孙海凤+陈宇岚+侯霄雷

摘 要 目的：探討运动联合穴位按摩治疗社区糖尿病合并下肢动脉硬化闭塞症患者的效果。方法：选择伴有下肢动脉硬化闭塞症的糖尿病患者150例，随机分为社区管理组和运动干预组各75例。社区管理组进行常规糖尿病管理，运动干预组在社区管理基础上进行运动联合穴位按摩干预。分别比较两组在干预前和干预9、18个月后的跛行距离、动脉硬化指数（AI）、踝肱指数（ABI）、血管多普勒超声表现。结果：干预9个月时，运动干预组患者的跛行距离大于干预前和社区管理组（P<0.05）；AI小于干预前（4.82±1.61比5.28±1.30，P<0.05）。干预18个月时，运动干预组患者的跛行距离为（697±199）m，ABI为0.87±0.19，均大于社区管理组的（635±241）m和0.78±0.22（P<0.05）；AI、腘动脉内膜中层厚度均小于社区管理组（P<0.05）。干预前后社区管理组的跛行距离、ABI、内膜中层厚度比较差异均无统计学意义（P>0.05）。结论：对于糖尿病合并下肢动脉硬化闭塞患者应在常规社区管理基础上联合运动和穴位按摩进行干预，对患者症状改善和病情控制有积极意义。

关键词 下肢动脉硬化闭塞；糖尿病；运动疗法；穴位按摩

中图分类号：R587.1 文献标志码：A 文章编号：1006-1533（2017）02-0027-03

Effect of exercise combined with acupoint massage in the treatment of the diabetes mellitus with lower limb arteriosclerosis obliterans

SUN Haifeng1， CHEN Yulan1， HOU Xiaolei2（1.Sichuanbeilu Community Health Service Center of Hongkou District， Shanghai 200080， China； 2.Yueyang Integrated Traditional Chinese

and Western Medicine Hospital affiliated to Shanghai TCM University of Shanghai 200437， China）

ABSTRACT Objective： To investigate the effect of exercise combined with acupoint massage in the treatment of the diabetes mellitus with lower limb arteriosclerosis obliterans. Methods： One hundred and fifty cases of diabetes mellitus with lower limb arteriosclerosis obliterans were selected and randomly divided into a community management group and an exercise intervention group with 75 cases each. The community management group received the conventional diabetic management， while the exercise intervention group received the exercise combined with acupoint massage on the base of the community management. The claudication distance， atherogenic index（AI）， ankle brachial index（ABI）and expression of vascular Doppler ultrasound were compared on admission， after 9 and 18 months of intervention. Results： After intervention for 9 months， the claudication distance of the exercise intervention group was longer than those before intervention and the community management group（P<0.05）， AI was lower than that before intervention（4.82±1.61 vs 5.28±1.30， P<0.05）. After intervention for 18 months， claudication distance and ABI of the exercise intervention group were（697±199）m and 0.87±0.19， while those were （635±241）m and 0.78±0.22 in the community management group（P<0.05）. AI and popliteal artery intima-media thickness of the exercise intervention group were less than those of the community management group（P<0.05）. Claudication distance，ABI and intima-media thickness of the community management group were compared before and after the intervention and there were no significant differences（P>0.05）. Conclusion： The diabetic patients with lower limb arteriosclerosis obliterans should be intervened by exercise combined with acupoint massage based on the conventional community management， which has positive significance to the improvement of the symptoms and the control of the disease.

KEY WORDS diabetes management； arteriosclerosis obliterans； exercise therapy； acupoint massage

糖尿病管理是社区卫生服务中心的一项基本工作，其目的是减少并发症、降低死亡率、减少医疗费用和提高患者生活质量。目前，糖尿病的社区管理包括饮食、运动、药物控制及自我检测。对于不同阶段的糖尿病患者管理策略也应有所不同，如合并下肢动脉硬化闭塞症的糖尿病患者与单纯糖尿病患者在运动这一健康处方上理应有所差别。本研究旨在探讨运动联合穴位按摩对糖尿病合并下肢动脉硬化闭塞患者的影响，以期为此类糖尿病患者的社区管理提供新的思路。

1 资料与方法

1 . 1 一般资料

选择四川北路街道社区卫生服务中心2014年6月前糖尿病管理在册人员150例，均符合2011年《下肢动脉硬化闭塞症（ASO）（WS339-2011）》的诊断标准[1]：①年龄大于40岁；……