摘要
目的：
慢性盆腔炎是妇科常见病、多发病,其发病率有逐年上升的趋势,且病情顽固,病程较长,迁延反复,严重影响了女性的身心健康和正常生活。针灸治疗慢性盆腔炎相关症状具有悠久的历史,穴位埋线是近年来兴起的新型治疗方法,在穴位内注入羊肠线,通过羊肠线在体内吸收而产生—系列复杂作用,起到治疗疾病的作用。穴位埋线既保留了针灸的优势,又可延长每个穴位刺激时间,缩短病人治疗时间,临床疗效肯定。本课题采用穴位埋线治疗慢性盆腔炎,观察穴位埋线与常规针刺治疗慢性盆腔炎的临床疗效差别,为穴位埋线治疗本病提供依据。
方法：
采用随机、对照的临床试验研究方法,按照电脑随机生成数字奇数分配到穴位埋线组,偶数分配至常规针刺组进行对照研究。穴位埋线组选穴：分为两组,①气海、归来、肝俞,②关元、次髎、血海(归来、肝俞、次髎、血海均为双侧,两组交替使用)。隔10日埋线一次,埋线3次为一疗程。如恰为女性月经期,则顺延至月经干净后的次日进行埋线。治疗两个疗程后检测相关指标,评价疗效。常规针刺组选穴同埋线组,隔日治疗一次,女性月经期间停针,10次为一疗程,间歇一天后继续下一疗程,治疗2个月后进行评价疗效。观察指标及疗效评定参照国家中医药管理局2002年制定的《中药新药临床研究指导原则》中“慢性盆腔炎诊断标准”。
结果：
本研究所有病例均来自台湾元品中医诊所,观察70例慢性盆腔炎患者,共完成64例病例观察,穴位埋线组33例,常规针刺组31例。通过对患者基线资料的比较,(P>0.05),两组患者基线资料具有可比性。
1.治疗前后中医症状积分比较：治疗1月后,比较穴位埋线组与常规针刺组治疗前后中医症状积分,穴位埋线组治疗后较治疗前症状积分有明显降低,经t检验,(P<0.001=,差异具有显著统计学意义；常规针刺组治疗后较治疗前症状积分有明显降低,经t检验,(P<0.001),差异具有显著统计学意义；两组治疗后积分比较,(P<0.05),两组治疗前后积分的差值相比较,(P<0.05),差异均具有统计学意义,穴位埋线组相比于常规针刺组,对中医症状积分的改善更加明显。
2.治疗后中医症状复常率：穴位埋线组患者治疗后下腹疼痛复常率为63.33%,常规针刺组为51.72%；腰骶胀痛方面,穴位埋线组复常率为89.29%,常规针刺组复常率75.86%；带下量多,穴位埋线组复常率86.67%,常规针刺组29.41%；带下色黄复常率穴位埋线组为78.26%,常规针刺组复常率40.00%；带下味臭穴位埋线组复常率为71.43%,常规针刺组83.33%；神疲乏力方面,穴位埋线组复常率为73.08%,常规针刺组复常率为54.17%；低热起伏方面,穴位埋线组复常率为66.67%,常规针刺组100.00%；月经失调方面,穴位埋线组复常率17.65%,常规针刺组复常率为33.33%;经行腹痛加重穴位埋线组复常率为80.00%,常规针刺组复常率为70.59%；胸胁乳房胀痛复常率为85.00%,常规针刺组复常率为26.32%；经血暗红有血块方面,穴位埋线组复常率80.00%,常规针刺组复常率为66.67%。经χ2检验,P<0.05,差异有统计学意义。
3.治疗前后局部体征复常率比较：穴位埋线组患者治疗后子宫活动受限、压痛体征复常率为76.67%,常规针刺组为56.00%；穴位埋线组患者治疗后一侧附件增厚、压痛体征复常率为47.06%,常规针刺组为54.55%；穴位埋线组患者治疗后双侧附件增厚、压痛体征复常率为46.15%,常规针刺组为28.57%；穴位埋线组患者治疗后骶韧带增粗、压痛复常率为72.73%,常规针刺组为37.50%。经χ2检验,(P>0.05),差异无显著统计学意义。
4.治疗1月后两组总体疗效比较：治疗1月后穴位埋线组痊愈6例,占19.18%；显效17例,占51.52%；有效9例,占27.27%；无效1例,占3.03%。常规针刺组痊愈4例,占12.90%：显效6例,占19.35%：有效13例,占41.94%：无效8例,占25.81%。经卡方分析,(P<0.05),差异具有统计学意义,穴位埋线组的疗效均优于常规针刺组。
5.治疗后两组患者各证型间疗效比较：治疗1月后,穴位埋线组属于湿热瘀结型患者共计17例,痊愈2例,显效10例,有效5例,无效0例；常规针刺组属于湿热瘀结型患者共计12例,痊愈1例,显效2例,有效7例,无效3例；经Ridit分析,(P>0.05),差异无统计学意义,对于湿热蕴结型患者,穴位埋线与常规针刺组疗效相当。穴位埋线组属于气滞血瘀型患者共计11例,痊愈3例,显效5例,有效3例,无效0例；常规针刺组属于气滞血瘀型患者共计12例,痊愈1例,显效2例,有效7例,无效2例；经Ridit分析,P<0.05,差异有统计学意义,对于气滞血瘀型患者穴位埋线组效果为优。穴位埋线组属于寒湿凝滞型患者共计5例,痊愈1例,显效2例,有效1例,无效1例;常规针刺组属于寒湿凝滞型患者共计12例,痊愈1例,显效2例,有效7例,；经Ridit分析,(P>0.05),差异无统计学意义,对于寒湿凝滞型,穴位埋线组与常规针刺组疗效相当。
6.不良反应：穴位埋线组共7人次局部出现皮下瘀血,1人次出现痛感持续超过2天,4人出现酸胀感持续超过2天。常规针刺组4人次针刺局部出现皮下血肿,2人出现酸胀感持续超过2天。两组患者不良反应经处理后均痊愈,无感染等明显后遗症。两组患者均未出现严重不良反应。
结论：
穴位埋线组及常规针刺组均可改善慢性盆腔炎患者中医症状积分,穴位埋线组较于常规针刺组,对中医症状积分的改善更明显。在改善下腹痛、腰胀痛、带下味臭、经行腹痛加重方面,两组复常率相当。穴位埋线组改善带下量多、带下色黄、神疲乏力、胸胁乳房胀痛等方面,复常率优于常规针刺组。常规针刺组在带下味臭,低热起伏,月经失调等方面,复常率优于穴位埋线组。在改善子宫活动受限、压痛,方面,骶韧带增粗、压痛方面,穴位埋线组复常率优于常规针刺组。在附件增厚、压痛(一侧或者双侧)方面,两组复常率差异不明显。穴位埋线组的痊愈率、显效率均优于常规针刺组。对于气滞血瘀型患者穴位埋线组效果为优。两组患者均未出现严重不良反应。
Objective
The chronic pelvic inflammation diease(C盆腔炎)is a common gynecological disease.It has a rising incidence, long course and is recurrent. C盆腔炎serious impact on the women's physical and mental health and normal life. Acupuncture used in treating C盆腔炎has long history in China. Catgut embedding therapy is a new treatment in rescent years. By embedding Catgut in selected acupoints, it stimulate the body, accelerate the metabolism through a complex progress and then can relieve syndromes of C盆腔炎.Catgut embedding therapy keeps the advantage of acupuncture and moxibustion, and prolong stimulate time for each point, shorten the patient treatment time, clinical curative effect for sure. To observe the clinical efficacy of treating Chronic Pelvie Inflammatory Disease respectively with Catgut embedding Therapy,Regular acupuncture.
Methods
