四妙勇安汤加味结合电针夹脊穴治疗Wagner 0级糖尿病足临床效果观察

Clinical Effect of Modified Simiao Yong'an Decoction(四妙勇安汤加味)Combined with Electroacupuncture at Jiaji Acupoints in Treatment of Wagner Grade 0 Diabetic Foot

目的 观察四妙勇安汤加味结合电针夹脊穴治疗Wagner 0级糖尿病足临床效果,为临床治疗Wagner 0级糖尿病足提供可靠的方法。方法 将医院收治的260例Wagner 0级糖尿病足患者(2019年1月-2022年1月)进行试验研究,并以随机数字表法将患者分成两组,对照组与观察组各130例,对照组给予西医常规治疗,观察组常规治疗并予四妙勇安汤加味结合电针夹脊穴治疗。两组数据观察:临床疗效、治疗前后中医证候(患肢麻木疼痛、肢软乏力、纳差、身热口干等)积分变化及下肢感觉神经传导速度(胫后神经及腓肠神经、腓浅神经及腓总神经)变化、趾肱指数(toe brachial index, TBI)和踝肱指数(ankle brachial index, ABI)变化、血清白介素-1(interleukin-1,IL-1)及白介素-6(interleukin-6,IL-6)、肿瘤坏死因子α(tumor necrosis factor Alpha, TNF-α)变化、治疗后多伦多临床神经病变量表(Toronto clinical scoring system, TCSS)情况和不良反应。结果 观察组患者治疗总有效率(97.69%,127/130)比对照组(91.54%,119/130)更高(P<0.05);两组患者治疗前中医证候(患肢麻木疼痛、肢软乏力、纳差、身热口干等)积分、下肢感觉神经传导速度、TBI及ABI、IL-1及IL-6、TNF-α水平等指标比较,P>0.05,治疗后各组患者中医证候(患肢麻木疼痛、肢软乏力、纳差、身热口干等)积分、下肢感觉神经传导速度、TBI及ABI、IL-1及IL-6、TNF-α水平等指标均改善,观察组患者治疗后中医证候(患肢麻木疼痛、肢软乏力、纳差、身热口干等)积分、下肢感觉神经传导速度、TBI及ABI、IL-1及IL-6、TNF-α水平等指标均优于对照组(P<0.05);观察组患者治疗后TCSS评分情况优于对照组(P<0.05);两组未见不良反应。结论 四妙勇安汤加味结合电针夹脊穴治疗Wagner 0级糖尿病足效果显著,无不良反应,值得应用。

Objective To observe the clinical effect of Modified Simiao Yong'an Decoction(四妙勇安汤加味)combined with electroacupuncture at Jiaji acupoints in the treatment of Wagner grade 0 diabetic foot so as to provide a reliable method for the clinical treatment of Wagner grade 0 diabetic foot.Methods A total of 260 patients with Wagner grade 0 diabetic foot admitted to the hospital(from January 2019 to January 2022)were enrolled in this experimental study.The patients were randomly divided into control group and observation group with 130 cases in each group.Patients in the control group were treated with conventional western medicine,while those in the observation group were treated with conventional treatment and Modified Simiao Yong'An Decoction(combined with electroacupuncture at Jiaji acupoints.The clinical efficacy,changes of TCM syndrome scores(numbness and pain of the affected limb,weakness of limb,anorexia,body heat and dry mouth,etc.),changes of lower limb sensory nerve conduction velocity(posterior tibial nerve,sural nerve,superficial peroneal nerve and common peroneal nerve),changes of toe brachial index(TBI)and ankle brachial index(ABI),serum levels of interleukin-1(IL-1),interleukin-6(IL-6)and tumor necrosis factor alpha(TNF-α),Toronto clinical scoring system(TCSS)and adverse reactions after treatment of two groups were observed.Results The total effective rate in the observation group(97.69%,127/130)was higher than that in the control group(91.54%,119/130)(P<0.05).Before treatment,the scores of TCM syndromes(numbness and pain of the affected limbs,weakness of limbs,poor appetite,body heat and dry mouth,etc.),sensory nerve conduction velocity of lower limbs,the values of TBI and ABI,the levels of IL-1,IL-6 and TNF-αin two groups were not significant(P>0.05).After treatment,TCM syndromes(numbness and pain of the affected limbs,weakness of limbs,poor appetite,body heat and dry mouth,etc.),sensory nerve conduction velocity of lower limbs,values of TBI and ABI,the levels of IL-1,IL-6,TNF-αand other indicators were improved in each group.After treatment,the scores of TCM syndrome(numbness and pain of the affected limbs,weakness of limbs,poor appetite,body heat and dry mouth,etc.),sensory nerve conduction velocity of lower limbs,values of TBI and ABI,the levels of IL-1,IL-6 and TNF-αin the observation group were better than those in the control group(P<0.05).The TCSS score of the observation group was better than that of the control group after treatment(P<0.05).There were no adverse reactions in the two groups.Conclusion Modified Simiao Yong'An Decoction combined with electroacupuncture at Jiaji acupoints in the treatment of Wagner grade 0 diabetic foot has remarkable effect and no adverse reactions,which is worthy of application.