中药熏蒸联合针灸治疗气滞血瘀型腰椎间盘突出症的临床效果及其对炎性指标的影响

Clinical efficacy of fumigation with traditional Chinese drug combined with acupuncture and moxibustion for treatment of lumbar disc herniation with patterns of qi stagnation and blood stasis and its effect on inflammatory indicators

目的观察行气散瘀中药熏蒸联合针灸治疗气滞血瘀型腰椎间盘突出症的临床效果及其对炎性指标的影响。方法将96例气滞血瘀型腰椎间盘突出症患者随机分为对照组和观察组,每组48例,两组患者均给予硬膜外封闭治疗,观察组加用行气散瘀中药局部熏蒸及针灸治疗,两组疗程均为4周。观察两组患者治疗前后血清肿瘤坏死因子α(TNF-α)、转化生长因子β1(TGF-β1)、基质金属蛋白酶3(MMP-3)、β-内啡肽(β-EP)、前列腺素E_(2)(PGE_(2))水平的变化及两组胫神经传导速度(TNCV)、腓总神经传导速度(CPNCV)、症状评分(及腰背部疼痛、活动障碍症状评分)、日本骨科协会(JOA)评分,比较两组临床疗效。结果治疗后,观察组血清TNF-α、TGF-β1、MMP-3、PGE_(2)水平及症状评分均低于对照组,β-EP水平、JOA评分高于对照组,并且TNCV、CPNCV快于对照组(均P<0.05);观察组治疗总有效率为95.83%(46/48),高于对照组的75.00%(36/48)(P<0.05)。结论硬膜外封闭联合中药熏蒸、针灸治疗气滞血瘀型腰椎间盘突出症临床效果好,能更有效减轻患者炎症反应,缓解患者疼痛症状,改善腰椎功能,进而提高神经传导功能。

Objective To observe the clinical efficacy of fumigation with traditional Chinese drug for regulating qi and dissipating blood stasis combined with acupuncture and moxibustion for the treatment of patients with lumbar disc herniation with patterns of qi stagnation and blood stasis,as well as its impact on inflammatory indicators.Methods Ninety-six patients with lumbar disc herniation with patterns of qi stagnation and blood stasis were randomized to control group(n=48)or observation group(n=48).Patients in the two groups were given epidural block therapy,the observation group received local fumigation with traditional Chinese drug for regulating qi and dissipating blood stasis combined with acupuncture and moxibustion additionally,and the treatment lasted for four weeks in both groups.The related indices of patients in the two groups were observed before and after the treatment,including changes in serum tumor necrosis factorα(TNF-α),transforming growth factorβ1(TGF-β1),matrix metalloproteinase 3(MMP-3),β-endorphin(β-EP),and prostaglandin E_(2)(PGE_(2))levels,as well as tibial nerve conduction velocity(TNCV),common peroneal nerve conduction velocity(CPNCV),symptoms scores(lumbodorsal region pain,movement disorder symptoms scores),and Japanese Orthopaedics Association(JOA)scores,and clinical efficacy was compared between the two groups.Results After the treatment,the observation group exhibited lower serum levels of TNF-α,TGF-β1,MMP-3,and PGE_(2),lower scores for the symptoms,a higherβ-EP level and,an increased JOA score,and faster TNCV and CPNCV as compared with the control group(all P<0.05);the total effective rate for treatment of the observation group was higher than that of the control group(95.83%[46/48]vs 75.00%[36/48],P<0.05).Conclusion For patients with lumbar disc herniation with patterns of qi stagnation and blood stasis,the combination of epidural block,fumigation with traditional Chinese drug,and acupuncture and moxibustion achieves favorable clinical effects,which can reduce the inflammation response more effectively,ameliorate pain symptoms,improve the lumbar function,thus improving the nerve conduction function.