杵针对糖尿病高危足患者震动感觉阈值和生活质量的影响
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摘要
目的:评价杵针对糖尿病高危足患者震动感觉阈值和生活质量的影响。方法:将糖尿病高危足患者132例随机分为观察组和对照组,每组66例。对照组采用糖尿病常规治疗和护理,观察组在对照组的基础上于至阳八阵、命门八阵、河车命强段、足三里、涌泉、三阴交、太溪穴位采用杵针疗法,杵针干预每日1次,连续干预4周,干预后3个月和6个月随访。分别于干预前、干预后比较两组足部震动感觉阈值(VPT);干预前、干预后即刻、干预后3个月及6个月采用2型糖尿病生活质量评定量表修订版(DMQLS)比较两组生活质量,并评定两组临床疗效。结果:干预后两组患者震动感觉阈值及生活质量均有改善(P<0.01,P<0.05)。观察组干预后双足第一足趾趾腹和足背的VPT均低于同期对照组(均P<0.01)。观察组干预后即刻、干预后3个月和6个月DMQLS总分及各维度得分均低于同期对照组(P<0.01,P<0.05);重复测量方差分析结果显示两组DMQLS总分及各维度得分在时间、组间及交互效应中均有统计学意义(P<0.01,P<0.05),两组DMQLS总分及各维度得分均低于前一时间点(P<0.01,P<0.05)。观察组总有效率为100.0%(64/64),高于对照组的95.1%(59/62,P<0.05)。结论:杵针能降低糖尿病高危足患者的足部震动感觉阈值,改善足部感觉神经功能,提高生活质量。
Objective To evaluate the effects of the pestle needling therapy on the vibration perception threshold (VPT) and the quality of life (QOL) in the patients of high-risk diabetic foot. Methods A total of 132 patients of high risk diabetic foot were randomized into an observation group and a control group, 66 cases in each one. In the control group, the routine treatment and nursing for diabetes were applied. In the observation group, on the base of the treatment as the control group, the pestle needling therapy was used at Zhiyangbazhen, Mingmenbazhen, Hechemingqiangduan, Zusanli (ST 36), Yongquan (KI 1), Sanyinjiao (SP 6) and Taixi (KI 3). The intervention with the pestle needling therapy was given once every day, consecutively for 4 weeks. The follow-up visit was conducted in 3 months and 6 months after the intervention. Vibration perception threshold (VPT) was observed before and after intervention in the two groups. Separately, before intervention, at the end of intervention, 3 months after intervention and 6 months after intervention, the type 2 diabetes mellitus quality life scale (DMQLS), the revised edition was adopted to compare the QOL between the two groups. The effects were evaluated in the two groups. Results After intervention, the VPT and QOL were all improved in the two groups (P<0.01, P<0.05). In the observation group, after intervention, VPT at the first toes and the dorsum of the feet was lower than the control group at the same time point (all P<0.01). In the observation group, the total scores and the score of each dimension item in the DMQLS of the revised edition were all lower than the control group correspondently at the end of intervention, 3 months after intervention and 6 months after intervention (P<0.01, P<0.05). The repeated ANOVA results showed that the differences were significant in the total scores and the score of each dimension in the aspects of time, inter-group and interaction effect (P<0.01, P<0.05). The total scores and score of each dimension item in the DMQLS were lower than those the earlier time point (P<0.01, P<0.05). The total effective rate was 100.0% in the observation group, which was superior to 95.1% (59/62) in the control group (P<0.05). Conclusion The pestle needling therapy reduces the foot VPT and improves the sensory nerve function of the foot and the QOL in the patients of high-risk diabetic foot.
Objective To evaluate the effects of the pestle needling therapy on the vibration perception threshold (VPT) and the quality of life (QOL) in the patients of high-risk diabetic foot. Methods A total of 132 patients of high risk diabetic foot were randomized into an observation group and a control group, 66 cases in each one. In the control group, the routine treatment and nursing for diabetes were applied. In the observation group, on the base of the treatment as the control group, the pestle needling therapy was used at Zhiyangbazhen, Mingmenbazhen, Hechemingqiangduan, Zusanli (ST 36), Yongquan (KI 1), Sanyinjiao (SP 6) and Taixi (KI 3). The intervention with the pestle needling therapy was given once every day, consecutively for 4 weeks. The follow-up visit was conducted in 3 months and 6 months after the intervention. Vibration perception threshold (VPT) was observed before and after intervention in the two groups. Separately, before intervention, at the end of intervention, 3 months after intervention and 6 months after intervention, the type 2 diabetes mellitus quality life scale (DMQLS), the revised edition was adopted to compare the QOL between the two groups. The effects were evaluated in the two groups. Results After intervention, the VPT and QOL were all improved in the two groups (P<0.01, P<0.05). In the observation group, after intervention, VPT at the first toes and the dorsum of the feet was lower than the control group at the same time point (all P<0.01). In the observation group, the total scores and the score of each dimension item in the DMQLS of the revised edition were all lower than the control group correspondently at the end of intervention, 3 months after intervention and 6 months after intervention (P<0.01, P<0.05). The repeated ANOVA results showed that the differences were significant in the total scores and the score of each dimension in the aspects of time, inter-group and interaction effect (P<0.01, P<0.05). The total scores and score of each dimension item in the DMQLS were lower than those the earlier time point (P<0.01, P<0.05). The total effective rate was 100.0% in the observation group, which was superior to 95.1% (59/62) in the control group (P<0.05). Conclusion The pestle needling therapy reduces the foot VPT and improves the sensory nerve function of the foot and the QOL in the patients of high-risk diabetic foot.
