基于红外线热成像技术探索“按之则热气至”的按压次数-热效应机制研究

Warm Qi Arrives after Tuina:Dose-effect Association between Number of Tuina and Warming Effect Measured Using Infrared Thermal Imaging

背景推拿量效关系的客观测量方法越来越多,但将红外线热成像技术与推拿量效关系结合的研究较少。目的通过对比不同的叠掌按压法次数(3、5、7次)下治疗区域温度值、肌张力、压痛阈值变化,为红外线热成像技术运用于推拿量效关系提供依据。方法于2021-06-17—12-24在广东省中医院大德路总院推拿科招募18例胸椎小关节紊乱(病变节段在T3~T4)患者。将患者分为按压7次组(n=6)、按压5次组(n=6)、按压3次组(n=6),接受叠掌按压法治疗,次数分别为7、5、3次。采用红外线热成像仪获取患者全身的红外热像图,提取病变区域的平均温度值;运用软组织张力测试分析系统测量病变胸椎处旁竖脊肌的肌张力;运用痛阈测定仪测量病变胸椎棘突旁体表部位的压痛阈值。结果按压3次组干预后的T3棘突右旁开0.5寸(T3 R)温度值及T4棘突右旁开0.5寸(T4 R)温度值均低于干预前(P<0.05)。干预后,三组T3棘突左旁开0.5寸(T3 L)在0.2 kg的力下肌张力、T3 R在0.2 kg的力下肌张力、T4棘突左旁开0.5寸(T4 L)在0.2 kg的力下肌张力、T4 L在0.5 kg的力下肌张力、T4 L在0.8 kg的力下肌张力、T4 R在0.2 kg的力下肌张力、T4 R在0.5 kg的力下肌张力比较,差异均有统计学意义(P<0.05)。按压7次组干预后T3 R在0.2、0.5 kg的力下肌张力高于干预前(P<0.05)。按压3次组干预后T3 L、T3 R、T4 L、T4 R压痛阈值低于干预前(P<0.05)。按压7次组干预后T3 L、T3 R压痛阈值低于干预前(P<0.05)。三组患者在接受治疗时均未出现不良事件。结论按压次数较少可能产生较好的疗效。红外线热成像技术作为推拿量效关系的测量方式仍需要进一步研究。结合本研究的问题可进一步为红外线热成像与推拿的关系提供研究思路。

Background An increasing number of objective measurements are used to explore the dose-effect relationship of Tuina,but infrared thermal imaging has been rarely used.Objective To compare the temperature,muscle tone and pain threshold in the lesion area yielded by different times(3,5 and 7)of Tuina with cross-palm pressing manipulation using infrared thermal imaging,providing a basis for the use of infrared thermal imaging to study the dose-effect of Tuina.Methods Eighteen patients with thoracic facet joint disorder(T3-T4)who visited Tuina Department,Guangdong Provincial Hospital of Chinese Medicine(Dade Road Main Hospital)from 17th June,2021 to 24th December,2021 were recruited and randomized into three groups by the number of Tuina with cross-palm pressing manipulation:7-time group(n=6),5-time group(n=6)and 3-time group(n=6).The infrared thermal imager was utilized to obtain a full body infrared thermogram,and extract the average temperature in the lesion area.The muscle tone of the erector spinae muscle adjacent to the affected thoracic vertebrae was measured by the tissue tension test.The pain pressure threshold of the site adjacent to paraspinal process of the affected thoracic vertebra was measured by the pain-threshold analyzer.Results After intervention,the temperature on the site 0.5 inch to the right spinous process of T3(T3 R)or T4(T4 R)in 3-time group decreased significantly(P<0.05).After intervention,there were statistically significant differences among the three groups in muscle tension on the site 0.5 inch to the left spinous process of T3(T3 L)at 0.2 kg,T3 R at 0.2 kg,on the site 0.5 inch to the left spinous process of T4(T4 L)at 0.2 kg,T4 L at 0.5 kg,T4 L at 0.8 kg,T4 R at 0.2 kg,or T4 R at 0.5 kg(P<0.05).The muscle tnsion of T3 R at 0.2 and 0.5 kg was higher significantly in 7-time group after intervention(P<0.05).The pain pressure threshold of T3 L,T3 R,T4 L,and T4 R was lowered significantly in 3-time group after intervention(P<0.05).The pain pressure threshold of T3 L and T3 R was lowered significantly in 7-time group after intervention(P<0.05).No adverse events were reported.Conclusion Fewer number of Tuina with cross-palm pressing manipulation may generate better improvement in clinical outcomes.Further research is required to explore the dose-effect of Tuina using the infrared thermal imaging,and our study may provide useful ideas for reference.