内热针松解术治疗腰椎间盘突出症的安全性研究

发布时间：2018-01-22 03:43

本文关键词： 内热针腰椎间盘突出症安全性高血压　出处：《中国人民解放军医学院》2016年硕士论文　论文类型：学位论文

【摘要】：目的：本研究通过使用内热针松解术治疗腰椎间盘突出症,观察内热针治疗后创伤对皮肤、对肌酶、粘稠度等血液相关指标以及对基本生命体征的影响,全面评价内热针松解术治疗腰椎间盘突出症的安全性,为临床规范化的开展此项治疗打下基础。方法：(1)选取2015年2月-12月解放军总医院康复医学中心病区及门诊收治的107例(年龄34岁至78岁)经影像学检查诊断为腰椎间盘突出症且病程在半年以上的患者作为研究对象。(2)内热针松解治疗：确定棘突位置,平L4-L5棘突向两侧各布两排针,分别取距棘突2cm(椎板),3cm(椎板横突交界),4cm(横突)定进针点,选择规格为1.1mm×10cm的内热针,针数10根,针距1.0-2.Ocm,加热至42度,治疗20min。(3)观察内热针治疗后对皮肤及全身的影响,计算不良反应的发生率。治疗前一天、治疗后12-24h、治疗后21天空腹抽血测定红细胞、红细胞压积、血红蛋白、白细胞、血小板、D-二聚体、肌酸激酶、乳酸脱氢酶、谷丙转氨酶、谷草转氨酶、肌酐及尿素氮,分析内热针治疗对肌酶、粘稠度等血液指标的影响。动态监测入室时、麻醉时、针刺时、治疗中及治疗后心率、呼吸、血压、血氧饱和度,分析内热针治疗对基本生命体征的影响。按有无高血压病分两组,高血压组48例,非高血压组59例,比较两组患者血压和心率的波动情况。(4)统计学分析：应用SPSS17.0统计软件进行数据分析,计量数据用均数±标准差表示,方差齐采用t检验,方差不齐采用秩和检验,计数数据采用卡方检验,以P0.05为差异有统计学意义。结果：(1)本研究中107例腰椎间盘突出症患者经内热针治疗后轻度不良反应的发生率为17.76%,无中重度不良事件发生。轻度不良反应中对皮肤的影响包括：淤血(5.6%),红肿(2.8%),出血(2.8%);其他：乏力(3.7%),口渴(2.8%)。(2)内热针治疗对相关血液指标的影响：治疗前、治疗后12-24h及治疗后21天红细胞、红细胞压积、血红蛋白、血小板、白细胞、D-二聚体检测结果比较差异无统计学意义(P0.05)；肌酸激酶、乳酸脱氢酶的检测结果比较差异无统计学意义(P0.05);谷丙转氨酶、谷草转氨酶、血肌酐、尿素氮的检测结果比较差异无统计学意义(P0.05)。(3)内热针治疗对生命体征的影响：所有患者在心电监护下顺利完成治疗,生命体征波动相对平稳,无心血管意外发生。心率、呼吸及血压在麻醉时和针刺时有轻度升高,但均在可控范围之内,一般于针刺(10-20)min后恢复至治疗前状态。高血压组与非高血压组不同时间点收缩压和舒张压比较差异有统计学意义(p0.05),心率比较差异无统计学意义(p0.05)。高血压组与非高血压组治疗过程中血压和心率的升高幅度比较差异无统计学意义(p0.05)。高血压组与非高血压组治疗过程中血压心率超过基础值20%的发生率比较差异无统计学意义(p0.05)。结论：(1)内热针治疗腰椎间盘突出症对皮肤损伤较小,对血液粘稠度、肌酶、肝酶等血液指标无明显影响,生命体征总体波动平稳,是一项安全性的治疗方法。(2)内热针治疗后不良事件的发生率低。个别患者针刺后可出现轻度皮下淤血、红肿、出血等现象,一般无需特殊处理可自行缓解。(3)高血压患者与血压正常患者内热针治疗的耐性程度相当,但考虑高血压患者基础血压相对较高且变异性大,因此对于此类患者应在内科治疗病情相对稳定的情况下谨慎进行。(4)提高安全性的措施有：治疗前停止抗凝、抗血小板治疗;治疗中严密心电监护,完善急救车内急救物品及药物齐全；拔针后应适当延长压迫时间或应用外用药物促进皮肤愈合及预防感染等。
[Abstract]:Objective: This study through the use of internal needle decompression of lumbar disc herniation, observe the heat after the treatment of skin wound, on muscle enzymes, blood viscosity index and the influence on the basic vital signs, comprehensive evaluation of the thermal safety solution of pine needle for treatment of lumbar disc herniation, clinical standardized to carry out this therapy. Methods: (1) a total of 107 cases of -12 months of February 2015 the PLA general hospital wards and outpatient rehabilitation medical center hospital (aged 34 to 78 years) diagnosed by imaging examination for patients with lumbar disc herniation and the duration of the disease in more than half of the year as the research object. (2) thermal needle loosening therapy: determine spinousposition, flat L4-L5 spinous process on both sides of the cloth to the two row, were taken from the spinous process (2cm, 3cm (lamina) at the junction of the transverse process, lamina) 4cm (transverse) set the entry point, choose the specifications for the internal needle 1.1mm * 10cm. Pin number 10 Root, stitch 1.0-2.Ocm, heated to 42 degrees, the treatment of 20min. (3) to observe the effect on the skin and body heat after the treatment, the incidence of adverse reactions is calculated. One day before treatment, 12-24h after treatment, after treatment 21 the fasting blood determination of erythrocyte, hematocrit, hemoglobin, white blood cells. Platelet, two D- dimer, creatine kinase, lactate dehydrogenase, alanine aminotransferase, aspartate aminotransferase, creatinine and urea nitrogen, analysis of thermal needle therapy on muscle enzymes, influence blood viscosity index. The dynamic monitoring of burglary, anaesthesia, acupuncture, treatment and after treatment of heart rate, respiration, blood pressure, blood oxygen saturation analysis of thermal effects on acupuncture treatment of basic vital signs. According to whether hypertension were divided into two