电针联合双氯芬酸钠治疗急性痛风性关节炎的即时镇痛效应:随机对照试验

Immediate analgesic effect of electroacupuncture combined with diclofenac sodium on acute gouty arthritis:a randomized controlled trial

目的:观察电针联合双氯芬酸钠对急性痛风性关节炎(AGA)的即时镇痛效应。方法:将90例AGA患者随机分为小剂量药物组(30例,剔除1例,脱落1例)、常规药物组(30例,脱落1例)及针药结合组(30例)。小剂量药物组口服双氯芬酸钠缓释胶囊50 mg;常规药物组口服双氯芬酸钠缓释胶囊100 mg;针药结合组在小剂量药物组的基础上联合电针治疗,选取患侧阿是穴、大都、太冲、太白、内庭、三阴交、足三里、阴陵泉,太冲与足三里、三阴交与阴陵泉分别连接电针,连续波,频率2 Hz。比较各组患者治疗前及治疗后10 min、2 h、4 h、6 h疼痛视觉模拟量表(VAS)评分,治疗前及治疗后10 min、6 h关节压痛和肿胀评分,并记录治疗结束24 h内双氯芬酸钠加药率。结果:治疗后10 min,针药结合组患者VAS、关节压痛、关节肿胀评分较治疗前降低(P<0.05),且VAS评分低于其他两组(P<0.05);治疗后2、4、6 h,3组患者VAS评分均较治疗前降低(P<0.05),且针药结合组低于小剂量药物组(P<0.05);治疗后6 h,3组患者关节压痛评分及针药结合组、常规药物组关节肿胀评分均较治疗前降低(P<0.05),针药结合组关节压痛、肿胀评分低于小剂量药物组(P<0.05)。针药结合组和常规药物组双氯芬酸钠加药率分别为3.3%(1/30)和3.4%(1/29),均低于小剂量药物组的17.9%(5/28,P<0.05)。结论:电针联合双氯芬酸钠治疗AGA具有良好的即时镇痛效应,且具有镇痛药物用量小、不良反应少的优势。

Objective To observe the immediate analgesic effect of electroacupuncture(EA)combined with diclofenac sodium on acute gouty arthritis(AGA).Methods A total of 90 patients with AGA were randomly divided into a low-dose medication(LM)group(30 cases,1 case was eliminated,1 case dropped off),a conventional medication(CM)group(30 cases,1 case dropped off)and a combination of acupuncture and medication(AM)group(30 cases).The LM group was given oral administration of 50 mg diclofenac sodium sustained-release capsule;the CM group was given oral administration of 100 mg diclofenac sodium sustained-release capsule;on the basis of the treatment of LM group,the AM group was treated with electroacupuncture at ashi points,Dadu(SP 2),Taichong(LR 3),Taibai(SP 3),Neiting(ST 44),Sanyinjiao(SP 6),Zusanli(ST 36)and Yinlingquan(SP 9)on the affected side,and Taichong(LR 3)and Zusanli(ST 36),Sanyinjiao(SP 6)and Yinlingquan(SP 9)were connected to electroacupuncture respectively,continuous wave,2 Hz in frequency.The visual analogue scale(VAS)scores of pain before treatment and after 10 min,2 h,4 h and 6 h of treatment completion,joint tenderness and swelling scores before treatment and after 10 min and 6 h of treatment completion were compared,and the rate of diclofenac sodium addition within 24 h after treatment completion was recorded among the three groups.Results After 10 min of treatment completion,the scores of VAS,joint tenderness and joint swelling in the AM group were lower than those before treatment(P<0.05),and the VAS score in the AM group was lower than that in the other two groups(P<0.05).After 2,4 and 6 h of treatment completion,the VAS scores of the three groups were lower than those before treatment(P<0.05),and the scores in the AM group were lower than those in the LM group(P<0.05).After 6 h of treatment completion,the joint tenderness scores of the three groups and the joint swelling scores of the AM group and the CM group were lower than those before treatment(P<0.05),and the joint tenderness and swelling scores of the AM group were lower than those of the LM group(P<0.05).The rate of diclofenac sodium addition was 3.3%(1/30)and 3.4%(1/29)in the AM group and the CM group,respectively,which were lower than 17.9%(5/28)in the LM group(P<0.05).Conclusion Electroacupuncture combined with diclofenac sodium have a good immediate analgesic effect in the treatment of AGA,and have the advantages of small dosage of analgesic drugs and less adverse reactions.