腰痹逐瘀止痛汤结合调脊通督针法治疗气滞血瘀型腰椎间盘突出症临床疗效及安全性观察

Clinical Efficacy and Safety of Yaobi Zhuyu Zhitong Decoction(腰痹逐瘀止痛汤)Combined with Regulating The Spine and Dredging Du meridian Needling in Treatment of Lumbar Intervertebral Disc Herniation with Qi Stagnation and Blood Stasis

目的探究腰痹逐瘀止痛汤结合调脊通督针法治疗气滞血瘀型腰椎间盘突出症临床疗效及安全性。方法气滞血瘀型腰椎间盘突出症患者95例,采取随机数字表法将其分为两组,予以对照组(47例)常规临床治疗,予以观察组(48例)常规临床治疗+腰痹逐瘀止痛汤结合调脊通督针法治疗,分析比较各组患者治疗效果、治疗前后中医症状(腰腿痛、腰部僵硬、舌黯紫/瘀斑、舌苔薄白/薄黄、脉沉涩/弦)积分变化以及前列腺素E_(2)(PEG_(2))、5-羟色胺(5-HT)等疼痛介质水平变化、治疗前后疼痛评分(VAS)情况改变、血清白介素-6(IL-6)及白介素1(IL-1β)、C反应蛋白(CRP)及肿瘤坏死因子α(TNF-α)水平变化、腰椎功能评分(JOA)变化及Oswestry功能障碍指数评分变化(ODI)、生存质量评分变化、不良反应发生率。结果观察组治疗总有效率(95.83%,46/48)高于对照组(80.85%,38/47),P<0.05;治疗前,两组患者腰腿痛、腰部僵硬、舌黯紫/瘀斑、舌苔薄白/薄黄、脉沉涩/弦等中医症状积分、PEG2、5-HT、VAS评分情况、IL-6及IL-1β、CRP及TNF-α水平、JOA及ODI评分、生存质量评分比较,P>0.05,治疗后各组患者腰腿痛、腰部僵硬、舌黯紫/瘀斑、舌苔薄白/薄黄、脉沉涩/弦等中医症状积分、PEG_(2)、5-HT、VAS评分情况、IL-6及IL-1β、CRP及TNF-α水平、JOA及ODI评分、生存质量评分均改善,观察组患者治疗后腰腿痛、腰部僵硬、舌黯紫/瘀斑、舌苔薄白/薄黄、脉沉涩/弦等中医症状积分、PEG_(2)、5-HT、VAS评分情况、IL-6及IL-1β、CRP及TNF-α水平、JOA及ODI评分、生存质量评分均优于对照组,P<0.05;观察组患者不良反应(6.25%,3/48)与对照组(4.26%,2/47)均较低,P>0.05。结论腰痹逐瘀止痛汤结合调脊通督针法治疗气滞血瘀型腰椎间盘突出症临床疗效显著,患者中医症状改善,腰椎功能恢复良好,疼痛缓解,不良反应少,安全可靠,且患者生活质量改善,值得应用。

Objective To explore the clinical efficacy and safety of Yaobi Zhuyu Zhitong Decoction(腰痹逐瘀止痛汤)combined with regulating the spine and dredging Du meridian needling in the treatment of lumbar intervertebral disc herniation with Qi stagnation and blood stasis.Methods Ninety-five cases of lumbar disc prolapse with Qi stagnancy and blood stasis syndrome were selected.By taking a random number table method,they were divided into two groups.The control group’s patients(n=47)were treated with routine clinical treatment and the observation group’s patients(n=48)were treated with routine clinical treatment and Yaobi Zhuyu Zhitong Decoction combined with regulating the spine and dredging Du meridian needling.We analyzed and compared the integral change of TCM symptoms(waist and leg pain,waist stiff,dark purple tongue/ecchymosis,thin white/thin yellow coating on the tongue,pulse acerbity/string)and levels of prostaglandin E2(PEG2),serotonin(5-HT),interleukin 6(IL-6)and interleukin 1(IL-1β),C-reactive protein(CRP)and tumor necrosis factor alpha(TNF-α),pain score(VAS),lumbar function score(JOA)and Oswestry disability index score(ODI),changes in quality of life score and incidence of adverse reactions of the two groups before and after treatment.Results The total effective rate in the observation group(95.83%,46/48)was higher than that in the control group(80.85%,38/47)(P<0.05).Before treatment,TCM symptoms such as lumbago and leg pain,stiffness of the back,dark purple/ecchyma of the tongue,thin white/yellow coating on the tongue,pulse sinking and astringence/string,PEG2,5-HT,VAS score,IL-6,IL-1,CRP and TNF-α,JOA and ODI scores,and quality of life score between the two groups were significant(P>0.05).After treatment,TCM symptom scores such as lumbago and leg pain,stiffness of the back,dark purple/ecchyma of the tongue,thin white/yellow coating on the tongue,pulse dullness/string,PEG2,5-HT,VAS scores,IL-6,IL-1,CRP and TNF-α,JOA and ODI scores,and quality of life scores were all improved in each group.After treatment,the scores of TCM symptoms,such as lumbago and leg pain,lumbar stiffness,dark purple/ecchyma on tongue,thin white/yellow coating on tongue,pulse sinking and astragalus/string,PEG2,5-HT,VAS score,IL-6,IL-1,CRP and TNF-α,JOA and ODI score,and quality of life score in the observation group were all better than those in the control group(P<0.05).Adverse reactions in the observation group(6.25%,3/48)and the control group(4.26%,2/47)were lower(P>0.05).Conclusion The treatment of lumbar intervertebral disc herniation caused by Qi stagnation and blood stasis with Yaobi Zhuyu Zhitong Decoction combined with regulating the spine and dredging Du meridian needling method has a significant clinical effect.The patients'TCM symptoms are improved.The lumbar function is restored well and the pain is alleviated.There are few adverse reactions.It is safe and reliable,and the patients'quality of life is improved.It is worthy of application.