补阳还五汤联合穴位贴敷对腰椎间盘突出症患者UBE 术后腰椎功能及血清疼痛介质水平的影响

Effect of Buyang Huanwu Decoction Combined with Acupoint Application on Lumbar Function and Serum Levels of Pain Mediators in Patients with Lumbar Disc Herniation After Unilateral Biportal Endoscopy

摘要:

目的：观察补阳还五汤联合穴位贴敷对腰椎间盘突出症（LDH） 患者单侧双通道内镜（UBE） 术后腰椎功能及血清疼痛介质水平的影响。方法：选取2023年7月—2025年1月南阳市第一人民医院收治的104例LDH患者为研究对象，按随机数字表法分为贴敷组和联合组各52例。贴敷组术后予以穴位贴敷治疗，联合组在贴敷组基础上予以补阳还五汤治疗，2组均连续治疗4周。比较2组临床疗效、不良反应发生率，以及治疗前后中医证候评分、血清疼痛介质［5-羟色胺（5-HT）、神经肽Y（NPY）、前列腺素E2 （PGE2）、P物质（SP）］ 水平、腰椎功能［Oswestry功能障碍指数（ODI） 评分、日本骨科协会评估治疗分数量表（JOA）评分］、血液流变学指标水平。结果：治疗后，联合组总有效率为96.15%（50/52），贴敷组为73.08%（38/52），2组比较，差异有统计学意义（P＜0.05）。治疗后，2组腰腿刺痛、痛处固定、痛处拒按、腰部板滞、活动受限、感觉异常等中医证候评分及总分均较治疗前降低（P＜0.05），且联合组各项评分及总分均低于贴敷组（P＜0.05）。治疗后，2组血清5-HT、NPY、PGE2、SP水平均较治疗前降低（P＜0.05），且联合组5-HT、NPY、PGE2、SP水平均低于贴敷组（P＜0.05）。治疗后，2组ODI评分均较治疗前降低（P＜0.05），JOA评分均较治疗前升高（P＜0.05）；且联合组ODI评分低于贴敷组（P＜0.05），JOA评分高于贴敷组（P＜0.05）。治疗后，2组红细胞聚集指数、红细胞压积、凝血因子Ⅰ、血浆黏度均较治疗前降低（P＜0.05），且联合组4项指标水平均低于贴敷组（P＜0.05）。联合组不良反应发生率为1.92%（1/52），贴敷组为7.69%（4/52），2组比较，差异无统计学意义（P＞0.05）。结论：补阳还五汤联合穴位贴敷治疗LDH疗效较好，可降低血清疼痛介质水平，促进腰椎功能恢复，改善中医证候及血液流变学状态，且安全性良好。

Abstract:

Abstract：Objective：To observe the effect of Buyang Huanwu Decoction combined with acupoint application on lumbar function and serum levels of pain mediators in patients with lumbar disc herniation (LDH) after unilateral biportal endoscopy （UBE）. Methods： A total of 104 LDH patients admitted to Nanyang First People's Hospital from July 2023 to January 2025 were selected as study subjects and divided into the acupoint application group and the combination group using the random number table method，with 52 cases in each group. The acupoint application group received acupoint application treatment，while the combination group received Buyang Huanwu Decoction in addition to the acupoint application treatment. Both groups were treated continuously for four weeks. Clinical efficacy，incidence of adverse reactions，as well as changes in traditional Chinese medicine syndrome scores，serum levels of pain mediators [5-hydroxytryptamine （5-HT）， neuropeptide Y （NPY）， prostaglandin E2 （PGE2）， substance P （SP）]， lumbar function [Oswestry Disability Index （ODI） score， Japanese Orthopaedic Association （JOA） assessment score]， and hemorheology indicators were compared between the two groups before and after treatment. Results：After treatment， the total effective rate was 96.15% （50/52） in the combination group and 73.08% （38/52） in the acupoint application group， with a statistically significant difference between the two groups （P＜0.05）. After treatment， the sub-item scores for traditional Chinese medicine syndromes （stabbing pain in the low back and leg，fixed location of pain，pain that is unbearable of pressure，stiffness of lumbar，limited mobility，paresthesia） and total scores decreased in both groups compared with those before treatment （P＜0.05）， and all sub-item traditional Chinese medicine syndrome scores and the total score in the combination group were lower than those in the acupoint application group （P＜0.05）. After treatment，the serum levels of 5-HT，NPY，PGE2，and SP decreased in both groups compared with those before treatment （P＜0.05）， and the levels of these pain mediators in the combination group were lower than those in the acupoint application group （P＜0.05）. After treatment，the ODI scores decreased and the JOA scores increased in both groups compared with those before treatment （P＜0.05），and the combination group had a lower ODI score and a higher JOA score than the acupoint application group （P＜0.05）. After treatment， the erythrocyte aggregation index， hematocrit， coagulation factor Ⅰ ， and plasma viscosity decreased in both groups compared with those before treatment （P＜0.05）， and the levels of these four hemorheology indicators in the combination group were lower than those in the acupoint application group （P＜0.05）. The incidence of adverse reactions was 1.92% （1/52） in the combination group and 7.69% （4/52） in the acupoint application group， with no statistically significant difference between the two groups （P＞0.05）. Conclusion： Buyang Huanwu Decoction combined with acupoint application demonstrates superior efficacy in treating LDH. It can effectively reduce serum levels of pain mediators， promote the recovery of lumbar function， improve traditional Chinese medicine syndromes and hemorheological condition， with a good safety profile.