减压放血针加电针治疗急性期肩周炎临床疗效观察

Clinical observation of blood-letting to reduce pressure plus electroacupuncture for acute scapulohumeral periarthritis

目的：评价减压放血针加电针治疗急性期肩周炎的临床疗效,并探讨其作用机制。方法：将66例患者随机分为观察组（34例）和对照组（32例）。两组均进行基础电针治疗,穴取肩髃、肩髎、肩前、肩贞、曲池、阿是穴为主,每天1次,治疗9d。观察组再予减压放血疗法,于患肩阿是穴点刺后拔罐,出血量3～10mL,每3d1次,共3次;对照组口服布洛芬缓释胶囊0.3g,每日2次,共9d。采用酶联免疫吸附法测定观察组第1次、第3次放血后患者罐血中5-羟色胺（5-HT）和前列腺素E2（PGE2）水平。采用数字评估量表（NRS）评分观察两组患者治疗前后NRS疼痛等级改变和肩关节活动改善程度,并评定两组综合疗效。结果：观察组第3次放血后罐血中5-HT、PGE2含量均较第1次放血后显著降低（均P〈0.001）;两组患者治疗后NRS疼痛等级、肩关节活动程度均明显改善（均P〈0.001）,且观察组优于对照组（均P〈0.05）;治疗结束后观察组治愈4例、显效20例、有效9例、无效1例,对照组分别为1例、10例、15例、6例,观察组疗效优于对照组（P〈0.05）。结论：减压放血针加电针治疗肩周炎疗效显著,可有效镇痛、改善肩关节功能,且疗效优于口服布洛芬缓释胶囊合电针。其作用机制可能与放血疗法可直接排出患肩局部血液里炎性物质有关。

Objective To evaluate the clinical effect of blood-letting to reduce pressure combined with electroacupuncture for acute scapulohumeral periarthritis and to explore its mechanism.Methods Sixty-six patients were randomly assigned into an observation group（34cases）and a control group（32cases）.Electroacupuncture（EA）was used at Jianyu（LI 15）,Jianliao（TE 14）,Jianqian（Extra）,Jianzhen（SI 9）,Quchi（LI 11）and ashi points in the two groups,once a day for 9days.Besides,blood-letting to reduce pressure was applied at ashi points in the observation group,namely cupping therapy after blood-letting puncture 3times,3-10 mL a time,once3 days.Ibuprofen capsules were prescribed orally for 9days in the control group,0.3g a time,twice a day.5-hydroxy-tryptamine（5-HT）and prostaglandin E2（PGE2）of blood in the cups were tested by enzyme linked immunosorbent assay after the first and third blood-letting in the observation group.The changes of numerical rating scale（NRS）grades for pain and shoulder joint movements were observed.The comprehensive effects of the two groups were evaluated.Results The contents of 5-HT and PGE2 after the third blood-letting apparently decreased compared with those after the first operation in the observation group（both P〈0.001）.The grades of NRS and shoulder movements were obviously improved after treatment in the two groups（all P〈0.001）,with better results in the observation group（both P〈0.05）.The result of 4cured cases,20 apparently effective cases,9effective cases and 1noneffective case in the observation group was superior to that of 1,10,15,6in the control group（P〈0.05）.Conclusion Blood-letting therapy combined with EA can ease pain and improve shoulder joint function of scapulohumeral periarthritis,and the effect is better than that of ibuprofen combined with EA.The mechanism may be related to directly discharging the inflammatory substances in local blood of the affected shoulder.