放血联合针刺治疗急性痛风性关节炎临床研究
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摘要
目的:观察放血联合针刺治疗急性痛风性关节炎(AGA)的临床疗效。方法:将符合纳入标准的78例AGA患者随机分为治疗组38例和对照组40例。治疗组采用放血联合针刺治疗,对照组口服秋水仙碱片和依托考昔片,观察周期为1周。在治疗前、治疗后1 h、4 h、1 d(疗程第2日)、3 d、7 d(全疗程结束之后次日)6个时间点进行疼痛强度自我评定以及功能障碍、红肿、拒按程度等评定;治疗前以及疗程结束后次日晨检测血尿酸(SUA)。结果:治疗后1 h,治疗组各种症状积分均降低,和治疗前比较有明显好转(P<0.05),与对照组比较差异有统计学意义(P<0.05);从治疗后4 h开始,对照组的疼痛较治疗前改善(P<0.05),红肿、功能障碍等症状较治疗组改善不明显;疗程结束时,两组SUA水平均较治疗前下降(P<0.05),但未达到正常水平。结论:放血联合针刺能迅速改善AGA红、肿、热、痛的急迫症状,在1 h即时疗效上优势明显。
Objective:To observe the clinical efficacy of bloodletting combined with acupuncture on the treatment of acute gouty arthritis(AGA). Methods:Seventy eight patients with AGA meeting the inclusion criteria were randomly assigned to a treatment group with 38 patients and a control group with 40 patients.The treatment group was treated with bloodletting combined with acupuncture,while the control group was given colchicine and etoricoxib tablets for oral administration. The observation period was 1 week. Pain intensity self-assessment and degrees of dysfunction,redness,and nay to be pressed were evaluated at 6 time points,before treatment,1 h,4 h,1 d(the 2 nd day of treatment),3 d,7 d(the next day after the end of the treatment) after treatment. Serum uric acid(SUA) was measured before treatment and the morning after the end of treatment. Results:At 1 h after the treatment,the scores of various symptoms in the treatment group decreased,and there was a significant improvement compared with before treatment(P<0.05). Four hours after treatment,the pain in the control group was relieved more than before treatment(P<0.05). The symptoms of redness and dysfunction were not significantly improved compared with the treatment group. At the end of the treatment,the SUA level of the two groups decreased compared with before treatment(P<0.05),but did not reach normal level. Conclusion:Bloodletting combined with acupuncture can quickly improve the acute symptoms of redness,swollen,hot and pain in AGA,and the effect is obvious in 1 h.
Objective:To observe the clinical efficacy of bloodletting combined with acupuncture on the treatment of acute gouty arthritis(AGA). Methods:Seventy eight patients with AGA meeting the inclusion criteria were randomly assigned to a treatment group with 38 patients and a control group with 40 patients.The treatment group was treated with bloodletting combined with acupuncture,while the control group was given colchicine and etoricoxib tablets for oral administration. The observation period was 1 week. Pain intensity self-assessment and degrees of dysfunction,redness,and nay to be pressed were evaluated at 6 time points,before treatment,1 h,4 h,1 d(the 2 nd day of treatment),3 d,7 d(the next day after the end of the treatment) after treatment. Serum uric acid(SUA) was measured before treatment and the morning after the end of treatment. Results:At 1 h after the treatment,the scores of various symptoms in the treatment group decreased,and there was a significant improvement compared with before treatment(P<0.05). Four hours after treatment,the pain in the control group was relieved more than before treatment(P<0.05). The symptoms of redness and dysfunction were not significantly improved compared with the treatment group. At the end of the treatment,the SUA level of the two groups decreased compared with before treatment(P<0.05),but did not reach normal level. Conclusion:Bloodletting combined with acupuncture can quickly improve the acute symptoms of redness,swollen,hot and pain in AGA,and the effect is obvious in 1 h.
引文
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[15]吕凯露,夏有兵,程洁,等.刺血疗法对急性痛风性关节炎大鼠局部抗炎因子的影响[J].中国康复理论与实践,2015,21(3):276-279.
