杵针对糖尿病高危足患者足部感觉神经功能和症状的影响
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摘要
目的评价杵针对糖尿病高危足患者足部电流感觉阈值和临床症状的影响。方法选取132例糖尿病高危足患者,随机分为试验组和对照组,每组66例,对照组采用糖尿病常规治疗和护理,试验组在对照组的基础上加用杵针干预,每日1次,共干预4周。两组在干预前、干预4周后采用双足腓浅神经及足踝中部前方(L_4/L_5/S_1)的快速电流感觉阈值(R-CPT)和临床症状积分(CSIT),评价足部感觉神经功能和临床症状的改善效果。结果干预后,两组患者L_4/L_5/S_1区段细有髓鞘(Ad)和无髓鞘(C)感觉神经纤维的R-CPT及CSIT均下降(P<0.05),且试验组低于对照组,差异有统计学意义(P<0.01)。结论在常规治疗和护理的基础上加用杵针干预能降低糖尿病高危足患者的足部电流感觉阈值,改善足部感觉神经功能,减轻临床症状。
Objective To evaluate the effect of pestle acupuncture on the current perception threshold(CPT) and clinical symptoms of foot in patients with high-risk diabetic foot. Method A total of 132 patients with high-risk diabetic foot were enrolled and randomized into a trial group and a control group, with 66 cases in each group. The control group was intervened by routine treatment and nursing care for diabetes, and the trial group was additionally given pestle acupuncture, once a day for 4 weeks. Before and after 4-week intervention, the rapid current perception threshold(R-CPT) of bilateral superficial peroneal nerves and the anterior middle of ankles(L_4/L_5/S_1) and the clinical symptom integral table(CSIT) were evaluated to determine the improvements in the sensory nerve function and clinical symptoms of foot. Result After intervention, the R-CPT of the fine myelinated(Ad) and non-myelinated(C)sensory nerve fibers of L_4/L_5/S_1 and CSIT declined in the two groups(P<0.05), and the trial group was significantly lower than the control group(P<0.01). Conclusion Pestle acupuncture in addition to routine treatment and nursing care can reduce the foot CPT, improve the foot sensory nerve function, and mitigate clinical symptoms in patients with high-risk diabetic foot.
Objective To evaluate the effect of pestle acupuncture on the current perception threshold(CPT) and clinical symptoms of foot in patients with high-risk diabetic foot. Method A total of 132 patients with high-risk diabetic foot were enrolled and randomized into a trial group and a control group, with 66 cases in each group. The control group was intervened by routine treatment and nursing care for diabetes, and the trial group was additionally given pestle acupuncture, once a day for 4 weeks. Before and after 4-week intervention, the rapid current perception threshold(R-CPT) of bilateral superficial peroneal nerves and the anterior middle of ankles(L_4/L_5/S_1) and the clinical symptom integral table(CSIT) were evaluated to determine the improvements in the sensory nerve function and clinical symptoms of foot. Result After intervention, the R-CPT of the fine myelinated(Ad) and non-myelinated(C)sensory nerve fibers of L_4/L_5/S_1 and CSIT declined in the two groups(P<0.05), and the trial group was significantly lower than the control group(P<0.01). Conclusion Pestle acupuncture in addition to routine treatment and nursing care can reduce the foot CPT, improve the foot sensory nerve function, and mitigate clinical symptoms in patients with high-risk diabetic foot.
引文
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[5]华珊珊,李闺臣,彩虹,等.运动疗法对糖尿病周围神经病变影响的研究进展[J].中华护理杂志,2017,52(10):1252-1256.
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[11]刘瑾,袁晓勇,袁戈恒,等.糖尿病患者高危足筛查及分级、干预规范流程的构建[J].中华糖尿病杂志,2017,9(5):281-285.
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[14]吴玉环,谭志雄,罗雪琴,等.中医临床护理路径结合视频健康教育在糖尿病高危足患者中的应用[J].国际医药卫生导报,2018,24(16):2477-2480.
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[17]谭薪兴,黄敏,郭梦,等.杵针疗法临床应用与研究进展[J].世界最新医学信息文摘(电子版),2018,18(55):47-48,51.
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[21]梁繁荣.针灸学[M].上海:上海科学技术出版社,2012:42-137.
[22]Inceu GV,Veresiu IA.Measurement of current perception thresholds using the Neurometer(?)-applicability in diabetic neuropathy[J].Clujul Med,2015,88(4):449-452.
[23]白亚娟.临床症状积分表在糖尿病周围神经病变筛查中的价值研究[D].杭州:浙江中医药大学,2015:9-11.
[24]王志平,熊英琼.电流感觉阈值检测仪的临床应用[J].江西中医药大学学报,2017,29(3):115-117.
[25]潘雪,顾峻菱,胡华斌,等.电流感觉阈值检测在2型糖尿病周围神经病变诊断中的应用[J].解放军医学杂志,2016,41(11):970-972.
