蜂针疗法、针刺联合常规西药治疗颈肩腰腿痛的效果分析.pdf

论著 社区中医药CHINESE COMMUNITY DOCTORS中国社区医师2024年第40卷第8期中国社区医师2024年第40卷第8期doi:10.3969/j.issn.1007-614x.2024.08.025摘要目的：探讨蜂针疗法、针刺联合常规西药治疗颈肩腰腿痛的效果。方法：选取2021年5月2022年8月陇南市礼县三峪乡卫生院收治的90例颈肩腰腿痛患者作为研究对象，以随机数字表法分为对照组和观察组，各45例。对照组采用常规西药联合针刺治疗，观察组在对照组基础上采用蜂针疗法治疗。比较两组治疗效果。结果：观察组治疗总有效率高于对照组，复发率低于对照组，差异有统计学意义(P0.05)。治疗前，两组日本矫形外科协会量表(JOA)、Oswestry功能障碍问卷(ODQ)评分比较，差异无统计学意义(P0.05)；治疗后，两组JOA评分高于治疗前，且观察组高于对照组，两组ODQ评分低于治疗前，且观察组低于对照组，差异有统计学意义(P0.05)。治疗前，两组血清丙二醛(MDA)、超氧化物歧化酶(SOD)、-内啡肽(-EP)、前列腺素E2(PGE2)水平比较，差异无统计学意义(P0.05)；治疗后，两组MAD、PGE2水平低于治疗前，且观察组低于对照组，两组SOD、-EP水平高于治疗前，且观察组高于对照组，差异有统计学意义(P0.05)。结论：蜂针疗法、针刺联合常规西药治疗颈肩腰腿痛的效果显著，可缓解临床症状，降低复发率，改善机体氧化应激状态和颈肩腰腿功能。关键词颈肩腰腿痛；蜂针疗法；针刺；功能障碍；关节肿胀中图分类号R274文献标识码AEffect Analysis of Bee Needle Therapy,Acupuncture Combined with Conventional Western Medicine in Treatmentof Neck,Shoulder,Low Back and Leg PainDong Xiyuan1,Wang Guizi2,Liu Hailong3Department of Traditional Chinese Medicine General Practice,Longlin Town Health Center in Li County1,Longnan 742221,GansuProvince,ChinaDepartment of Cerebrology,Li County Traditional Chinese Medicine Hospital2,Longnan 742200,Gansu Province,ChinaDepartment of Physiotherapy,Longlin Town Health Center in Li County3,Longnan 742221,Gansu Province,ChinaAbstractObjective:To investigate the effect of bee needle therapy,acupuncture combined with conventional western medicinein treatment of neck,shoulder,low back and leg pain.Methods:A total of 90 subjects with neck,shoulder,low back and legpain admitted to Longnan City Li County Sanyu Town Health Center from May 2021 to August 2022 were selected as the studysubjects.The patients were divided into control group and observation group according to random number table method,with 45cases in each group.The control group was treated with conventional western medicine combined with acupuncture,and the observation group was treated with bee needle therapy on the basis of control group.The treatment effects were compared betweenthe two groups.Results:The total effective rate of treatment in the observation group was higher than that in the control group,and the recurrence rate in the observation group was lower than that in the control group,and the difference was statistically