针刀结合火针治疗骶神经功能障碍综合征随机对照研究（英文）
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摘要
目的:为小针刀和火针联合阴部神经阻滞治疗骶神经功能障碍综合征(SNDS)患者的可行性和方案的改进提供依据。方法:将75例骶神经功能障碍综合征患者按照随机数字表随机分为治疗组(小针刀及毫火针治疗联合阴部神经阻滞)和对照组(阴部神经阻滞治疗)。经1个疗程治疗后,比较治疗前后肛门直肠疼痛的视觉模拟评分(VAS)、排便障碍、肛门失禁、腰痛或腰酸的VAS、腹胀和腹痛的VAS等指标评价疗效。结果:两组患者治疗前后组内在排便障碍(包括排便间隔、排便时间、粪便性质指数、排便困难程度指数)方面比较,差异均有统计学意义(均P<0.05),但治疗后两组间比较无统计学意义(均P>0.05)。两组患者治疗前后组内在肛门失禁、腰痛或腰酸、腹胀腹痛评分比较,差异均有统计学意义(均P<0.05),但治疗后两组间比较无统计学意义(均P>0.05)。两组患者治疗前后组内的肛门直肠痛VAS比较,差异均有统计学意义(均P<0.05),治疗后两组间比较,差异有显著统计学意义(1.61±0.95vs3.04±1.81,P<0.01)。治疗组总有效率高于对照组,差异有统计学意义(94.74 vs 81.08, P<0.01)。治疗后,两组之间满意度比较,差异无统计学意义(P>0.05)。结论:小针刀和火针联合阴部神经阻滞治疗骶神经功能障碍综合征能更有效减轻肛门直肠痛,提高总有效率。
Objective: To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome(SNDS). Methods: Seventy-five patients with SNDS were randomized into the treatment group(acupotomy and fire needle and pudendal nerve block therapy) and the control group(pudendal nerve block therapy). After a course of treatment, Visual Analogue Scales(VAS) of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result: Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group(all P < 0.05), but the differences of those indexes between two groups were not statistically significant(all P > 0.05) after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment(all P < 0.05). However, after treatment, the differences between two groups were not statistically significant(all P > 0.05). VAS scores of anorectal pain in the two groups were statistically different before and after the treatment(both P < 0.05), and that of the treatment group was statistically lower than control group after the treatment(1.61 ± 0.95 vs. 3.04 ± 1.81, P < 0.01), the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant(94.74% vs. 81.08%, P < 0.01), there was no difference in self-evaluation between the two groups(P > 0.05). Conclusion: In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.
Objective: To provide the clinical evidence to evaluate the feasibility and refine the protocol for acupotomy combined with fire needle and pudendal nerve block therapy in treatment of sacral nerve dysfunction syndrome(SNDS). Methods: Seventy-five patients with SNDS were randomized into the treatment group(acupotomy and fire needle and pudendal nerve block therapy) and the control group(pudendal nerve block therapy). After a course of treatment, Visual Analogue Scales(VAS) of anorectal pain, defecation disorders, anal incontinence, VAS of lumbar pain or soreness, VAS of abdominal distension and pain were compared before and after the treatment. Result: Scores of defecation disorders, including defecation interval time index, defecation time index, fecal property index and defecation difficulty index, of patients with SNDS in the two groups were statistically different before and after the treatment in the same group(all P < 0.05), but the differences of those indexes between two groups were not statistically significant(all P > 0.05) after the treatment,. Scores of anal incontinence, VAS scores of lumbar pain or soreness, VAS scores of abdominal pain and distension in the two groups were statistically different before and after the treatment(all P < 0.05). However, after treatment, the differences between two groups were not statistically significant(all P > 0.05). VAS scores of anorectal pain in the two groups were statistically different before and after the treatment(both P < 0.05), and that of the treatment group was statistically lower than control group after the treatment(1.61 ± 0.95 vs. 3.04 ± 1.81, P < 0.01), the total effective rate of the treatment group was higher than that of the control group, and the difference was statistically significant(94.74% vs. 81.08%, P < 0.01), there was no difference in self-evaluation between the two groups(P > 0.05). Conclusion: In treating SNDS, acupotomy combined with fire needle and pudendal nerve block therapy can more effectively alleviate anorectal pain and improve the total effective rate.
引文
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[10]Bharucha AE, Wald A, Enck P. Functional anorectal disorders. Gastroenterology2006;130(5):1510-18.
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[2]Chen SM, Yu QH. Anorectal disease complicated with anorectal neurosis. Shenzhen J Integr Tradit Chin West Med 2002;12(6):366-7.
[3]Rome Committee Functional gastrointestinal disorders:RomeⅢcriteria. Mod Dig Interv 2007;12(2):137-40.
[4]Yang JL, Li ZL, Ji WX, et al. Clinical analysis of perineal pain syndrome. Pain Clin J 2005;1(2):73-367.
[5]Mizuno S, Takebayashi T, Kirita T, et al. The effects of sympathetic nerves on lumber radicular pain:a behavioral and immunohistochemical study. J Bone Joint Surg Br 2007;89(12):1666-72.
[6]Haanpaa M, Attal N, Backonja M, et al. NeuPSIG guidelines on neuropathic pain assessment. Pain 2011;152(1):14-27.
[7]Jensen TS, Baron R, Haanpaa M, et al. A new definition of neuropathic pain.Pain 2011;152(10):2204-5.
[8]Zhang Y, Yu JB. Acupuncture for modern anesthesia. Int J Anesthesiol Resusc2013;34(2):145-9.
[9]Zhang J, Zhang N. Study on mechanisms of acupuncture analgesia. Chin Acupunct Moxib, 27(01):72-75.
[10]Bharucha AE, Wald A, Enck P. Functional anorectal disorders. Gastroenterology2006;130(5):1510-18.
[11]Van 0 L, Crowell M D, Drossman D A, et al. Biopsychosocial aspects of functional gastrointestinal disorders. Gastroenterology 2016;150(6):1355-67 e2.
[12]Han K, Yang BX, Song L, et al. The clinical feature analysis of perineal pain.Chin J Pain Med 2012;18(11):642-4.
[13]Wo CX, Sun LH, Wang W, et al. The application of combined therapy in the treatment of intractable anal perineal pain. J. Guizhou Med. Univ.2012;37(6):650-3.