不同配穴热敏灸对照传统艾灸治疗晚期肺癌化疗后血小板减少症的疗效

The curative effect of different acupoints thermosensitive moxibustion and traditional moxibustion on thrombocytopenia after chemotherapy for advanced lung cancer

目的:热敏灸的特色在于其对热敏腧穴的探查以及精准持续的刺激,本研究旨在以传统艾灸对照不同取穴探查的热敏灸治疗对化疗后血小板减少症的影响。方法:选取山东省潍坊市中医院100例肺癌晚期化疗后出现血小板减少症的患者,用随机数字表法分为A组和B组。A组依据我科前期经验取穴探查;B组根据国内同行的大数据分析取穴探查;连续治疗2 d,每日1次,对两组患者按照热灸操作规范进行最多20 min的穴位探查。以2 d中是否至少获得1次穴位热敏化作为最终统计分析的组内分层条件,获得热敏感者列入A1组或B1组,采用后续热敏灸的施灸手法;未获得热敏感者列入A2/B2组,采用传统艾灸疗法(温和灸、回旋灸、雀啄灸)。比较两组在第1天、3天、5天、8天、15天各指标变化,评价疗效的差异;并且采用层次分析法(Analytic Hierarchy Process,AHP)法联合熵权法计算各评价指标综合权重;进而计算A1、A2、B1、B2四种疗法的综合评分。结果:(1)A组相较于B组易更快获得热敏感;(2)A组、B组及A1组、B1组均能升高血小板计数,且A组较B组升高更快;(3)A组、B组均可快速改善中医症状积分,且随着结束时间的延长而减弱,分别在第15天,第8天恢复至治疗开始前的水平;(4)A组、B组均可改善患者的生活质量(P <0.05);(5)综合评分:A1组> B1组> A2组> B2组;(6)两组无不良反应出现,均安全。结论:热敏灸相较于传统灸法而言,不论何种配穴均可获得更佳的提升血小板速度和力度,迅速改善中医证候;但随着热敏灸结束时间的延长而减弱。选取足三里穴、肺俞穴、气海穴、关元穴、膏肓穴进行穴位探查可更快、更易获得热敏感,且相较于其他取穴的热敏灸疗法提升血小板更快,力度更强、更持久。

Objective: The characteristics of thermosensitive moxibustion lie in its exploration of thermosensitive acupoints and precise and continuous stimulation. This study aims to compare the effect of thermosensitive moxibustion with different acupoint exploration on thrombocytopenia after chemotherapy with traditional moxibustion as a control. Methods: A total of 100 patients with thrombocytopenia after advanced lung cancer chemotherapy were selected and divided into two groups by random number table method. Group A was based on the previous experience of our department for acupoint exploration, group B was based on big data analysis of domestic counterparts for acupoint exploration, once a day for 2 consecutive days, the patients in the two groups were subjected to acupoint exploration for a maximum of 20 minutes according to the hot moxibustion operation specification. Those who obtained heat sensitivity were included in group A1/B1, and those who did not obtain heat sensitivity were included in group A2/B2, using traditional moxibustion therapy(mild moxibustion, circling moxibustion, bird peck moxibustion). The differences in the therapeutic effects were compared between group A and B, the changes of each index on the 1st, 3 rd, 5th, 8th, and 15th days were evaluated, and the AHP analytic hierarchy process combined with the entropy weight method was used to calculate the comprehensive weight of each evaluation index, so as to calculate the comprehensive score of four treatments A1, A2, B1, and B2. Results:(1)Compared with group B, group A was easier to acquire heat sensitivity faster.(2)Both groups A, B and A1, B1 could increase platelet count, and group A was increased faster than group B.(3)Both groups A, B could rapidly improve the TCM symptom score, and it weakened with the prolongation of the end time, and recovered to the level before treatment on the 15th and 8th day respectively.(4)Both groups A, B could improve the quality of life of patients(P<0.05).(5)Comprehensive score: A1>B1>A2>B2.(6)The re was of no adverse reaction in both groups, and it was safe. Conclusion: Compared with traditional moxibustion, thermosensitive moxibustion can achieve better platelet-raising speed and intensity regardless of the acupoints, and rapidly ameliorate TCM syndromes. However, selecting Zusanli(ST36), Feishu(BL13), Qihai(RN06), Guanyuan(RN12), and Gaohuang(BL43)points for acupoint exploration can obtain heat sensitivity faster and easier. Compared with other acupoint-selected thermosensitive moxibustion therapy, the platelets increase faster, and the intensity is stronger and more durable.