人迎气口脉法指导针刺对膝骨关节炎患者桡动脉血流灌注量的影响

Effect of Renying-Qikou Pulse-Taking Guided Acupuncture on Radial Artery Blood Perfusion in Patients with KOA

目的:观察人迎气口脉法指导针刺与常规针刺治疗膝骨关节炎(KOA)的疗效差异,观察针刺前后患者桡动脉血流灌注量的变化趋势。方法:将36例KOA患者随机分为观察组和对照组各18例。观察组按人迎气口脉法辨别阴阳后,选用表里经原穴行针刺治疗:①少阳病和厥阴病取丘墟、太冲;②太阳病和少阴病取太溪、京骨;③阳明病和太阴病取冲阳、太白。用平补平泻法,留针15 min,脉平后出针。对照组选用犊鼻、内膝眼、梁丘、血海、阳陵泉与大杼,按常规针刺治疗。两组均1周治疗1次,4周为一疗程,共治疗1个疗程。观察两组治疗前后疼痛视觉模拟量表(VAS)评分、西安大略和麦克马斯特大学骨关节炎指数量表(WOMAC)评分和双手桡动脉血流灌注量的变化。结果:两组VAS评分治疗后均较治疗前明显降低(P<0.05);观察组WOMAC评分治疗后较治疗前下降不明显(P>0.05),对照组WOMAC评分治疗后较治疗前明显降低(P<0.05);观察组双手桡动脉血流灌注量差值治疗后较治疗前显著减小(P<0.05),对照组治疗后较治疗前差异无统计学意义(P>0.05)。治疗后组间比较,两组VAS评分治疗前后差值、WOMAC评分治疗前后差值差异无统计学意义(P>0.05)。观察组临床总有效率37.5%(6/16)与对照组的38.9%(7/18)疗效相当,差异无统计学意义(P>0.05)。结论:两种针刺疗法均能改善VAS评分,减轻患者疼痛,且临床总有效率相当,其中人迎气口脉法指导针刺可能是通过调整患者双手桡动脉血流灌注量从而调整患者阴阳平衡状态来缓解临床症状,本研究为针灸治疗KOA提供科学依据。

Objective:To observe the difference in curative effect between Renying-Qikou pulse-taking guided acupuncture and conventional acupuncture in treatment of knee osteoarthritis(KOA),and to observe the change trend of radial artery blood perfusion before and after acupuncture.Methods:36 KOA patients were randomly divided into the observation group(n=18)and the control group(n=18).After identifying Yin and Yang according to Renying-Qikou pulse-taking,the observation group was treated with needling Yuan-source points of outer and inner meridians.Qiuxu(GB40)and Taichong(LR3)were chosen for Shaoyang disease and Jueyin disease;Taixi(KI3)and Jinggu(BL64)were used for Taiyang disease and Shaoyin disease;Chongyang(ST42)and Taibai(SP3)were selected for Yangming disease and Taiyin disease.The manipulation of mild reinforcing and mild reducing was applied,with the needles retaining for 15 minutes.The needles were pulled out after the pulse was balanced.The control group was treated with needling Dubi(ST35),Neixiyan(EX-LE4),Liangqiu(ST34),Xuehai(SP10),Yanglingquan(GB34)and Dazhu(BL11).Both groups were treated once a week for four weeks.VAS score,WOMAC score and radial artery blood perfusion in both hands were observed before and after the treatment in the two groups.Results:VAS score was significantly lower after the treatment than that before the treatment in the two groups(P<0.05).WOMAC score was not significantly decreased after the treatment compared with that before the treatment in the observation group(P>0.05),whereas WOMAC score was significantly decreased after the treatment compared with that before the treatment in the control group(P<0.05).The difference of radial artery blood perfusion in both hands was significantly decreased after the treatment compared with that before the treatment in the observation group(P<0.05),whereas which was not significantly changed after the treatment compared with that before the treatment in the control group(P>0.05).There were no significant differences in the difference value of VAS score and WOMAC score before and after the treatment between the two groups(P>0.05).The total effective rate of the observation group was 37.5%(6/66),which was equivalent to 38.9%(7/18)of the control group(P>0.05).Conclusion:The two acupuncture treatments can improve VAS score and relieve patients’pain,and the total clinical effective rate is similar.Acupuncture guided by Renying-Qikou pulse-taking may alleviate clinical symptoms by adjusting the blood perfusion of radial artery in both hands and adjusting the balance of Yin and Yang of the patients.This study provided scientific basis for acupuncture in treatment of KOA.