腰三针与常规针刺分别联合关节松动术治疗腰椎间盘突出症患者的疗效分析

<正>我国传统医学认为,腰椎间盘突出症( lumbar disc herniation, LDH)属于“痹症”、“腰痛”范畴,针灸治疗LDH的效果已得到肯定^[1]。腰三针作为“靳三针”学术体系中的一支,常用于治疗腰部疾病,但与关节松动术联合治疗LDH的研究较少。本研究以常规针刺联合关节松动术为对照,观察腰三针联合关节松动术对LDH患者的治疗效果,现报告如下。     

温针灸治疗压力性尿失禁效果观察

目的探讨温针灸治疗压力性尿失禁的效果。方法将90例压力性尿失禁患者随机分为功能锻炼组、针刺组、温针灸组，各30例。三组入院时均给予皮肤护理、情志调护、饮食处方、排尿训练等常规护理治疗。在此基础上，功能锻炼组、针刺组和温针灸组分别采用盆底肌肉功能锻炼和毫针刺法、温针灸治疗并比较疗效。结果三组治疗效果比较，差异有统计学意义（P〈0．01），温针灸组痊愈率最高、针刺组次之、功能锻炼组最低。结论温针灸治疗压力性尿失禁效果较好。     

温针灸治疗压力性尿失禁效果观察

目的 探讨温针灸治疗压力性尿失禁的效果.方法 将90例压力性尿失禁患者随机分为功能锻炼组、针刺组、温针灸组,各30例.三组入院时均给予皮肤护理、情志调护、饮食处方、排尿训练等常规护理治疗.在此基础上,功能锻炼组、针刺组和温针灸组分别采用盆底肌肉功能锻炼和毫针刺法、温针灸治疗并比较疗效.结果 三组治疗效果比较,差异有统计学意义(P＜0.01),温针灸组痊愈率最高、针刺组次之、功能锻炼组最低.结论 温针灸治疗压力性尿失禁效果较好.     

浮针结合针刺治疗腰椎间盘突出症50例

浮针是一种新兴的疗法,是在传统的中医针灸理论、阿是穴理论和腕踝针理论基础上发展而来。镇痛效果立竿见影,但有时维持时间不够长。为了发挥浮针疗法的镇痛优势而克服其不足之处,笔者运用浮针结合针刺治疗腰椎间盘突出症所致腰痛患者50例。现报道如下。     

从针灸"治神"临床推广谈医者个人德与能的修养

1"治神"临床推广引发的有关问题与思考 针灸治病以其适应症广泛、疗效迅速、治疗方便及安全无毒副作用等特点深受欢迎,国内外政府组织均加大了对针灸研究的资金投入,国际化的态势标志着针灸学进入了一个新的发展阶段."醒脑开窍"针刺法自从在国内外推广以来,收到了很好的临床效果,但也有很多地方的推广者,却难以达到同样的临床疗效,原因是什么呢?我将原因暂时归纳为以下两点:一是施术者对中医学中的"神"与"治神"思想认识不足,二是施术者针刺技术与个人综合素质较低.     

针刺结合经皮神经电刺激疗法治疗慢性腰痛的随机对照研究

目的评估针刺结合经皮神经电刺激疗法治疗慢性腰痛的效果。方法100例慢性腰痛患者随机分成4组:针刺组(ACP)、经皮神经电刺激组(TENS)、针刺+经皮神经电刺激组(A+T)、空白对照组(CT);疗程相同,1次/周,共治疗5次;评价标准采用视觉模拟评分(VAS)和汉译Roland-Mor-ris功能障碍调查表(CRMDQ)。结果前三组VAS和CRMDQ评分均降低;A+T尤为显著(P0.01)。结论慢性腰痛采用A+T比单用针刺或TENS更有效。     

空心针灸针治疗慢性腰腿痛106例疗效分析

目的:观察常规取穴配合空心针灸针针刺肾俞、膀胱俞、阿是穴加穴位注射治疗各种慢性腰腿痛的疗效。方法:将208例患者随机分为治疗组106例,对照组102例。治疗组接受常规针刺治疗,穴取肾俞、膀胱俞、阿是穴加穴位注射法,对照组接受普通针灸治疗,针刺点为肾俞、膀胱俞、阿是穴。两组均留针20mi n。结果:治疗组有效率为97.6%,对照组为86.3%,两组疗效差异有统计学意义(P<0.05)。结论:空心针治疗组的疗效优于普通针灸对照组。     

