吕明芳 朱小燕 万康敏 胡秀武

*基金项目：江西省卫生健康委科技计划项目（20204087）；国家自然科学基金委员会资助项目（81960900）

【摘要】 目的：探讨长蛇灸联合熏洗包熏蒸在腰椎间盘突出症（气滞血瘀型）患者治疗中的应用价值，观察其对炎症因子、疼痛介质水平的影响。方法：将2019年6月—2020年12月因腰椎间盘突出症于南昌市洪都中医院就诊且中医证型属于气滞血瘀型的90例患者纳入研究，用随机数字表法将患者分为对照组、观察A组、观察B组，各30例。对照组予硬膜外封闭治疗，观察A组予硬膜外封闭治疗+熏洗包熏蒸治疗治疗，观察B组予硬膜外封闭治疗+熏洗包熏蒸+长蛇灸治疗。治疗2周后比较临床效果。结果：治疗后，三组血清肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）、超敏C反应蛋白（hypersensitive C reactive protein，hs-CRP）、白介素-1β（interleukin-1，IL-1β）、血清前列腺素E2（prostaglandin E2，PGE2）、5-羟色胺（5-hydroxytryptamine，5-HT）水平均较治疗前降低，观察B组均低于观察A组、对照组，观察A组上述指标水平均低于对照组，差异均有统计学意义（P<0.05）。治疗后三组视觉模拟评分法（visual analogue scale，VAS）评分均降低，日本骨科协会（Japanese orthopaedic association，JOA）评分及血清β-内啡肽（β-endorphin，β-EP）均较治疗前升高，观察B组VAS评分数值水平低于观察A组、对照组，JOA评分及β-EP数值水平则均高于观察A组及对照组，观察A组VAS评分水平低于对照组，JOA评分及β-EP数值则均更高，差异均有统计学意义（P<0.05）。结论：对于腰椎间盘突出症（气滞血瘀型）患者而言采用长蛇灸联合熏洗包熏蒸可减轻炎症反应，降低疼痛介质，改善临床症状及腰椎功能，安全性高，有助于临床效果提高。

【关键词】 长蛇灸 中药熏蒸 气滞血瘀型 腰椎间盘突出症 疼痛介质 炎症因子

Effects of Long-snake Moxibustion Combined with Fumigation with Fumigation Pack on Pain Mediators and Inflammatory Factors in Patients with Qi Stagnation and Blood Stasis Type of Lumbar Disc Herniation/LYU Mingfang， ZHU Xiaoyan， WAN Kangmin， HU Xiuwu. //Medical Innovation of China， 2024， 21（15）： 0-080

[Abstract] Objective： To investigate the application value of long-snake moxibustion combined with fumigation with fumigation pack in the treatment of patients with lumbar disc herniation （Qi stagnation and blood stasis type）， to observe its influence on the levels of inflammatory factors and pain mediators. Method： A total of 90 patients who were treated in Nanchang Hongdu Hospital of Traditional Chinese Medicine from June 2019 to December 2020 due to lumbar disc herniation and whose traditional Chinese medicine syndrome type was Qi stagnation and blood stasis were included in the study， the patients were divided into a control group， observation group A and observation group B by random number table method， with 30 cases in each group. The control group received epidural blockade treatment. Observation group A received epidural blockade treatment + fumigation with fumigation pack treatment， observation group B received epidural blockade treatment + fumigation with fumigation pack treatment + long-snake moxibustion treatment. The clinical effect was compared after 2 weeks of treatment. Result： After treatment， serum tumor necrosis factor-α （TNF-α）， hypersensitive C reactive protein （hs-CRP）， interleukin-1β （IL-1β）， serum prostaglandin E2 （PGE2）， 5-hydroxytryptamine （5-HT） of the three groups were decreased compared to those before treatment， those in observation group B were lower than those in observation group A and the control group， the levels of the above indicators in group A were lower than those in the control group， the differences were statistically significant （P<0.05）. After treatment， visual analogue scale （VAS） were decreased， Japanese orthopaedic association （JOA） scores and serum β-endorphin （β-EP） were increased of the three groups compared to those before treatment， and the VAS score level in observation group B was lower than that in observation group A and the control group， JOA score and β-EP value level were higher than those of the observation group A and the control group， while the VAS score level of the observation group A was lower than that of the control group， and the JOA score and β-EP value were higher， the differences were statistically significant （P<0.05）. Conclusion： For patients with lumbar disc herniation （Qi stagnation and blood stasis type）， the use of long-snake moxibustion combined with fumigation with fumigation pack can reduce inflammation， reduce pain mediators， improve clinical symptoms and lumbar function， with high safety， and contribute to the improvement of clinical efficacy.

[Key words] Long-snake moxibustion Traditional Chinese medicine fumigation Qi stagnation and blood stasis type Lumbar disc herniation Pain mediators Inflammatory factors

First-author's address： Prevention and Treatment Center， Nanchang Hongdu Hospital of Traditional Chinese Medicine， Nanchang 330000， China

doi：10.3969/j.issn.1674-4985.2024.15.018

腰椎间盘突出症是临床常见的退行性腰椎疾病，在此基础上纤维环破裂，髓核突入椎管，压迫马尾神经或脊神经根，引起腰背部疼痛、活动障碍等症状，严重影响患者身心[1]。腰椎间盘突出症高发于中青年男性，目前认为年龄、运动行为、职业、遗传等均与本病相关[2]。研究表明，炎症反应存在于该疾病全程，促炎因子引起组织水肿、压迫，进而引起疼痛等临床症状，是否有效减轻炎症反应已成为评估及判定预后的重要依据[3-5]。……