楼喜强　刘襄　刘小菊

[摘要] 目的 探討热敏灸脐法对因胰岛素治疗2型糖尿病（T2DM）诱发急性痛性神经病变的临床疗效。 方法 选取2018年2月至2020年7月在本院因胰岛素治疗诱发急性痛性神经病变的住院患者36例，采用分层随机法分为实验组和对照组，每组各18例。两组均在控制血糖基础予以口服常规剂量普瑞巴林治疗，实验组在口服常规剂量普瑞巴林基础上联合热敏灸脐法治疗。治疗4周后，评估两组治疗前后简明疼痛评估量表（BPI）评分、医院焦虑抑郁量表（HADS）评分和糖尿病患者生存质量评估量表（DQOL）评分情况;测定周围神经传导速度（PNCV）的变化，对两组患者进行疗效评定，并观察不良反应发生情况。 结果 治疗4周后，两组BPI评分均低于治疗前，除工作、与他人关系、生活兴趣三个维度外，实验组其余维度评分均低于对照组，差异有统计学意义（P<0.05）。治疗4周后，两组HADS评分、DQOL评分较治疗前显著降低，且实验组低于对照组，差异有统计学意义（P<0.05）。治疗4周后，PNCV（MCV、SCV）大于治疗前，且实验组高于对照组，差异有统计学意义（P<0.05）。实验组总有效率（94.44%）高于对照组（83.33%），差异有统计学意义（P<0.05）。两组均未发生严重不良反应。 结论 普瑞巴林联合热敏灸脐法治疗胰岛素治疗相关急性痛性神经病变疗效显著，可明显减轻疼痛症状，改善患者焦虑抑郁状态，提高睡眠和生活质量，促进神经功能恢复，值得临床推广应用。

[关键词] 热敏灸;脐疗;2型糖尿病;急性痛性神经病变;周围神经传导速度

[中图分类号] R259          [文献标识码] B          [文章编号] 1673-9701（2021）06-0141-04

Evaluation of therapeutic effect of heat-sensitive moxibustion on umbilicus in acute painful neuropathy caused by insulin

Lou Xiqiang   Liu Xiang   Liu Xiaoju

Lishui Hospital of Traditional Chinese Medicine in Zhejiang Province， Lishui   323000， China

[Abstract] Objective To investigate the clinical effect of heat sensitive moxibustion on umbilicus on acute painful neuropathy induced by insulin in the treatment of type 2 diabetes mellitus（T2DM）. Methods A total of 36 patients with acute painful neuropathy induced by insulin treatment in our hospital from February 2018 to July 2020 were selected and randomly divided into experimental group and control group， 18 cases in each group. Both groups were treated with conventional oral dose of pregabalin on the basis of blood sugar control， while the experimental group was treated with conventional dose of pregabalin combined with heat-sensitive moxibustion on the umbilicus. After 4 weeks of treatment， the scores of brief pain inventory（BPI）， hospital anxiety and depression ccale（HADS） and diabetes quality of life（DQOL） were evaluated before and after treatment. The changes of peripheral nerve conduction velocity（PNCV） and the curative effect of the two groups of patients were measured and the adverse reactions were observed. Results After 4 weeks of treatment， the BPI scores of the two groups were lower than before treatment， except for the three dimensions of work， relationship with others and interest in life， the scores of the other dimensions of the experimental group were lower than those of the control group， the difference was statistically significant（P<0.05）. After 4 weeks of treatment， the HADS score and DQOL score of the two groups were significantly lower than before treatment， and the experimental group was lower than the control group， the difference was statistically significant（P<0.05）. After 4 weeks of treatment， PNCV（MCV， SCV） was higher than before treatment， and the experimental group was higher than the control group， the difference was statistically significant（P<0.05）. The total effective rate of the experimental group（94.44%） was higher than that of the control group（83.33%）， the difference was statistically significant（P<0.05）. No serious adverse reactions occurred in both groups. Conclusion Pregabalin combined with heat-sensitive moxibustion on umbilicus has significant effect on insulin treatment-related acute painful neuropathy， which can obviously relieve their pain symptoms， improve anxiety and depression， improve sleep and quality of life， and promote the recovery of neurological function. It is worthy of clinical application.

[Key words] Heat-sensitive moxibustion; Umbilicus therapy; Type 2 diabetes mellitus; Acute painful neuropathy; Peripheral nerve conduction velocity

胰岛素治疗相关急性痛性神经病变属于治疗诱发的糖尿病性神经病变，是糖尿病临床治疗常见的急性并发症之一，可发生于血糖控制情况快速改善的慢性高血糖患者[1-2]，其主要临床表现为重度难治性疼痛和自主神经功能障碍伴睡眠障碍，超过一半患者合并焦虑、抑郁症状，严重影响患者生活质量。以往认为胰岛素治疗相关急性痛性神经病变很罕见，但随着我国2型糖尿病住院治疗群体数量日渐庞大，有研究显示，高达11%的T2DM患者会出现急性痛性神经病变[3]。……