吴建华 鞠振国 王轶 张基栋 杨海燕 马超群

摘要：目的 觀察通脉穴贴膏联合前列地尔注射液治疗下肢动脉硬化闭塞症（ASO）的临床疗效。方法 将180例ASOⅡ期（间歇跛行期）患者按就诊先后顺序随机分为穴贴组、西药组、联合组，每组60例。各组均戒烟、饮食控制、适当运动，控制血糖、血压，停用降血脂、抗血凝药物。穴贴组予通脉穴贴膏，每次选双下肢具有治痿痹功效的穴位10～12个，交替敷贴，每日1次，连续40 d为1个疗程。西药组予前列地尔注射液10 μg，加生理盐水10 mL，静脉滴注，每日1次，15 d为1个疗程，连用2个疗程，疗程间隔10 d；联合组予通脉穴贴膏合前列地尔注射液，用法同上。观察3组临床疗效，治疗前后症状体征积分、踝肱指数、血脂及胫前、胫后、足背动脉血流峰值。结果 穴贴组总有效率为78.33%（47/60），西药组为80.00%（48/60），联合组为93.33%（56/60），联合组总有效率优于穴贴组和西药组（P<0.05），穴贴组与西药组比较差异无统计学意义（P>0.05）。3组治疗前后症状体征积分、踝肱指数比较差异有统计学意义（P<0.05，P<0.01），治疗后组间比较差异无统计学意义（P>0.05）。穴贴组、联合组治疗前后血脂比较差异有统计学意义（P<0.05）。3组治疗前后胫前、胫后、足背动脉血流峰值比较差异有统计学意义（P<0.05，P<0.01）。结论 通脉穴贴膏贴敷治疗ASO具有较好疗效，与前列地尔注射液疗效相当，可调节血脂、提高动脉血流量，二者联用疗效更佳。

关键词：下肢动脉硬化闭塞症；中医外治疗法；穴位贴敷；通脉穴贴膏

DOI：10.3969/j.issn.1005-5304.2017.09.008

中图分类号：R269.544 文献标识码：A 文章编号：1005-5304（2017）09-0030-05

Clinical Observation of Tongmai Acupoint Plaster Combined with Alprostadil Injection for Treatment of Lower Extremity Arteriosclerosis Obliterans WU Jian-hua， JU Zhen-guo， WANG Yi， ZHANG Ji-dong， YANG Hai-yan， MA Chao-qun， CHEN Li-xia （Xuzhou Hospital of Traditional Chinese Medicine， Xuzhou 221003， China）

Abstract： Objective To observe the efficacy of Tongmai Acupoint Plaster combined with Alprostadil injection for treatment of lower extremity arteriosclerosis obliterans （ASO）. Methods Totally 180 cases of ASO Ⅱ （intermittent claudication period） patients were randomly divided into acupoint sticking group， combination group， Western medicine group， with 60 cases in each group. All groups quit smoking， had diet control， proper exercise， control of blood sugar， stop hypolipidemic and anti-coagulation medicine. The acupoint sticking group was treated with Tongmai Acupoint Plaster， each selected with the efficacy of treatment of lower limbs paralysis acupoint 10-12， alternating dressing； dressing was changed 1 time a day， 40 day as a treatment course. Western medicine group was given Alprostadil injection 10 μg， with 10 mL of normal saline， intravenous infusion， once a day， 15 d as a treatment course， for two courses， with 10 d as interval. Combination group was treated with Tongmai Acupoint Plaster combined with Alprostadil injection， the same as the application method above. The clinical efficacy， the scores of symptoms and signs， the ankle brachial index， blood lipid， the peak value of blood flow in the tibial anterior，posterior tibial， and dorsalis pedis arteries were observed and compared between the 2 groups. Results The total effective rate was 78.33% （47/60） in the acupoint sticking group， 80.00% （48/60） in the Western medicine group， and 93.33% （56/60） in the combination group， with the combination group better than the acupoint sticking group and Western

基金项目：江苏省中医药科技项目（BY2015087）

medicine group （P<0.05）. There was no statistical significance between acupoint sticking group and Western medicine group （P>0.05）. There was statistical significance in scores of symptoms and signs， ankle brachial index before and after treatment in the three groups （P<0.05， P<0.01）； There was no statistical significance after treatment （P>0.05）. There was statistical significance in blood lipids before and after treatment in acupoint sticking group and combination group （P<0.05）. There was statistical significance in tibial anterior， posterior tibial， and dorsalis pedis artery peak before and after treatment in the three groups （P<0.05， P<0.01）. Conclusion Tongmai Acupoint Plaster has good efficacy in the treatment of ASO， equivalent with the efficacy of Alprostadil injection， which can regulate blood lipids and improve arterial blood flow. Ther combination of them has better efficacy.

Key words： lower extremity arteriosclerosis obliterans； TCM external therapy； acupoint application； Tongmai Acupoint Plaster

下肢动脉硬化闭塞症（arteriosclerosis obliterans，ASO）是由动脉粥样硬化引起的一种慢性闭塞性疾病。一般发生于下肢大中动脉，多见于40岁以上中老年人。早期主要临床表现为下肢麻木、肿胀、酸痛、发凉，进而出现间歇性跛行甚或静息痛，日久发生肢端溃疡、坏疽，病情严重者导致截肢或危及生命。我们采用通脉穴贴膏联合前列地尔注射液治疗本病，取得较好疗效，现报道如下。……