蛇蝎散加味治疗腰椎间盘突出症神经痛（寒湿型）临床疗效观察

发布时间：2019-02-11 10:39

【摘要】：目的:通过观察口服中药蛇蝎散加味在治疗腰椎间盘突出症神经痛(寒湿型)中的临床疗效,探讨其治疗腰椎间盘突出症神经痛的作用机制及临床运用价值。方法:选择前来安徽省中医院骨科门诊就诊的腰椎间盘突出症患者,通过严格筛选,纳入符合观察标准的患者60例,随机分成治疗组30例,对照组30例。对性别、年龄、病程、治疗前VAS、JOA评分进行统计学分析,排除差异性,治疗组给予口服蛇蝎散加味治疗,每日一剂(全蝎3g,蜈蚣3g,乌梢蛇10g,制附片10g,干姜10g,炙甘草15g,茯苓10g,白术10g,桂枝10g)温水冲服,早晚分服,连续服药14天;对照组采用腰痛宁胶囊治疗,每次3粒,每日3次,连续服药14天。对两组患者椎间盘突出导致的神经症状及对生活的影响情况进行记录、评分,对比观察两组药物总有效率、治疗前后VAS疼痛评分及JOA评分变化,对所记录数据进行整理,并作统计学分析。结果:在纳入临床观察的两组患者中,性别、年龄、病程、治疗前VAS疼痛评分及JOA下腰痛评分经统计学分析无差异,具有可比性。两组治疗前后组内VAS疼痛评分经统计学分析,P均小于0.01,说明两组治疗均有效;治疗后两组组间VAS评分统计学分析,P0.01,说明治疗后两组疼痛评分有差异;两组患者治疗前后VAS评分差值经统计学分析,显示P0.05,有统计学差异,提示了两组患者治疗后疼痛改善程度不同,治疗组疼痛减轻程度较对照组好;治疗前后两组组内JOA评分经统计学分析,P均小于0.01,说明两组治疗前后临床症状均有改善;治疗后两组组间JOA评分经统计学检验,P0.05,说明治疗后两组患者相关功能状态评分有差异;对两组患者治疗前后JOA评分的差值进行统计学分析,P0.01,差异有统计学意义,说明两组患者治疗后JOA评分有差异,两组患者临床改善程度不同,治疗组功能改善较对照组明显。口服蛇蝎散加味组患者中,治愈10人,显效12人,有效6人,总有效率为93.33%。口服腰痛宁胶囊的患者中,治愈6人,显效10人,有效9人,总有效率为83.33%。经秩和检验分析,Z=-3.17,P=0.020.05,统计学有差异,治疗组较对照组疗效显著。综合分析得出治疗组及对照组均取得明显的临床疗效,治疗效果均较满意,但治疗组疗效较于对照组更为理想。结论:经过临床疗效观察和统计学分析后,可以得出结论:蛇蝎散加味与腰痛宁胶囊均可在一定程度上减轻或消除寒湿型腰椎间盘突出症患者腰痛、下肢放射痛、麻木等神经症状,可明显改善患者生活质量,减轻患者痛苦,但蛇蝎散加味临床疗效更为显著,治疗后疼痛评分明显下降、JOA评分增加,治疗有效率高于腰痛宁组。通过后期观察随访,病人对治疗效果的满意度较高,日常生活工作基本不受影响。所以,我们可以说蛇蝎散加味在寒湿型腰椎间盘突出症患者的治疗中临床疗效较好,值得作为基础药物运用于适合保守的患者。
[Abstract]:Objective: to observe the clinical effect of snake and scorpion powder on the treatment of neuralgia of lumbar disc herniation (cold and wet type), and to explore the mechanism and clinical application value of the treatment of neuralgia of lumbar intervertebral disc herniation. Methods: 60 patients with lumbar disc herniation were selected from orthopedic outpatient department of Anhui traditional Chinese Medicine Hospital. 60 patients who met the observation criteria were selected and randomly divided into treatment group (n = 30) and control group (n = 30). Sex, age, course of disease, and VAS,JOA score before treatment were statistically analyzed, and the difference was excluded. The treatment group was treated with oral snake and scorpion powder, once a day (Scorpio 3g, centipede 3g, Wutiao snake 10g, appended tablet 10g, dried ginger 10g). Roasted liquorice 15g, Poria cocos 10g, Atractylodes macrocephala 10g, Guizhi 10g) warm water, morning and evening were taken separately and continuously for 14 days; The control group was treated with Yutongning capsule, 3 capsules per time, 3 times a day for 14 days. The neurological symptoms caused by intervertebral disc herniation and their influence on life were recorded and scored. The total effective rate, VAS pain score and JOA score before and after treatment were compared between the two groups, and the recorded data were sorted out. Statistical analysis was made. Results: there was no significant difference in sex, age, course of disease, VAS pain score and JOA low back pain score between the two groups. The VAS pain scores of the two groups before and after treatment were statistically analyzed (P < 0.01), which indicated that the two groups were effective, and the VAS scores of the two groups were statistically analyzed after treatment (P 0.01), which indicated that there were differences in the pain scores between the two groups after treatment. The difference of VAS score between the two groups before and after treatment showed a statistical difference (P0.05), which indicated that the pain improvement degree of the two groups was different after treatment, the pain relief degree of the treatment group was better than that of the control group. Before and after treatment, the JOA scores in the two groups were statistically analyzed, P < 0.01, indicating that the clinical symptoms of the two groups were improved before and after treatment. After treatment, the JOA scores of the two groups were statistically tested, P0.05, indicating that there were differences in the scores of the related functional status between the two groups after treatment. The difference of JOA score between the two groups before and after treatment was statistically analyzed, P0.01, the difference was statistically significant, which indicated that there were differences in JOA score between the two groups after treatment, and the clinical improvement degree of the two groups was different. The function improvement of the treatment group was more obvious than that of the control group. In the treated group, 10 patients were cured, 12 were effective and 6 were effective. The total effective rate was 93.33. Among the patients with Yutongning capsule, 6 were cured, 10 were markedly effective and 9 were effective. The total effective rate was 83.33. The results of rank sum test showed that the treatment group was more effective than the control group. Comprehensive analysis showed that both the treatment group and the control group had obvious clinical effect, and the therapeutic effect was satisfactory, but the curative effect of the treatment group was better than that of the control group. Conclusion: after clinical observation and statistical analysis, it can be concluded that both Shexiu Powder and Yutongning capsule can alleviate or eliminate low back pain and lower limb radiodynia in patients with cold and wet lumbar disc herniation to a certain extent. Numbness and other neurological symptoms can significantly improve the quality of life of patients and alleviate the pain of patients, but the clinical efficacy of Scorpio Powder is more significant. After treatment, the pain score decreased significantly, the JOA score increased, and the effective rate of treatment was higher than that of Yutongning group. Through later observation and follow-up, the patients' satisfaction with the therapeutic effect was higher, and their daily life and work were not affected. Therefore, we can say that snake and scorpion powder in the treatment of cold and wet lumbar disc herniation patients clinical efficacy is better, it is worthy of being used as a basic drug for conservative patients.
【学位授予单位】：安徽中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R274.9

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