毛彬　张莉　魏巍源

摘要 目的：探討养元活血汤联合温针灸治疗产后腰痛的临床效果。方法：选取2017年2月至2018年4月孝感市妇幼保健院收治的产后腰痛患者64例作为研究对象，按照随机数字表法分为对照组和观察组，每组32例，对照组患者单纯给予温针灸治疗;观察组患者则在对照组基础上加用养元活血汤内服，连续治疗2周为1个疗程。比较2组患者的临床效果，评估患者的腰部疼痛程度、功能障碍程度，采用SF-36生命质量表评价治疗前后的生命质量，检测血清中6-酮前列腺素Flα（6-Keto-PGFlα）、白细胞介素-1β（IL-1β）、降钙素基因相关肽（CGRP）、血栓素2（TXB2）水平。结果：观察组的有效率90.62%明显高于对照组的75.00%（P<0.05）;观察组患者的VAS、ODQ评分明显低于对照组（P<0.05）;2组患者的生命质量相关睡眠、精神、食欲、日常生活能力等评分较治疗前明显升高（P<0.05）;观察组患者的睡眠、精神、食欲、日常生活能力评分明显高于对照组（P<0.05）;2组患者的血清6-Keto-PGFlα水平较治疗前上升，IL-1β、CGRP、TXB2水平较治疗前下降（P<0.05）;观察组患者的血清6-Keto-PGFlα水平高于对照组;IL-1β、CGRP、TXB2水平均低于对照组（P<0.05）。结论：养元活血汤联合温针灸利于减轻产后腰痛患者的痛感，改善腰功能障碍，提高产后患者的生命质量，其起效的机制可能在于通过调控血清中6-Keto-PGFlα、IL-1β、CGRP、TXB2水平而改善血液微循环，抑制血小板聚集和血栓形成，抑制致炎物质，从而发挥镇痛作用。

关键词 产后腰痛;养元活血汤;温针灸;临床研究

Warming Needle Moxibustion Combined with Yangyuan Huoxue Decoction for the Treatment of Postpartum Backache

MAO Bin，ZHANG Li，WEI Weiyuan

（Department of Postpartum Rehabilitation of Xiaogan Maternal and Child Health Care Hospital in Hubei Province，Xiaogan 432100，China）

Abstract Objective：To explore the clinical effect of self-designed Yangyuan Huoxue Decoction combined with warming needle moxibustion on postpartum backache.Methods：A total of 64 patients with postpartum low back pain who were admitted to Xiaogan maternal and child health care hospital in Hubei province from February 2017 to April 2018 were selected.They were divided into the control group and the observation group，with 32 cases each.Patients in the control group were treated with warming needle moxibustion alone.Observation group patients were given self-designed Yangyuan Huoxue Decoction for oral administration on the basis of control group，continuous treatment for 2 weeks as a course of treatment.The clinical effects of the two groups were compared.Before and after treatment，the degree of the patients′ waist pain and disability was evaluated，and Sf-36 quality of life table was used before and after treatment to evaluate the quality of life.Serum levels of 6-Keto-PGFlα，IL-1β，CGRP and TXB2 were detected.Results：The effective rate of 90.62% in the observation group was significantly higher than that in the control group of 75.00%，（P<0.05）.The VAS and ODQ scores of the observation group were significantly lower than those of the control group（P<0.05）.The scores of sleep，spirit，appetite and daily living ability in the two groups were significantly higher than those before treatment（P<0.05）.The scores of sleep，spirit，appetite and daily living ability in the observation group were significantly higher than those in the control group（P<0.05）.Serum levels of 6-Keto-PGFlα were increased and IL-1β，CGRP and TXB2 were decreased in both groups（P<0.05）.Serum levels of 6-Keto-PGFl alpha were higher in the observation group than in the control group.The levels of IL-1β，CGRP and TXB2 were lower in the observation group than those of the control group（P<0.05）.Conclusion：The self-designed Yangyuan Huoxue Decoction combined with warming needle moxibustion is helpful to relieve pain in postpartum lumbago patients，improve lumbar dysfunction，and improve postpartum patients′ quality of life.The mechanism may be the improvement of blood microcirculation through 6-Keto-PGFlα，IL-1β，CGRP，TXB2 regulation，inhibition of platelet aggregation and thrombosis，and inhibition of inflammatory substances.

Keywords Postpartum backache; Self-designed Yangyuan Huoxue Decoction; Warming needle moxibustion; Clinical research

中图分类号：R271.43文献标识码：Adoi：10.3969/j.issn.1673-7202.2020.15.024

产后腰痛是女性产后常见疾病之一，患者以产后出现不同程度的腰骶关节僵硬冷痛、腰骶部酸困不适、转侧翻身困难等为主诉，多见遇冷、劳累后疼痛加重[1]。目前研究认为，该病病因较为复杂，与产后腰部负荷过重、长期固定体位、骶髂关节稳定性差、骨盆韧带回缩无力等有关[2]。当前，现代医学临床上多给予口服或者局部注射止疼药物治疗，旨在缓解产妇疼痛，但其影响乳汁分泌，不利于母乳喂养，且易于复发。比较而言，中医学认为，产后腰痛属于中医学“腰脊痛”“腰痛”的范畴，结合产后患者“多虚”“多瘀”的病机特点，我们临床多采用内外合治，不仅利于提高临床疗效，且利于母乳喂养。本次研究中，对64例产后腰痛患者采用养元活血汤联合温针灸治疗，效果满意，现报道如下。……