groups, 48 cases of non hypertension group, hypertension group 59 cases, the fluctuation of blood pressure and heart rate were compared between the two groups. (4) statistical analysis: SPSS17.0 statistical software was used for data analysis The measurement data, with a mean standard deviation of that variance by t test, the missingvariance Wilcoxon test was used, count data using the chi square test, with P0.05 as the difference was statistically significant. Results: (1) in this study, 107 cases of patients with lumbar disc herniation by heat after the treatment of mild adverse reactions the incidence rate was 17.76%, no severe adverse events. Including the impact on the skin of mild adverse reactions: congestion (5.6%), red (2.8%), bleeding (2.8%); (3.7%) other: fatigue, thirst (2.8%). (2) the treatment effect on related blood indicators: heat treatment needle before and after the treatment of 12-24h and 21 days after treatment of red blood cells, hematocrit, hemoglobin, platelet, leukocyte, two D- dimer detection results showed no significant difference (P0.05); creatine kinase, lactate dehydrogenase assay results showed no significant difference (P0.05); alt, valley Grass transaminase, serum creatinine, urea nitrogen test results showed no significant difference (P0.05). (3) the treatment effect on the vital signs of the internal needle: all patients completed the treatment under ECG monitoring of vital signs, relatively stable, without cardiovascular accidents. Heart rate, respiration and blood pressure increased slightly in anesthesia and acupuncture, but in the controllable range, generally in acupuncture (10-20) min after the return to the state before treatment. The hypertension group and non hypertension group at different time points of systolic blood pressure and diastolic blood pressure were significantly difference (P0.05), no significant difference in heart rate (P0.05). Blood pressure and heart rate during the treatment hypertension group and non hypertension group increased rate had no significant difference (P0.05). Blood pressure and heart rate than the basic level there was no significant difference occurred in 20% of the treatment process of the hypertension group and non hypertension group Significance (P0.05). Conclusion: (1) thermal needle for treatment of lumbar disc herniation on the skin damage is small, on the viscosity of blood and muscle enzymes, had no significant effect on liver enzymes and blood index, vital signs overall steady, is a safe and effective therapeutic method. (2) after the treatment of bad heat the event rate is low. Some patients after acupuncture can have mild subcutaneous congestion, swelling, bleeding and other phenomena, generally without the need for special treatment can be relieved. (3) a considerable degree of tolerance in patients with hypertension and blood pressure in patients with normal heat needle treatment of hypertension, but considering the relatively high and large variation, so for such a patients should be relatively stable in the medical treatment condition cautious. (4) improve safety measures: before treatment to stop anticoagulation, antiplatelet therapy; treatment of close monitoring, improve the emergency emergency vehicle goods and drugs is complete After drawing the needle, the time of compression should be extended or the external use of drugs should be used to promote the healing of the skin and prevent infection.

【学位授予单位】：中国人民解放军医学院
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.9

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