[26]王天鹭,赵挺洋,赵诚炫,等.感觉神经定量检测在2型糖尿病下肢周围神经损伤中的临床研究[J].中华临床医师杂志(电子版),2015,9(15):2812-2815.
[27]李媛,曾克武,王学美,等.糖尿病相关脑微血管病变研究进展[J].中国中药杂志,2017,(12):2247-2253.
[28]邱春光,卢长青.糖尿病微血管病变发生机制研究现状[J].心血管病学进展,2007,28(1):13-14.
[29]于学江,王小梅.中药通心络对糖尿病微血管病变防治研究[J].辽宁中医杂志,2010,(2):281-283.
[30]衣运玲,姜军作,张萍.针刺三主穴对糖尿病周围神经病变患者氧化应激状态的影响[J].中华中医药学刊,2009,27(11):2385-2386.
[31]陈妮,沈卫东.针刺对气阴两虚型糖尿病周围神经病变患者的临床观察[J].辽宁中医杂志,2012,39(12):2476-2480.
[32]王芳,张留巧,蒋运兰,等.足部反射区按摩和中药浴足对中、高危糖尿病足患者生存质量的影响[J].护士进修杂志,2010,25(4):324-326.
[33]胡幼平,徐贞杰,吴佳,等.杵针疗法干预亚健康状态:随机对照研究[J].中国针灸,2012,32(11):1019-1022.
[34]金彩云,李美玲,陈明秀,等.黄芪桂枝五物汤通荣并治糖尿病高危病足的探讨[J].云南中医中药杂志,2018,39(6):12-14.
[35]刘宇.中药熏蒸治疗糖尿病高危足的中医护理研究[J].内蒙古中医药,2017,(15):162-163.
[36]毛奇.黄芪桂枝五物汤治疗老年糖尿病高危足的临床观察[J].中国现代药物应用,2017,11(11):187-188.
[37]蒋运兰,胡月,李颖馨,等.杵针疗法治疗腰腿痛有效性和安全性的系统评价[J].北京中医药,2018,(8):703-707.
[38]田琳,崔霞.浅析杵针疗法的临床应用[J].内蒙古中医药,2017,(2):143-144.
[39]刘栩豪,余洋,钟磊,等.杵针腰阳关八阵、河车命强段治疗腰痹病31例[J].中国针灸,2016,36(3):295-298.
[40]马秋艳,张敬华,牛俊岩,等.至阳八阵推拿联合赖氨葡锌治疗小儿厌食症的随机对照研究[J].针灸临床杂志,2017,33(8):45-48.
[41]马秋艳,张敬华,牛俊岩,等.命门八阵推拿联合赖氨葡锌颗粒治疗小儿慢性腹泻的临床研究[J].中国中医药信息杂志,2017,24(10):31-34.
[42]宋书昌,卢智,陈华,等.足三里穴证治机理探讨[J].中医临床研究,2013,5(22):38-40.
[2]唐威.超前护理在糖尿病高危足患者中的应用[J].中国药物与临床,2018,18(8):1455-1457.
[3]王璐,邓燕,杨静娟,等.糖尿病高危足循证护理实践方案的构建研究[J].实用妇科内分泌杂志(电子版),2018,5(21):135-135,137.
[4]Schaper NC,Van Netten JJ,Apelqvist J,et al.Prevention and management of foot problems in diabetes:ASummary Guidance for Daily Practice 2015,based on the IWGDF guidance documents[J].Diabetes Res Clin Pract2017,124:84-92.
[5]华珊珊,李闺臣,彩虹,等.运动疗法对糖尿病周围神经病变影响的研究进展[J].中华护理杂志,2017,52(10):1252-1256.
[6]李廷尉.糖尿病周围神经病变的发病机制及诊治研究进展[J].右江医学,2015,43(3):369-372.
[7]岳仁宋,毛黎黎,黄俊莉.糖足煎剂治疗糖尿病高危足近期疗效观察[J].时珍国医国药,2014,25(10):2434-2436.
[8]邹晟怡.住院2型糖尿病患者糖尿病高危足筛查分析[D].苏州:苏州大学,2015:13.
[9]Boulton AJ,Vileikyte L,Ragnarson-Tennvall G,et al.The global burden of diabetic foot disease[J].Lancet,2005,366(9498):1719-1724.
[10]van Acker K,Léger P,Hartemann A,et al.Burden of diabetic foot disorders,guidelines for management and disparities in implementation in Europe:a systematic literature review[J].Diabetes Metab Res Rev,2014,30(8):635-645.
[11]刘瑾,袁晓勇,袁戈恒,等.糖尿病患者高危足筛查及分级、干预规范流程的构建[J].中华糖尿病杂志,2017,9(5):281-285.
[12]姜雨婷,郭海玲,田润溪,等.艾灸治疗糖尿病高危足有效性的系统评价[J].护理研究,2017,31(22):2718-2724.