All70cases were collected from Tai Wan Yuanpin Chinese hospital. After this research finish, we observed64cases,33in Catgut embedding Group and31in Regular Acupuncture Group. Baseline of two groups were compared and had no significant difference (P>0.05).(1) TCM symptom score before and after treatment:the treatment in January, TCM symptom score before and after treatment of acupoint catgut embedding group and the routine acupuncture group, catgut implantation at acupoint group after treatment than before treatment symptom score decreased significantly, by t test, P<0.001, the difference was statistically significant; routine acupuncture group after treatment compared with pre-treatment symptom score decreased significantly by t test, P<0.001, statistically significant difference, the routine acupuncture group one month after treatment can effectively reduce the chronic pelvic inflammatory disease in patients with traditional Chinese medicine symptom score; and two sets of points after treatment, P<0.05, the difference of the integrals in the two groups before and after treatment comparison, P<0.05, the differences were statistically significant, catgut implantation at acupoint group compared to conventional acupuncture group, TCM symptom score improvement is more apparent.(2) TCM symptoms after treatment, recovery rate:catgut implantation at acupoint group were abdominal pain after treatment, recovery rate of63.33%,51.72%in the routine acupuncture; lumbosacral tenderness aspects, catgut implantation at acupoint group recovery rate of89.29%. routine acupuncture recovery rate of75.86%; vaginal discharge volume, catgut implantation at acupoint review rate of86.67%,29.41%of the routine acupuncture group; acupoint catgut embedding group of vaginal discharge yellow normalization rate was78.26%, normalization of the routine acupuncture group rate of40.00%; taken off the bad taste acupoint catgut implantation group was71.43%,83.33%of the routine acupuncture group; Shenpi fatigue aspects of acupoint catgut embedding group recovery rate of73.08%, the routine acupuncture group recovery rate of54.17%; low heat terms of ups and downs, the acupoint catgut embedding group complex regular rate of66.67%,100.00%of the routine acupuncture group; negative menstrual disorders, catgut implantation at acupoint recovery rate of17.65%, the routine acupuncture group recovery rate of33.33%; increase the line of abdominal pain acupuncture points catgut embedding group recovery rate of80.00%, the routine acupuncture group recovery rate of70.59%; Xiong Xie breast tenderness recovery rate of85.00%, the routine acupuncture group recovery rate of26.32%; blood dark blood clots aspects acupoint catgut embedding group normalization rate of80.00%, the routine acupuncture group recovery rate of66.67%. X2test, P<0.05, statistically significant differences.(3) Local signs of recovery rate before and after treatment:catgut implantation at acupoint group after the treatment of uterine activity limitation, tenderness, signs of recovery rate of76.67%, routine acupuncture was56.00%; acupoint catgut embedding group after the treatment side of the annex to increase thick, tenderness Signs complex often was47.06%,54.55%in the routine acupuncture; acupoint catgut embedding group after the treatment of bilateral annex thickening, tenderness, signs of recovery rate of46.15%,28.57%in the routine acupuncture; catgut implantation at acupoint sacral ligament thickening in the group of patients after treatment, the tenderness recovery rate of72.73% 37.50%conventional acupuncture. x2test, P>0.05, the difference was statistically significant. The improvement of uterine activity is limited, tenderness, respect, sacral ligament thickening, tenderness aspects, catgut implantation at acupoint group normalization rate than the routine acupuncture group. Thickening in the attachment, tenderness (unilateral or bilateral), two groups of normal difference is not obvious.(4) Two groups after treatment in January, the overall efficacy:treatment in January acupoint catgut embedding group healed in6cases, accounting for19.18%; effective in17cases, accounting for51.52%; effective in nine cases, accounting for27.27%; and one cases, accounting for3.03%. Routine acupuncture group recovered four cases, accounting for12.90%; effective in6cases, accounting for19.35%; effective13cases, accounting for41.94%;8cases, accounting for25.81%. Ridit analysis, P<0.05, the difference was statistically significant, the acupoint catgut embedding group cure rate, markedly effective rate is better than the routine acupuncture group.