significant(P0.05);After treatment,the JOA scores in the twogroups were higher than those before treatment,and the scores in the observation group were higher than those in the controlgroup,while the ODQ scores in the two groups were lower than those before treatment,and the ODQ scores in the observationgroup were lower than those in the control group,and the difference was statistically significant(P0.05);After treatment,the levels of MAD and PGE2 in the two groupswere lower than those before treatment,and the levels in the observation group were lower than those in the control group,whilethe levels of SOD and-EP in the two groups were higher than those before treatment,and the levels in the observation groupwere higher than those in the control group,and the difference was statistically significant(P1 h；临床资料完整。排除标准：合并心、肺、脑、肝、肾或血液系统严重疾病者；合并严重感染者；惧怕蜂针者。方法：对照组采用常规西药联合针刺治疗。常规西药：双氯芬酸钠肠溶缓释胶囊(生产厂家：海南普利制药股份有限公司；批准文号：国药准字H20000656)口服，0.1 g/次，1次/d。针刺：取穴足三里、梁丘、血海、犊鼻、合谷、外关、肩髎、肩髃，常规消毒后，使用0.30 mm40 mm一次性毫针进行针刺，提插捻转后留针20 min。观察在对照组基础上采用蜂针疗法治疗。取1只活蜂对患者进行皮试，对皮试处进行消毒，使用东北黑蜂活蜂尾针即扎即出，15 min后，若患者皮试处未出现变化即可继续治疗。依据患者病情，按照经络循行取主穴(阿是穴、风池、肝俞、脾俞、肾俞、足三里、三阴交)、配穴(游走性痛配风门、风市，疼痛固定不移者配大杼、阳陵泉，气虚体倦者刺关元、膀胱俞)。第一次应用2个蜂针，第2次可增加至3个蜂针，每次依据患者的病情逐渐增加蜂针量，每3 d进行1次。两组均治疗2个月，随访6个月。观察指标及疗效判定标准：临床疗效：a.康复：治疗后，患者关节肿胀、晨僵等临床症状消失，关节运动功能恢复；b.有效：治疗后，患者关节肿胀、晨僵等临床症状明显缓解，关节运动功能轻微受限；c.无效：临床症状未消失甚至加重，关节运动功能明显受限。总有效率=(康复+有效)例数/总例数100%。复发情况：随访期间患者再次出现下肢、关节、颈肩功能受限、疼痛加剧等症状视为复发。颈肩腰腿功能：采用日本矫形外科协会量表(JOA)、Oswestry功能障碍问卷(ODQ)评估，JOA满分17 分，分数越高表示颈肩腰腿功能越好；ODQ满分100分，分数越高表示功能障碍越严重。疾病相关因子：采集患者清晨空腹静脉血 3 mL，2 500 r/min离心15 min，取血清，采用全自动生化分析仪(生产厂家：重庆润康生物科技有限公司，型号：RC-400)检测患者血清丙二醛(MDA)、超氧化物歧化酶(SOD)、-内啡肽(-EP)、前列腺素E2(PGE2)水平。统计学方法：数据应用 SPSS 20.0统计学软件分析；计数资料以n(%)表示，采用2检验；计量资料以xs表示，采用t检验；P0.05表示差异有统计学意义。结果两组临床疗效及复发情况比较：观察组治疗总有效率高于对照组，复发率低于对照组，差异有统计学意义(P0.05)。见表1。两组JOA、ODQ评分比较：治疗前，两组JOA、ODQ 评分比较，差异无统计学意义(P0.05)；治疗后，两组 JOA评分高于治疗前，且观察组高于对照表1两组临床疗效及复发情况比较n(%)组别n临床疗效康复有效无效总有效复发对照组 4520(44.44)17(37.78)8(17.78)37(82.22)10(22.22)观察组 4524(53.33)20(44.44)1(2.22)44(97.78)3(6.67)27.2004.406P0.0190.036therapy,acupuncture combined with conventional western medicine have significant effects in the treatment of neck,shoulder,low back and leg pain,which can alleviate clinical