组VAS总积分均明显低于静息组(P<0.01)。治疗后热敏组总有效率为80.00%(24/30),半年后随访总有效率为79.17%(19/24);而静息组则为46.67%(14/30)、42.86%(6/14),热敏组均优于静息组(P<0.01)。结论:腧穴热敏状态灸法治疗KOA的临床疗效优于静息状态,临床中应更加重视腧穴的状态。

Objective To observe the clinical effect of moxibustion of different acupoints undergoing heat-sensitive state and resting state in the treatment of knee osteoarthritis （KOA） patients. Methods A total of 60 cases of KOA patients were en- rolled in the present trial. They were divided into heat-sensitive moxibustion （heat-sensitive） group and non-sensitive moxibustion group （resting group）. Moxibustion was applied to Neixiyan （EX-LE 4）, Waixiyan （i.e. Dubi, ST 35） and Heding （EX-LE 2） for about 45 min, once daily for 20 days. The heat-sensitive state was evaluated according to the patient＇s feeling. After moxibustion stimulation at the acupoint area, if the patient feels the heat penetrating from the skin surface to the deep tissue, or/and extending peripherally around the moxibustion site, or/and transmitting toward a certain direction, it is considered to be heat sensitization state. The therapeutic effect was evaluated by using visual analogue scale （VAS） for pain severity changes and by Guiding Princi- ples for Clinical Trials of New Drugs of Chinese Materia Medica for evaluating functional activity of the knee-joint. Results After 20 sessions of treatment and after a half year＇s follow-up, the total integrated scores of VAS in the heat-sensitive group were all lower than those of the resting group（ P^0.01 ）. Following 20 sessions of treatment, of the two 30 KOA patients in the heat-sensi- tive group and resting group, 14 （46.67 % ）and 5 （16.67 % ） experienceda marked improvement, 10 （33.33 % ） and 9 （30.00 % ） were effective, 6 （20.00 % ） and 16 （53.33 % ） were invalid, with the effective rates being 80.00 % and 46.67 %, respectively. Half-year＇s follow-up showed that the effective rates of the heat-sensitive group and resting group were 79. 17% （19/24） and 42.86% （6/14）, respectively, suggesting a better therapeutic effect of heat-sensitive moxibustion. Conclusion The clinical effect of heat-sensitive moxibustion is significantly superior to that of non-sensitive moxibustion in the treatment of KOA patients, being worthy of clinical application.