陈为坚 陈奕雄

摘要目的：观察委中刺络放血疗法对腰椎术后综合征的治疗效果，同时探讨该法对凝血系统的影响。方法：选取2016年1月至2017年1月广东省第二人民医院收治的腰椎间盘突出症术后综合征患者90例，随机分为对照组和观察组，每组45例。对照组接受腰腹肌功能训练、局部热敷及物理因子理疗，观察组在上述治疗方案基础上于委中穴刺络放血，1次/d，出血量控制在3～5 mL。2组均连续治疗10 d，比较治疗前后2组患者腰痛评定量表（JOA）、改良口述分级评分法（VRS）评分变化，凝血功能指标的水平变化。结果：治疗后2组JOA较治疗前升高，差异有统计学意义（P<005），其中观察组在主观症状、体征改善方面较对照组明显，差异有统计学意义（P<005）。2组治疗前VRS评分差异無统计学意义（P>005），治疗后2组VRS评分均有所改善，其中观察观察组改善优于对照组，差异有统计学意义（P<005）。2组治疗后凝血系统均有明显改善，其中观察组优于对照组，差异有统计学意义（P<005）。结论：委中刺络放血可明显改善腰椎术后综合征的临床症状及体征，提高患者生命质量，其作用机制可能与改善患者血液流变学状态有关。

关键词腰椎间盘突出症；术后综合征；并发症；委中；放血；凝血系统；疗效；改良口述分级评分法；作用机制

Efficacy Observation of the Weizhong （B40） Bloodletting Puncture in Postoperative Syndrome

of Lumbar Intervertebral Disc Protrusion and the Impact on Coagulation

Chen Weijian1， Chen Yixiong2

（1 The Second People′s Hospital of Guangdong Province， Guangdong 510317， China； 2 Department of Rehabilitation， Hospital

of Integrated Chinese and Western Medicine， University of Southern Medical University， Guangdong 510317， China）

AbstractObjective：To observe the curative effect of the weizhong （B40） bloodletting puncture in postoperative syndrome of lumbar intervertebral disc protrusion， and simultaneously to discuss the impact on coagulation system. Methods：A total of 90 patients with lumbar intervertebral disc prolapse postoperative syndrome in our hospital from January 2016 to January 2017 were included in the study and randomly divided into control group and the observation group， with 45 cases in each group. The control group had lumbar and abdominal muscles functional training， local hot compress and physiotherapy of physical agents， and the observation group had the weizhong （B40） bloodletting puncture on the basis of the above treatment， once per day. The bleeding volume was controlled in 3 to 5 mL. Both of the two groups had continuous treatment for 10 days. Lumbar pain rating scale （Japanese Orthopaedic Association， JOA）， scores changes of modified verbal rating scale （VRS）， and the index level changes of coagulation function of two groups before and after treatment were compared. Results：1）After treatment， JOA in the two groups was higher than before treatment， and the differences were with statistically significant （P<005）. The improvement of observation group were more obviously than the control group in terms of subjective symptoms and signs， and the differences had statistical significance （P<005）.2）the VRS grading of the two groups were with no significant statistical differences before treatment （P>005）， and VRS grading of the two groups were both improved after treatment. The improved cases of the observation group was better than that of the control group （P<005）. 3）The coagulation system indexes of the two groups were obviously improved after treatment， and the observation group was better than that of control group. The differences were with statistically significant （P<005）. Conclusion：Bloodletting puncture of weizhong （B40） can obviously improve the clinical symptoms and signs of lumbar intervertebral disc prolapse postoperative syndrome， improve the life quality of patients. The mechanism may related to the improving of the blood rheology state in patients.

Key WordsPostoperative syndrome of lumbar intervertebral disc prolapse， Secondary syndrome； Weizhong （B40）； Bloodletting； Coagulation system； Curative effect； VRS； Mechanism of action

中图分类号：R245文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.05.047

外科手術是目前治疗腰椎间盘突出症的主要手段，约40%的患者在术后存在残留的神经症状[1]，患者由此出现腰腿痛、麻木、皮肤感觉异常等，严重影响患者生命质量。从中医学角度来说椎间盘突出症术后综合征属于“腰腿痛”“痹证”“骨痹”等范畴。元代医家朱震亨在其《丹溪心法·腰痛》中描述“腰痛在湿热、肾虚、瘀血、挫闪、痰积”，认为瘀血阻络，气机不畅，不通则痛是腰腿痛、麻木等症状的主要原因，因此，活血化瘀是治疗本病的原则。刺络放血以气血及经络为生理基础，正如《灵枢·寿夭刚柔》中说，久痹不去身者，视其血络，尽出其血。……