symptoms,reduce the recurrence rate,and improve the oxidative stress stateof the body and neck,shoulder,waist and leg function.Key wordsNeck,shoulder,low back and leg pain;Bee needle therapy;Acupuncture;Dysfunction;Joint swelling74论著 社区中医药CHINESE COMMUNITY DOCTORS中国社区医师2024年第40卷第8期中国社区医师2024年第40卷第8期组，两组ODQ评分低于治疗前，且观察组低于对照组，差异有统计学意义(P0.05)。见表2。两组疾病相关因子水平比较：治疗前，两组MAD、SOD、-EP、PGE2水平比较，差异无统计学意义(P0.05)；治疗后，两组MAD、PGE2水平低于治疗前，且观察组低于对照组，两组SOD、-EP水平高于治疗前，且观察组高于对照组，差异有统计学意义(P0.05)。见表3。表2两组JOA、ODQ评分比较(xs，分)组别nJOA评分ODQ评分治疗前治疗后治疗前治疗后对照组45 6.611.03 10.311.68*73.265.03 55.295.62*观察组45 6.601.02 14.251.62*73.225.08 30.625.89*t0.04611.3250.03820.328P0.9630.0010.9700.001注：与本组治疗前比较，*P0.05表3两组疾病相关因子水平比较(xs)组别nMAD(mol/L)SOD(U/L)-EP(ng/L)PGE2(g/L)治疗前治疗后治疗前治疗后治疗前治疗后治疗前治疗后对照组4510.321.036.980.39*55.321.3985.615.46*163.2810.32211.3910.35*6.310.893.460.41*观察组4510.281.084.620.40*55.291.4098.615.61*162.0810.37278.3610.64*6.280.881.640.22*t0.18028.3380.10211.1400.55030.2660.16126.239P0.8580.0010.9190.0010.5840.0010.8730.001注：与本组治疗前比较，*P 0.05讨论颈肩腰腿痛的发生通常与机体受到寒冷刺激、缺乏运动锻炼有关，临床通常使用双氯芬酸钠肠溶缓释胶囊进行治疗，但停药后易复发。中医认为颈肩腰腿痛与劳倦内伤、年老体虚导致的肝肾亏虚相关，经脉失养、气血失和是颈肩腰腿痛的病机，治疗以祛风除湿、行气活血、温经散寒为原则4。本研究结果显示，蜂针疗法、针刺联合常规西药治疗可提高治疗效果，减少复发，改善患者颈肩腰腿功能。分析原因：毒蜂的尾刺似针，直接对人体进行螫刺能够刺激人体经络皮部，有助于疏通经络，调和气血，且蜂毒中含有的多肽酶及酶类物质有助于调节机体免疫力，可以发挥一定抗菌消炎、止痛消肿的作用5。蜂针疗法将针、药、灸联合，以毒蜂尾刺做针，以蜂毒做药，蜂针针刺可以扩张皮肤局部血管，使皮肤局部充血红肿，具有温灸的效果，治疗更彻底，更利于颈肩腰腿功能的恢复，且患者预后理想，可减少复发，改善患者日常生活质量。本研究结果显示，治疗后，观察组MAD、PGE2水平低于对照组，SOD、-EP水平高于对照组。说明蜂针疗法、针刺联合常规西药治疗颈肩腰腿痛，可以缓解患者疼痛，改善机体氧化应激状态，有助于加快致痛物质代谢产物清除。分析原因：研究证实，蜂针液具有消炎的作用，能够抑制多种病原体的生长、繁殖6。MDA水平与组织细胞受自由基损伤的严重程度呈正相关；-EP在痛觉传递过程中发挥重要作用，长时间的疼痛可降低-EP水平；SOD是清除机体自由基、避免自由基对机体组织产生损害的金属酶；PGE2是一种致痛因子，可以传递痛觉。蜂针液注入人体后，其中的去甲肾上腺素与多巴胺可直接抑制炎症，调节中枢及外周神经的疼痛信号传导，调节疾病相关因子水平。另一方面，蜂针液中的蜂毒肽可抑制细胞内活性氧过量生成，增强抗氧化防御，进而调节氧化-抗氧化平衡，达到抗氧化应激的目的。综上所述，蜂针疗法、针刺联合常规西药治疗颈肩腰腿痛的效果显著，可缓解患者临床症状，降低复发率，改善机体氧化应激状态和颈肩腰腿功能。参考文献1王志恒,周奎龙,梁志杰,等.温针灸联合中药熏蒸治疗老年颈肩腰腿痛的临床效果J.世界中医药,2020,15(12):1801-1805.2程洋洋,老锦雄.蜂针结合温针灸治疗髂骨致密性骨炎患者的临床疗效及对情绪状态的影响研究J.广州中医药大学学报,2022,39(8):1830-1835.3中华中医药学会.中医骨伤科常见病诊疗指南M.北京:中国中医药出版社,2012:56-62.4于晓原,王艳丽,张东舒,等.温针深刺颈夹脊穴对神经根型颈椎病的疗效观察J.成都医学院学报,2021,16(1):82-86.5陈建新,黄静宜,黄振俊.中医针灸综合治疗颈肩腰腿痛临床疗效观察与研究J.世界最新医学信息文摘,2019,19(46):250-251.6刘国科,周灵通,李万瑶,等.蜂针疗法联合塞来昔布治疗活动期强直性脊柱炎的临床观察J.上海针灸杂志,2020,39(5):594-597.75