归芍伤筋汤内服联合通络止痛散外敷治疗急性腰扭伤45例

Guishao Shangjin Decoction by Oral Combined Tongluo Zhitong Powder External Application in Treating 45 Cases with Acute Lumbar Sprain

摘要:

目的: 探讨归芍伤筋汤内服联合通络止痛散外敷治疗急性腰扭伤的临床疗效及作用机制. 方法: 将90例急性腰扭伤患者采用随机按数字表法分为对照组和观察组各45例.对照组采用布洛芬片内服,0.2 g/次,3次/d;及双氯芬酸二乙胺乳胶剂外用.观察组采用归芍伤筋汤内服联合通络止痛散外敷.两组疗程均为5 d.记录疼痛、压痛、肿胀和瘀斑评分;进行腰部活动障碍和腰部功能障碍评分;检测血液流变学、β-内啡肽(β-EP)、血栓素B₂(TXB₂)及6-酮前列腺素F_la(6-Keto-PGF_la)变化,以上指标治疗前后各评价1次. 结果: 经Ridit分析,观察组临床疗效优于对照组(P<0.05);治疗后观察组疼痛、压痛、肿胀和瘀斑评分低于对照组(P<0.01);腰部活动障碍和腰部功能障碍评分均低于对照组(P<0.01);观察组全血黏度、血浆黏度、纤维蛋白原、血小板聚集率等血液流变学指标的改善均优于对照组(P<0.01);治疗后观察组β-EP和6-Keto-PGF_la水平高于对照组(P<0.01), TXB₂水平低于对照组(P<0.01). 结论: 归芍伤筋汤内服联合通络止痛散外敷能促进急性腰扭伤患者血液循环,减轻炎症反应,提高β-EP水平,从而起到良好的镇痛、消肿效应,促进患者腰部活动功能的恢复.

Abstract:

Objective: To discuss the clinical effect and the action mechanism of Guishao Shangjin decoction by oral administration combined Tongluo Zhitong powder by external application in treating patients with acute lumbar sprain (ALS). Method: Ninety patients were randomly divided into control group (45 cases) and observation group (45cases) by random number table. Patients in control group took oral 0.2 g lbuprofen tablets 3 times daily plus dichofenac diethylammon by external application. Patients in observation group took oral Guishao Shangjin decoction and Tongluo Zhitong powder by external application. Patients in two groups received a 5-day period of treatment. The pain, tenderness, swelling and ecchymosis scores were recorded. The waist movement obstacles and waist dysfunction scores were conducted. The change of blood rheology, β-endorphin (β-EP), thromboxane B₂ (TXB₂), 6-Ketone prostaglandin F_la (6-Keto-PGF_la) were detected before and after treatment. Result: The clinical curative effect in observation group was superior to that incontrol group through Ridit analysis (P<0.05). Scores of pain, tenderness, swelling and ecchymosis in observation group were lower than those in control group (P<0.01). Scores of waist movement obstacles and waist dysfunction in observation group were lower than those in control group (P<0.01). Improvement of blood rheology indexes including whole blood viscosity (high shear, low shear), plasma viscosity, fibrinogen and platelet aggregation rate in observation group were superior to those in control group (P<0.01). After treatment, levels of β-EP and 6-Keto-PGF_lα of observation group were higher than those in control group (P<0.01), while the TXB₂ level was lower than that in control group (P<0.01). Conclusion: Guishao Shangjin decoction by oral administration combined Tongluo Zhitong powder by external application could promote blood circulation, reduce inflammatory reaction, and improve level of β-EP in patients with ALS. It has a good analgesia and detumescence effect, and coud enhance the recovery of waist activity function.