足三里刺脉术治疗Wagner 0级糖尿病足疗效观察

Acupuncture artery technique at Zusanli(ST 36)for Wagner grade 0 diabetic foot

目的:观察足三里刺脉术治疗Wagner 0级糖尿病足的临床疗效。方法:将60例Wagner 0级糖尿病足患者随机分为观察组和对照组,每组30例。两组均取双侧足三里穴,对照组在超声引导下避开足三里穴区下血管,进针约10 mm,留针5 min,不行针;观察组在超声引导下针刺足三里穴区下胫前动脉分支处,进针约25 mm,行上下提插手法5min后出针。两组均每周治疗2次,共治疗4周。分别于治疗前、首次治疗后和治疗结束后观察两组患者中医证候积分,采用红外热成像仪测量患者内踝、外踝、足底的脚掌内上方和脚掌外下方4个区域左右温度差值,采用超声多普勒测量右侧足三里穴下胫前动脉血流峰值指数对数(lnPS)、最大速度均值对数(ln TAMAX),采用超声多普勒血流检测仪和血压计测量踝肱指数(ABI),并比较两组临床疗效。结果:两组患者首次治疗后和治疗结束后中医证候积分均较治疗前降低(P<0.01,P<0.05),且观察组低于对照组(P<0.01)。观察组首次治疗后和治疗结束后脚掌内上方、脚掌外下方、内踝和外踝4个区域左右温度最大值差值、最小值差值及平均值差值较治疗前降低(P<0.05,P<0.01);观察组首次治疗后,脚掌内上方、内踝左右温度最大值差值低于对照组(P<0.05),治疗结束后,除内踝左右温度平均值差值外,脚掌内上方、脚掌外下方、外踝和内踝4个区域左右温度最大值差值、最小值差值、平均值差值均低于对照组(P<0.01,P<0.05)。观察组首次治疗后和治疗结束后右侧足三里穴下胫前动脉ln PS、ln TAMAX及ABI均较治疗前升高(P<0.01),且高于对照组(P<0.01)。观察组总有效率为96.7%(29/30),高于对照组的3.3%(1/30,P<0.05)。结论:足三里刺脉术能够有效改善Wagner0级糖尿病足患者的临床症状,提高患者下肢血管血流速度,减小左右下肢温差。

Objective To observe the clinical efficacy of acupuncture artery technique at Zusanli(ST 36)for Wagner grade 0 diabetic foot.Methods Sixty patients with Wagner grade 0 diabetic foot were randomly divided into an observation group and a control group,with 30 patients in each group.Both groups selected bilateral Zusanli(ST 36).In the control group,the needle was inserted about 10 mm under ultrasound guidance to avoid blood vessels in the Zusanli(ST 36)area,with needle retention for 5 min without manipulation.In the observation group,the needle was inserted about 25 mm under ultrasound guidance to the anterior tibial artery branch below Zusanli(ST 36),followed by lifting and thrusting manipulation for 5 min before withdrawing the needle.Both groups were treated twice a week for 4 weeks.The traditional Chinese Medicine(TCM)syndrome scores were observed;infrared thermography was used to measure the temperature difference between the left and right sides in four areas,i.e.the medial malleolus,lateral malleolus,and upper and lower parts of the sole of the foots;Doppler ultrasound was used to measure the logarithm of the peak systolic velocity(ln PS)and the logarithm of the time average maximum velocity(ln TAMAX)of the anterior tibial artery below the right Zusanli(ST 36);the ankle-brachial index(ABI)was measured using Doppler blood flow detector and blood pressure monitor before treatment,after the first treatment,and at the end of treatment.Clinical efficacy was compared between the two groups.Results Compared before treatment,the TCM syndrome scores in both groups were reduced after the first treatment and at the end of treatment(P<0.01,P<0.05),and the scores in the observation group were lower than those in the control group(P<0.01).In the observation group,compared before treatment,the maximum,minimum,and average temperature differences between the left and right sides of the upper and lower parts of the sole of the foots,medial malleolus,and lateral malleolus were reduced after the first treatment and at the end of treatment(P<0.05,P<0.01).After the first treatment,the maximum temperature difference between the left and right sides of the upper part of the sole of the foots and the medial malleolus in the observation group was lower than that in the control group(P<0.05).At the end of treatment,except for the average temperature difference of the medial malleolus,the maximum,minimum,and average temperature differences between the left and right sides of the upper and lower parts of the sole of the foots,medial malleolus,and lateral malleolus in the observation group were lower than those in the control group(P<0.01,P<0.05).After the first treatment and at the end of treatment,the ln PS,ln TAMAX,and ABI of the anterior tibial artery below the right Zusanli(ST 36)in the observation group were higher than those before treatment(P<0.01)and higher than those in the control group(P<0.01).The total effective rate in the observation group was 96.7%(29/30),higher than 3.3%(1/30)in the control group(P<0.05).Conclusion Acupuncture artery technique at Zusanli(ST 36)could effectively improve the clinical symptoms of patients with Wagner grade 0 diabetic foot,increase blood flow velocity in the lower limb vessels,and reduce the temperature difference between the left and right lower limbs.