神经根型颈椎病针灸治疗的临床研究概述

近年来，神经根型颈椎病的发病率持续升高，且年轻化趋势越来越显著。针灸以其独特的技术优势被广泛应用于该病的治疗中，包括针刺、灸法、针刺与灸法并用、针灸结合其它治疗等。本文介绍了针刺治疗的选穴原则、辨证思路、针刺手法，创新的特种针法，同时结合电针、耳针、水针、穴位埋线、灸法、综合治疗进行全面分析，了解目前针灸治疗神经根型颈椎病的临床研究现状和优势，总结了存在的不足，为针灸治疗神经根型颈椎病提供参考。     

针灸治疗下腰痛疗效的Meta分析

目的 :对针灸治疗下腰痛(LBP)的临床疗效进行Meta分析。方法 :计算机检索2004年1月至2014年5月Pub Med、EMbase、The Cochrane Library、中国生物医学文献数据库(CBM)、中国知网(CNKI)、维普(VIP)和万方数据库(Wanfang Data),查找针灸与其他疗法比较治疗LBP患者疗效的随机对照试验(RCT),由2位评价员依据纳入排除标准分别独立筛选文献、提取资料和评价纳入研究的方法学质量后,通过Rev Man 5.2软件对治疗前后VAS、ODI、JOA、RMDQ等评分变化进行Meta分析。结果 :最终纳入10个RCT,共计751例患者。Meta分析结果显示:单纯针灸治疗组VAS评分改善优于非针灸治疗组[RR=-1.32;95%CI(-1.41,-1.22);Z=27.28;P0.000 01];单纯针灸治疗组ODI评分改善优于非针灸治疗组[RR=-5.07;95%CI(-7.50,-2.65);Z=4.10;P0.000 1];单纯针灸治疗组JOA评分改善优于非针灸治疗组[RR=2.83;95%CI(2.02,3.63);Z=6.90;P0.000 01];单纯针灸治疗组RMDQ评分改善优于非针灸治疗组[RR=-2.80;95%CI(-3.49,-2.11);Z=7.95;P0.000 01]。结论:单纯针灸疗法在改善下腰痛患者疼痛症状和腰部功能障碍方面具有一定的疗效和优势。     

以甦醒穴为主针刺对一氧化碳中毒150例临床观察

目的:以甦醒穴为主,早期针灸干预,治疗一氧化碳中毒意识障碍患者.观察针刺综合疗法治疗一氧化碳中毒疗效.方法:将90例一氧化碳中毒患者随机分成针刺组和常规组,针刺组60例(在常规治疗基础上加用针法),常规组30例.两组在发病后治疗7天,将两组治疗率和Glasgow- pittsburgh评分、意识恢复时间变化作比较.结果:针刺组在恶有效率和清醒时间和Glasgow- pittsburgh评分改善均有显著疗效.针刺后护理对疗效有决定意义.结论:抓住最佳治疗时机,从整体上提高疗效,尽早配合针灸促醒,在常规治疗基础上配合针法治疗一氧化碳中毒行之有效的方法.     

薄氏腹针治疗黄褐斑的临床研究

目的：观察探讨薄氏腹针治疗黄褐斑的临床疗效及其机制。方法：90例女性黄褐斑患者随机分为腹针组、针刺组及对照组,每组30例,分别采用薄氏腹针、毫针、某品牌祛斑霜进行干预,结果数据采用SPSS17.0统计软件分析。结果：①临床观察发现,三组患者症状多数有不同程度的改善,但部分患者加重或无改善,且腹针疼痛程度较小甚至无痛,比较容易被患者接受,治疗过程中无明显不良反应出现;②腹针组皮损面积、颜色评分治疗前后均有显著性差异（P〈0.05）,针刺组皮损面积评分治疗前后有显著性差异（P〈0.05）、颜色评分治疗前后无显著性差异（P〉0.05）,对照组皮损面积、颜色评分治疗前后均无显著性差异（P〉0.05）,三组下降指数比较有显著性差异（P〈0.05）,腹针组下降指数最明显;③三组临床疗效比较有显著差异（P〈0.05）,腹针组疗效最显著。结论：薄氏腹针辨证治疗黄褐斑疗效显著,无明显不良反应。     

Acupuncture therapy for chronic lower back pain: a systematic review

INTRODUCTION

Chronic low back pain is a common condition affecting a significant proportion of the population and has large economic implications on the society. Acupuncture has grown in popularity as an alternative therapy for chronic low back pain. Recent National Institute for Health and Clinical Excellence (NICE) guidelines on low back pain offer a course of acupuncture as a baseline treatment option according to patient preference. The aim of this systematic review was to evaluate if this treatment option is justified in view of recent evidence available on the efficacy of acupuncture.