[16]孙益,童培建,李象钧,等.循经论治急性痛风性关节炎临床对照研究[J].中华中医药杂志,2016,31(7):2850-2852.
[17]崔文岚,吴蕊.王镁中西医结合分期辨治痛风经验[J]山东中医杂志,2016,35(6):551-553.
[18]解明月,张慧,王亚玲,等.基于细胞通路的针灸治疗类风湿关节炎镇痛、抗炎机制研究[J].中医药临床杂志,2017,29(10):1586-1588.
[19]欧阳晖,樊蓥,巩昌镇,等.美国阿片类药物危机与针灸发展的契机[J].中医药导报,2018,24(5):1-9.
[20]中华医学会风湿病学分会.原发性痛风诊断和治疗指南[J].中华风湿病学杂志,2011,15(6):410-413.
[2]田新平,曾小峰.加强痛风的长期规范化管理改善痛风患者的长远预后[J].浙江医学,2017,39(4):243-244.
[3]路杰,崔凌凌,李长贵.原发性痛风流行病学研究进展[J]中华内科杂志,2015,54(3):244-247.
[4]RICHETTE P,DOHERTY M,PASCUAL E,et al.2016updated EULAR evidence-based recommendations for the management of gout[J].Ann Rheum Dis,2017,1:29-42.
[5]杨澍,高秀清,高杉.抗痛风药不良反应文献分析[J].中国药房,2016,27(5):624-627.
[6]DOGHRAMJI P P,WORTMANN R L.Hyperuricemia and gout:new concepts in diagnosis and management[J].Postgrad Med,2012,124(6):98-109.
[7]中华医学会风湿病学分会.2016中国痛风诊疗指南[J]中华内科杂志,2016,55(11):892-899.
[8]安玉,刘志红.痛风诊断标准的演变及新标准解读[J].肾脏病与透析肾移植杂志,2016,25(2):165-169.
[9]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994:31-32.
[10]中华医学会内分泌学分会.高尿酸血症和痛风治疗中国专家共识[J].中华内分泌代谢杂志,2013,29(11):913-920.
[11]张瑾,丁健,吴华香.依托考昔和美洛昔康治疗急性痛风的疗效及安全性[J].中华老年医学杂志,2012,31(3):221-224.
[12]朱艳,俞红五,潘喻珍,等.刺血加艾灸治疗急性痛风性关节炎临床疗效观察[J].中国针灸,2015,35(9):885-888.
[13]黄祖波,周浩,王芹芹,等.钩针刺络放血结合磁圆梅针扣刺治疗急性痛风性关节炎62例即时效应的临床观察[J].四川中医,2016,34(11):194-195.
[14]孙许涛,张旭东,韩洁茹,等.补肾利湿法对急性痛风性关节炎大鼠IL-2、IL-16表达水平的影响[J].辽宁中医杂志,2015,42(8):1567-1569.
[15]吕凯露,夏有兵,程洁,等.刺血疗法对急性痛风性关节炎大鼠局部抗炎因子的影响[J].中国康复理论与实践,2015,21(3):276-279.
[16]孙益,童培建,李象钧,等.循经论治急性痛风性关节炎临床对照研究[J].中华中医药杂志,2016,31(7):2850-2852.
[17]崔文岚,吴蕊.王镁中西医结合分期辨治痛风经验[J]山东中医杂志,2016,35(6):551-553.
[18]解明月,张慧,王亚玲,等.基于细胞通路的针灸治疗类风湿关节炎镇痛、抗炎机制研究[J].中医药临床杂志,2017,29(10):1586-1588.
[19]欧阳晖,樊蓥,巩昌镇,等.美国阿片类药物危机与针灸发展的契机[J].中医药导报,2018,24(5):1-9.
[20]中华医学会风湿病学分会.原发性痛风诊断和治疗指南[J].中华风湿病学杂志,2011,15(6):410-413.