复荣通脉胶囊联合足底反射区穴位按摩治疗糖尿病高危足患者的疗效观察

Clinical Observation on Furong Tongmai Capsules Combined with Acupoint Massage in Plantar Reflex Zone in Treating High-Risk Diabetic Foot

目的 观察复荣通脉胶囊联合足底反射区穴位按摩治疗气阴两虚、瘀阻经络证糖尿病高危足患者的效果及对其足底峰值压力、神经传导的影响。方法 选取2020年6月—2021年5月期间衡水市中医医院收治的80例糖尿病高危足患者作为研究对象,按随机数字表及随机余数法分为对照组和治疗组,每组各40例。在基础治疗上,对照组给予反射区穴位按摩治疗,治疗组给予复荣通脉胶囊+反射区穴位按摩治疗。治疗12周后。观察比较两组患者临床疗效,治疗前后中医症状评分、血糖指标[空腹血糖(Fasting blood glucose,FBG)、糖化血红蛋白(Glycosylated hemoglobin,HbA1c)]、神经受损程度(TCSS评分)、踝肱指数(Ankle-brachial index,ABI值)、足底峰值压力、神经传导速度及复发率。结果 治疗后治疗组总有效率90.00%(36/40)明显高于对照组72.50%(29/40)差异有统计学意义(P<0.05)。治疗第4、8、12周后两组患者口渴喜饮、少气懒言、五心烦热、麻木刺痛中医症状评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组口渴喜饮、少气懒言、五心烦热、麻木刺痛中医症状评分均明显低于对照组同期,差异有统计学意义(P<0.05)。治疗第12周后两组患者血糖指标FBG、HbA1c水平均较治疗前降低,差异有统计学意义(P<0.05);两组间比较差异无统计学意义(P>0.05)。治疗第4、8、12周后两组患者TCSS评分均较治疗前降低,差异有统计学意义(P<0.05);且治疗组TCSS评分明显低于对照组同期,差异有统计学意义(P<0.05)。治疗第4、8、12周后两组患者ABI值均较治疗前升高,差异有统计学意义(P<0.05);且治疗组ABI值明显高于对照组同期,差异有统计学意义(P<0.05)。治疗第4、8、12周后两组患者足底峰值压力均较治疗前降低,差异有统计学意义(P<0.05);且治疗组足底峰值压力明显低于对照组同期,差异有统计学意义(P<0.05)。治疗第4、8、12周后两组患者腓总神经、正中神经、胫神经、尺神经传导速度均较治疗前升高,差异有统计学意义(P<0.05);且治疗组腓总神经、正中神经、胫神经、尺神经传导速度均明显高于对照组同期,差异有统计学意义(P<0.05)。1年后随访,两组患者均无失访。治疗组糖尿病足复发率为7.5%(3例),对照组糖尿病足复发率为25.00%(10例),两组间糖尿病足复发率比较,差异有统计学意义(χ^(2)=4.501,P<0.05)。结论 复荣通脉胶囊联合足底反射区穴位按摩治疗气阴两虚、瘀阻经络证糖尿病高危足效果显著,可有效改善患者临床症状,减轻足部神经受损程度,降低糖尿病足发生率。

Objective To observe the effect of Furong Tongmai Capsules combined with acupoint massage in plantar reflex zone in treating the patients with high-risk diabetic foot due to qi-yin deficiency and stasis obstructing meridians and collaterals and the influences of the treatment on peak plantar pressure and nerve conduction.Methods Eighty patients with high-risk diabetic foot treated in the Hengshui Hospital of Traditional Chinese Medicine from June 2020 to May 2021were assigned into a treatment group and a control group according to the random number table method and random number remainder method,with 40 patients in each group.On the basis of routine therapy,the control group received acupoint massage in plantar reflex zone,and the treatment group received Furong Tongmai Capsules+acupoint massage in plantar reflex zone.The patients in both groups were treated for 12 weeks,and the clinical efficacy and recurrence rate were compared between the two groups after treatment.The TCM symptom scores,blood glucose indicators[fasting blood glucose(FBG)and glycosylated hemoglobin(HbA1c)],nerve damage[Toronto Clinical Scoring System(TCSS)score],ankle-brachial index(ABI),peak plantar pressure,and nerve conduction velocity were compared between the two groups as well as between before treatment and after treatment.Results The total response rate in the treatment group was 90.00%(36/40),which was higher than that(72.50%,29/40)in the control group(P<0.05).At the weeks 4,8,and 12 of treatment,the scores of thirst with desire for drinking,short of breath and unwillingness to speak,vexing heat in chest,palms and soles,and numbness and tingling in both groups declined compared with those before treatment(P<0.05),and the treatment group had lower scores than the control group at the same time point(P<0.05).After 12 weeks of treatment,the levels of FBG and HbA1c declined in both groups(P<0.05)and had no statistical differences between groups(P>0.05).At the weeks 4,8,and 12 of treatment,the TCSS score in both groups declined compared with that before treatment(P<0.05),and the treatment group had lower TCSS score than the control group at the same time point(P<0.05).At the weeks 4,8,and 12,the ABI in both groups rose compared with that before treatment(P<0.05),and the ABI in the treatment group was higher than that in the control group(P<0.05).The treatment for 4,8,and 12 weeks lowered the plantar peak pressure and increased the conduction velocities of common peroneal nerve,median nerve,tibial nerve,and ulnar nerve in the two groups(P<0.05),and the changes in the treatment group were more obvious than the control group at the same time point(P<0.05).The follow-up lasted for a year,and neither group showed loss to follow-up.The recurrence rate of diabetic foot in the treatment group was 7.5%(3/40),which was lower than that(25.00%,10/40)in the control group(χ^(2)=4.501,P<0.05).Conclusion Furong Tongmai Capsules combined with acupoint massage in plantar reflex zone is effective in the treatment of high-risk diabetic foot due to qi-yin deficiency and stasis obstructing meridians and collaterals.This therapy can mitigate the clinical symptoms,relieve the foot nerve damage,and reduce the recurrence of diabetic foot.