(5) After treatment, between efficacy in patients with the syndrome types:treatment in January, the acupoint catgut embedding group belongs to the damp heat and junction in patients with a total of17cases,2cases recovered,10cases markedly effective in five cases, and0cases; conventional damp heat and junction in patients with a total of12cases in acupuncture group, recovered one cases, effective in two cases, effective in7cases,3cases; by Ridit analysis, P>0.05, the difference was not statistically significant, the heat Accumulation patients acupoint catgut embedding and routine acupuncture group efficacy. Acupoint catgut embedding group are a total of11cases of blood stasis in patients with cured three cases were cured,5cases,3cases effectively, and0cases; the routine acupuncture group belong to a total of12cases of patients with blood stasis type, recovered one cases two cases markedly effective in7cases, and two cases; Ridit analysis, P<0.05, the difference was statistically significant, and the acupoint catgut embedding group the average Ridit value0.3617, routine acupuncture group the average Ridit value of0.6268for the stagnation of qi blood stasis in patients with catgut implantation at acupoint group effect was excellent. Acupoint catgut embedding group belong to the cold and dampness stagnation type patients with a total of five cases, and recovered one cases, effective in two cases, the effective one cases and1case; routine acupuncture group belongs to the cold and dampness stagnation type patients with a total of12cases and recovered one cases were cured,2cases, effective in7cases; Ridit analysis, P>0.05, the difference was not statistically significant efficacy for the cold and dampness stagnation type, acupoint catgut embedding group and the routine acupuncture group.(6) Adverse reactions:catgut implantation at acupoint group of7people local ecchymosis, a person in pain continued over two days, four people a sense of soreness continued over two days. Routine acupuncture group (4people) acupuncture local subcutaneous hematoma, two people a sense of soreness continued over two days. Adverse reactions of the two groups of patients were cured after treatment, infection and other obvious sequelae. Two groups there were no serious adverse reactions.
Conelusion
Catgut embedding group and the routine acupuncture group can improve the TCM symptom score of patients with chronic pelvic inflammatory disease, and catgut implantation at acupoint group compared to the routine acupuncture group, TCM symptom score improved more significantly. In improving abdominal pain, lumbar pain, vaginal discharge, bad taste, line of abdominal pain aggravated aspects of the two sets of normalization rate. Acupoint catgut embedding group to improve the amount taken off, taken off the color yellow, Shenpi fatigue, Xiong Xie breast tenderness, etc., complex regular rate is better than the routine acupuncture group. The routine acupuncture group were taken off the bad taste, low thermal fluctuations, menstrual disorders, recovery in the rate of better than catgut implantation at acupoint group. The improvement of uterine activity is limited, tenderness, respect, sacral ligament thickening, tenderness aspects, catgut implantation at acupoint group normalization rate than the routine acupuncture group. Thickening in the attachment, tenderness (unilateral or bilateral), two groups of normal difference is not obvious. Acupoint catgut embedding group cure rate, markedly effective rate is better than the routine acupuncture group. For the effect of blood stasis in patients with catgut implantation at acupoint group is superior. Two groups there were no serious adverse reactions.
引文
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