[13]李静.糖痛外洗方治疗老年糖尿病高危足的临床分析[J].实用中西医结合临床,2018,18(10):75-77.
[14]吴玉环,谭志雄,罗雪琴,等.中医临床护理路径结合视频健康教育在糖尿病高危足患者中的应用[J].国际医药卫生导报,2018,24(16):2477-2480.
[15]钟枢才.杵针学[M].北京:中国中医药出版社,2006:1-7.
[16]杨斐,钟磊,董远蔚,等.杵针治疗老年腰腿痛临床观察[J].实用中医药杂志,2018,34(9):1111-1112.
[17]谭薪兴,黄敏,郭梦,等.杵针疗法临床应用与研究进展[J].世界最新医学信息文摘(电子版),2018,18(55):47-48,51.
[19]李仕明.糖尿病足(肢端坏疽)检查方法及诊断标准(草案)[J].中国糖尿病杂志,1996,14(2):126.
[20]国际糖尿病足工作组/IDF顾问组,李翔.2007糖尿病足处置和预防实用指南[J].中国糖尿病杂志,2007,15(11):Ⅰ-Ⅲ.
[21]梁繁荣.针灸学[M].上海:上海科学技术出版社,2012:42-137.
[22]Inceu GV,Veresiu IA.Measurement of current perception thresholds using the Neurometer(?)-applicability in diabetic neuropathy[J].Clujul Med,2015,88(4):449-452.
[23]白亚娟.临床症状积分表在糖尿病周围神经病变筛查中的价值研究[D].杭州:浙江中医药大学,2015:9-11.
[24]王志平,熊英琼.电流感觉阈值检测仪的临床应用[J].江西中医药大学学报,2017,29(3):115-117.
[25]潘雪,顾峻菱,胡华斌,等.电流感觉阈值检测在2型糖尿病周围神经病变诊断中的应用[J].解放军医学杂志,2016,41(11):970-972.
[26]王天鹭,赵挺洋,赵诚炫,等.感觉神经定量检测在2型糖尿病下肢周围神经损伤中的临床研究[J].中华临床医师杂志(电子版),2015,9(15):2812-2815.
[27]李媛,曾克武,王学美,等.糖尿病相关脑微血管病变研究进展[J].中国中药杂志,2017,(12):2247-2253.
[28]邱春光,卢长青.糖尿病微血管病变发生机制研究现状[J].心血管病学进展,2007,28(1):13-14.
[29]于学江,王小梅.中药通心络对糖尿病微血管病变防治研究[J].辽宁中医杂志,2010,(2):281-283.
[30]衣运玲,姜军作,张萍.针刺三主穴对糖尿病周围神经病变患者氧化应激状态的影响[J].中华中医药学刊,2009,27(11):2385-2386.
[31]陈妮,沈卫东.针刺对气阴两虚型糖尿病周围神经病变患者的临床观察[J].辽宁中医杂志,2012,39(12):2476-2480.
[32]王芳,张留巧,蒋运兰,等.足部反射区按摩和中药浴足对中、高危糖尿病足患者生存质量的影响[J].护士进修杂志,2010,25(4):324-326.
[33]胡幼平,徐贞杰,吴佳,等.杵针疗法干预亚健康状态:随机对照研究[J].中国针灸,2012,32(11):1019-1022.
[34]金彩云,李美玲,陈明秀,等.黄芪桂枝五物汤通荣并治糖尿病高危病足的探讨[J].云南中医中药杂志,2018,39(6):12-14.
[35]刘宇.中药熏蒸治疗糖尿病高危足的中医护理研究[J].内蒙古中医药,2017,(15):162-163.
[36]毛奇.黄芪桂枝五物汤治疗老年糖尿病高危足的临床观察[J].中国现代药物应用,2017,11(11):187-188.
[37]蒋运兰,胡月,李颖馨,等.杵针疗法治疗腰腿痛有效性和安全性的系统评价[J].北京中医药,2018,(8):703-707.
[38]田琳,崔霞.浅析杵针疗法的临床应用[J].内蒙古中医药,2017,(2):143-144.
[39]刘栩豪,余洋,钟磊,等.杵针腰阳关八阵、河车命强段治疗腰痹病31例[J].中国针灸,2016,36(3):295-298.
[40]马秋艳,张敬华,牛俊岩,等.至阳八阵推拿联合赖氨葡锌治疗小儿厌食症的随机对照研究[J].针灸临床杂志,2017,33(8):45-48.
[41]马秋艳,张敬华,牛俊岩,等.命门八阵推拿联合赖氨葡锌颗粒治疗小儿慢性腹泻的临床研究[J].中国中医药信息杂志,2017,24(10):31-34.
[42]宋书昌,卢智,陈华,等.足三里穴证治机理探讨[J].中医临床研究,2013,5(22):38-40.
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