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目的探讨前列地尔联合针灸治疗糖尿病周围神经病变(diabeitc peripheral neuropathy,DPN)的临床效果。方法选择2012年10月—2013年12月收治的DPN患者120例,随机分为对照组、前列地尔组和联合治疗组各40例,其中对照组积极控制血糖、血压及血脂外,给予甲钴铵500μg、维生素B1100 mg肌内注射,1次/d,疗程2周。前列地尔组:除一般治疗外,加用前列地尔注射液10μg溶于250 ml生理盐水中静脉滴注,1次/d,连用2周。联合治疗组:除上述前列地尔组治疗外,加用针灸治疗2周。针刺主穴取肾俞、胰俞、肝俞、脾俞、合谷,配合穴取外关透内关,三阴交、太溪、足三里穴。观察治疗后各组临床效果及主侧肢体正中神经、腓总神经的运动神经传导速度(motor nerve conduction velocity,MNCV))和感觉神经传导速度(sensory nerve conduction velocity,SNCV))的变化。计量资料采用配对t检验,组间均数比较采用方差分析,计数资料比较采用χ2检验,P<0.05为差异有统计学意义。结果对照组治疗后正中神经、腓总神经的MNCV和SNCV分别为(44.2±4.8)、(43.6±5.7)m/s和(43.2±6.0)、(36.4±4.1)m/s,前列地尔组的分别为(48.6±6.1)、(48.2±4.6)m/s和(52.3±5.5)、(42.5±4.0)m/s,联合治疗组的分别为(53.8±5.7)、(52.6±4.4)m/s和(52.3±5.5)、(49.5±4.7))m/s。三组正中神经和腓总神经MNCV和SNCV治疗后均明显升高,与治疗前比较差异均有统计学意义(均P<0.05)。其中以联合治疗组升高最为明显,而且与对照组及前列地尔组治疗后比较差异均有统计学意义(均P<0.05)。联合治疗组总有效率为87.5%,前列地尔治疗组为67.5%;对照组为60.0%,联合治疗组疗效显著优于前列地尔疗组和对照组,比较差异均有统计学意义(均P<0.05),且前列地尔组与对照组比较差异也有统计学意义(P<0.05)。结论前列地尔联合针灸治疗DPN具有明显疗效,可显著缓解患者肢体麻木、疼痛等症状,提高神经传导功能,效果明显优于单纯药物治疗。
Objective To investigate the clinical efficacy of alprostadil combined with acupuncture in treatment of diabetic peripheral neuropathy (DPN). Methods 120 cases of DPN patients who were admitted to our hospital from October 2012 to December 2013 were randomly divided into control group, alprostadil group and combination therapy group, 40 cases each. The control group was given positive control of blood glucose, blood pressure and lipids, Cobalt ammonium 500μg, vitamin B1100 mg intramuscular injection, 1 / d, treatment for 2 weeks. Alprostadil group: In addition to the general treatment, plus alprostadil 10μg dissolved in 250 ml saline intravenously, 1 / d, once every 2 weeks. Combination therapy group: In addition to the above alprostadil treatment, plus acupuncture treatment for 2 weeks. Acupuncture points from the main points Shenshu, pancreas, liver Yu, Pishu, Hegu, with the acupoints outside the pass through the customs, Sanyinjiao, too Creek, Zusanli points. The clinical effects and the changes of the median nerve, the motor nerve conduction velocity (MNCV) and the sensory nerve conduction velocity (SNCV) of the main limb were observed after treatment. Measurement data using paired t-test, between groups were compared using analysis of variance, count data were compared using the χ2 test, P <0.05 for the difference was statistically significant. Results The MNCV and SNCV of the median nerve and common peroneal nerve in the control group were (44.2 ± 4.8), (43.6 ± 5.7) m / s and (43.2 ± 6.0) and (36.4 ± 4.1) m / s, Group were (48.6 ± 6.1), (48.2 ± 4.6) m / s and (52.3 ± 5.5), (42.5 ± 4.0) m / s respectively, and were 53.8 ± 5.7 and 52.6 ± 4.4 in the combined treatment group ) m / s and (52.3 ± 5.5), (49.5 ± 4.7)) m / s. Three groups of median nerve and common peroneal nerve MNCV and SNCV after treatment were significantly increased, compared with before treatment were statistically significant (P <0.05). Among them, the combination therapy group was the most obvious increase, but also with the control group and the alprostadil group after treatment, the difference was statistically significant (P <0.05). The total effective rate was 87.5% in the combination therapy group and 67.5% in the alprostadil treatment group and 60.0% in the control group, with a significant difference between the combination therapy group and the alprostadil treatment group and the control group P <0.05), and the difference between the alprostadil group and the control group was also statistically significant (P <0.05). Conclusions Alprostadil combined with acupuncture has obvious curative effect on DPN, which can significantly relieve the numbness and pain of patients’ limbs and improve the nerve conduction function, and the effect is obviously better than that of simple drug treatment.