MATERIALS AND METHODS

Studies included were identified by a PubMed search for relevant, randomised, controlled trials on the 23 July 2009. A systematic review was performed.

RESULTS

Fifteen randomised controlled trials were identified. Of these, four met the eligibility criteria and were critically appraised. These trials suggest acupuncture can be superior to usual care in treating chronic low back pain, especially, when patients have positive expectations about acupuncture.

CONCLUSIONS

NICE guidelines of a course of acupuncture, offered according to patient preference as a treatment option for chronic low back pain, are justified.     

针刺对输尿管镜钬激光碎石术后疼痛及住院天数的影响

目的:观察针刺对输尿管镜钬激光碎石术后疼痛及住院天数等的影响。方法:选取泌尿外科需行输尿管镜钬激光碎石术住院患者100例,简单随机分为治疗组和对照组各50例,对照组采用常规手术方案,治疗组在常规手术的基础上术中加入针刺(气冲穴、足五里穴、曲泉穴)治疗,观察患者术后疼痛、术后满意率、住院天数等的差异。结果:治疗组的术后6 h、24 h疼痛量表评分分别为(1.50±0.82)分、(0.90±0.96)分,明显低于对照组的(2.47±1.20)分、(1.77±1.04)分(P<0.05);治疗组术后较为满意及非常满意患者共37例,对照组仅11例,治疗组满意度明显高于对照组(P<0.05);治疗组住院时间为(1.97±0.85)d,明显短于对照组的(3.00±0.95)d(P<0.05),均有统计学差异。结论:针刺运用于输尿管镜碎石术,能有效减少术后疼痛,减少患者术后恢复时间,缩短住院天数,是一种安全、有效、经济的方法,值得临床推广应用。     

The effect of pre-emptive acupuncture treatment on analgesic requirements after day-case knee arthroscopy

The role of acupuncture analgesia in the management of postoperative pain is yet to be clearly evaluated. We conducted a prospective, double-blind, randomised controlled study to evaluate the effect of acupuncture pretreatment on the analgesic requirement after knee arthroscopy. Forty-two patients presenting for unilateral knee arthroscopy were randomly allocated to receive a standard anaesthetic with or without acupuncture (given after the induction of anaesthesia). Visual analogue pain scores, time to first postoperative analgesia and total analgesia requirement in the first 24 h were recorded. There was no significant difference between the two groups in any of the outcome measures. We conclude that acupuncture analgesia has no additional effect when given under anaesthesia to patients undergoing knee arthroscopy.     

针刺缓解术后疼痛的文献计量学分析

目的 分析针刺缓解术后疼痛相关随机对照试验（RCT）的研究现状。
方法 检索PubMed、Cochrane、Embase、Web of Science、CBM和CNKI数据库,获取从建库至2019年5月收录的相关文献。
结果 纳入针刺缓解术后疼痛的RCT文献共198篇,研究者主要来自中国（66.7%）,多分布于麻醉科（30.3%）、针灸科（12.9%）、肛肠科（6.5%）。电针（46.5%）最为常用,针刺穴位多选用合谷（30.3%）、足三里（25.3%）和内关（18.7%）。92.4%的研究证实针刺可以缓解术后疼痛;仅8.6%的研究提及试验注册;37.4%的研究提及针刺操作者资质。电针缓解术后疼痛的有效率高于手捻针,而在减少镇痛药用量、延缓首次用药时间及降低术后不良反应发生率方面,其有效率均低于手捻针。73.7%的研究因样本量估算不达标而被评估为高偏倚风险。
结论 针刺缓解术后疼痛的RCT在试验注册、操作者资质、针刺操作细节等方面报告率较低,不同针刺技术缓解术后疼痛各具优劣,后续研究可参考CONSORT 2010和STRICTA提高证据报告质量,同时开展不同针刺技术的疗效比较研究,以寻找最佳镇痛方案。     