引文
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[3]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.
[4]Schaper NC,Van Netten JJ,Apelqvist J,et al.Prevention and management of foot problems in diabetes:a summary guidance for daily practice 2015,based on the IWGDF guidance documents[J].Diabetes Res Clin Pract,2017,124:84-92.
[5]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.
[6]钟枢才.杵针学[M].北京:中国中医药出版社,2006.
[7]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):1019-1023.
[8]马秋艳,张敬华,牛俊岩,等.至阳八阵穴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.
[9]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.
[10]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.
[11]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,1996,4(2):126.
[12]国际糖尿病足工作组/IDF顾问组.2007糖尿病足处置和预防实用指南[J].中国糖尿病杂志,2008,16(1):63-64.
[13]Yeboah K,Puplampu P,Boima V,et al.Peripheral sensory neuropathy in type 2 diabetes patients:a case control study in Accra,Ghana[J].J Clin Transl Endocrinol,2016,5:26-31.
[14]Garrow AP,Boulton AJ.Vibration perception threshold-a valuable assessment of neural dysfunction in people with diabetes[J].Diabetes Metab Res Rev,2006,22(5):411-419.
[15]付陈超.2型糖尿病患者生活质量量表的修订与考评[D].长沙:中南大学,2010.
[16]高明松,彭聪,谭燚.依帕司他联合甲钴胺对糖尿病周围神经病变患者震动感觉阈值的影响[J].广东医学,2012,33(3):408-409.
[17]刘丽.糖尿病高危足患者生存质量及其影响因素分析[J].中南医学科学杂志,2013,41(6):642-644.
[18]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.
[19]Jiang Y,Ran X,Jia L,et al.Epidemiology of Type 2 Diabetic Foot Problems and Predictive Factors for Amputation in China[J].Int J Low Extrem Wounds,2015,14(1):19-27.
[20]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.
[21]Azzopardi K,Gatt A,Chockalingam N,et al.Hidden Dangers revealed by misdiagnosed diabetic neuropathy:a comparison of simple clinical tests for the screening of vibration perception threshold at primary care level[J].Prim Care Diabetes,2017,10:1-5.
[22]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.
[23]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.
[24]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.
[25]Lai FC,Chen IH,Chen PJ,et al.Acupressure,Sleep and Quality of Life In Institutionalized Older Adults:A Randomized Controlled Trial[J].J Am Geriatr Soc,2017,65(5):e103-e108.
[26]袁旭,蔡定均,赵纪岚,等.电针对慢性情绪应激焦虑大鼠中枢5-HT含量及其代谢物水平的影响[J].时珍国医国药,2014,25(11):2787-2789.
[27]张茵,赵雅莉,徐蕾,等.情绪释放疗法对老年2型糖尿病患者自我效能的影响[J].中华护理杂志,2017,52(10):1207-1210.
[2]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.
[3]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.
[4]Schaper NC,Van Netten JJ,Apelqvist J,et al.Prevention and management of foot problems in diabetes:a summary guidance for daily practice 2015,based on the IWGDF guidance documents[J].Diabetes Res Clin Pract,2017,124:84-92.
[5]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.
[6]钟枢才.杵针学[M].北京:中国中医药出版社,2006.
[7]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):1019-1023.
[8]马秋艳,张敬华,牛俊岩,等.至阳八阵穴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.
[9]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.
[10]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.
[11]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,1996,4(2):126.
[12]国际糖尿病足工作组/IDF顾问组.2007糖尿病足处置和预防实用指南[J].中国糖尿病杂志,2008,16(1):63-64.
[13]Yeboah K,Puplampu P,Boima V,et al.Peripheral sensory neuropathy in type 2 diabetes patients:a case control study in Accra,Ghana[J].J Clin Transl Endocrinol,2016,5:26-31.
[14]Garrow AP,Boulton AJ.Vibration perception threshold-a valuable assessment of neural dysfunction in people with diabetes[J].Diabetes Metab Res Rev,2006,22(5):411-419.
[15]付陈超.2型糖尿病患者生活质量量表的修订与考评[D].长沙:中南大学,2010.
[16]高明松,彭聪,谭燚.依帕司他联合甲钴胺对糖尿病周围神经病变患者震动感觉阈值的影响[J].广东医学,2012,33(3):408-409.
[17]刘丽.糖尿病高危足患者生存质量及其影响因素分析[J].中南医学科学杂志,2013,41(6):642-644.
[18]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.
[19]Jiang Y,Ran X,Jia L,et al.Epidemiology of Type 2 Diabetic Foot Problems and Predictive Factors for Amputation in China[J].Int J Low Extrem Wounds,2015,14(1):19-27.
[20]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.
[21]Azzopardi K,Gatt A,Chockalingam N,et al.Hidden Dangers revealed by misdiagnosed diabetic neuropathy:a comparison of simple clinical tests for the screening of vibration perception threshold at primary care level[J].Prim Care Diabetes,2017,10:1-5.
[22]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.
[23]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.
[24]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.
[25]Lai FC,Chen IH,Chen PJ,et al.Acupressure,Sleep and Quality of Life In Institutionalized Older Adults:A Randomized Controlled Trial[J].J Am Geriatr Soc,2017,65(5):e103-e108.
[26]袁旭,蔡定均,赵纪岚,等.电针对慢性情绪应激焦虑大鼠中枢5-HT含量及其代谢物水平的影响[J].时珍国医国药,2014,25(11):2787-2789.
[27]张茵,赵雅莉,徐蕾,等.情绪释放疗法对老年2型糖尿病患者自我效能的影响[J].中华护理杂志,2017,52(10):1207-1210.