A systematic review on the effectiveness of complementary and alternative medicine for chronic non-specific low-back pain

The purpose of this systematic review was to assess the effects of spinal manipulative therapy (SMT), acupuncture and herbal medicine for chronic non-specific LBP. A comprehensive search was conducted by an experienced librarian from the Cochrane Back Review Group (CBRG) in multiple databases up to December 22, 2008. Randomised controlled trials (RCTs) of adults with chronic non-specific LBP, which evaluated at least one clinically relevant, patient-centred outcome measure were included. Two authors working independently from one another assessed the risk of bias using the criteria recommended by the CBRG and extracted the data. The data were pooled when clinically homogeneous and statistically possible or were otherwise qualitatively described. GRADE was used to determine the quality of the evidence. In total, 35 RCTs (8 SMT, 20 acupuncture, 7 herbal medicine), which examined 8,298 patients, fulfilled the inclusion criteria. Approximately half of these (2 SMT, 8 acupuncture, 7 herbal medicine) were thought to have a low risk of bias. In general, the pooled effects for the studied interventions demonstrated short-term relief or improvement only. The lack of studies with a low-risk of bias, especially in regard to SMT precludes any strong conclusions; however, the principal findings, which are based upon low- to very-low-quality evidence, suggest that SMT does not provide a more clinically beneficial effect compared with sham, passive modalities or any other intervention for treatment of chronic low-back pain. There is evidence, however, that acupuncture provides a short-term clinically relevant effect when compared with a waiting list control or when acupuncture is added to another intervention. Although there are some good results for individual herbal medicines in short-term individual trials, the lack of homogeneity across studies did not allow for a pooled estimate of the effect. In general, these results are in agreement with other recent systematic reviews on SMT, but in contrast with others. These results are also in agreement with recent reviews on acupuncture and herbal medicine. Randomized trials with a low risk of bias and adequate sample sizes are direly needed.     

The effectiveness of acupuncture in the management of acute and chronic low back pain. A systematic review within the framework of the Cochrane Collaboration Back Review Group.

STUDY DESIGN: A systematic review of randomized controlled trials. OBJECTIVES: To evaluate the efficacy and effectiveness of acupuncture for the management of nonspecific low back pain. SUMMARY OF BACKGROUND DATA: Acupuncture is one of the oldest forms of therapy, but little is known about the effectiveness of acupuncture for low back pain. METHODS: Randomized controlled trials were done to assess the effectiveness of all types of acupuncture treatment, which involves needling for subjects with nonspecific low back pain. Two reviewers blinded with respect to authors, institution, and journal independently assessed the methodologic quality of the studies. Because data were statistically and clinically too heterogeneous, a qualitative review was performed. The evidence was classified into four levels: strong, moderate, limited, or no evidence. RESULTS: Eleven randomized controlled trials were included. Overall, the methodologic quality was low. Only two studies met the preset "high quality" level for this review. No study clearly evaluated acupuncture for acute low back pain. The results indicate that there was no evidence showing acupuncture to be more effective than no treatment. There was moderate evidence indicating that acupuncture is not more effective than trigger-point injection or transcutaneous electrical nerve stimulation, and there was limited evidence that acupuncture is not more effective than placebo or sham acupuncture for the management of chronic low back pain. CONCLUSIONS: Because this systematic review did not clearly indicate that acupuncture is effective in the management of back pain, the authors would not recommend acupuncture as a regular treatment for patients with low back pain. There clearly is a need for more high-quality randomized controlled trials.     

围术期针刺应用的穴位选择现状分析

背景 针灸应用于包括疼痛在内的多种疾病历史悠久,近年来,针刺应用于围术期得到广泛重视,而针刺应用于围术期的关键是合理选穴. 目的 对近年来针刺在围术期应用中穴位选择的理论依据及临床应用进展进行回顾和总结,为针刺在围术期应用的后续研究提供借鉴. 内容 对针刺在围术期应用中穴位选择的理论依据和临床应用进展进行综述. 趋向 目前,针刺在围术期应用的穴位选择存在局限性,随着其应用方法的不断完善,针刺在围术期的临床应用效果必将得到提高.