【作者】 陈虹静；

【导师】 李万瑶；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 硕士

【摘要】 穴位注射疗法是指在人体经络循行的穴位上将针刺作用及药物药理作用互相结合治疗疾病的的一种疗法。医者依据临床上患者不同情况及输穴的治疗作用而选择穴位、压痛点、及反应点,根据药物的药理作用选取药液,将药液注入,以发挥药物和腧穴的双重作用,达到改善机体的功能状态和病理状态。是集针、药、穴三位一体的复合型针刺法,适应证范围相当广泛,凡是针灸治疗的适应症大部分均可采用此法。而穴位注射所使用的针具直径相较于毫针来得大,再加上药物的理化刺激与占位作用,对穴位的机械性刺激,远大于毫针针刺的刺激量,考虑患者对穴位注射刺激量之反应与接受度,是临床工作者不可忽略的因素,因其直接影响患者接受穴位注射的医从性。本研究从观察患者接受穴位注射治疗后主观感受,对于穴位注射治疗后出现的针感反应是否影响患者对穴位注射的接受度,为临床应用穴位注射治疗,提供选穴依据。目的从临床实践中,透过穴位注射与时间段的不同,观察患者的反应,以期增进患者对穴位注射的接受性,间接提升穴位注射之疗效。方法选择符合诊断、纳入、排除标准的受试者90例,按穴位分为三组,曲池穴、肾俞穴、足三里穴各30例,在每组穴位注射药物皆为复方当归注射液,每次每穴注射剂量2m1。患者采取坐位,选取穴位后,局部皮肤用安尔碘常规消毒后,选用七号注射针头采无痛快速进针法将针刺入皮下。并考虑患者个体差异及穴位所在部位肌肉丰厚程度决定进针的深度,以患者同身寸法为度,先以针尖至皮下后深至0.5至1寸,并缓慢提插或调整针尖方向,待患者有酸、麻、胀等针感反应后,回抽针芯,如无回血即可注入药液。每次每穴注射药量2m1。出针后用消毒棉签压迫片刻止血。记录患者每次穴注后当下、穴注后15分钟用圆规分别测量并记录患者产生的针感、每次穴注治疗后局部酸胀感涵盖的范围、是否影响四肢活动、以MeGill疼痛回答法评估疼痛。穴注后48小时,则采用电话随访以问卷方式了解患者具体情况。结果1.三组穴位在穴注后当下疼痛感上,穴注后当下与穴注后15分钟、穴注后48小时两组比较,P<0.01,差异有显着统计学意义。穴注后15分钟、穴注后48小时两组比较,差异无统计学意义(P>0.05)。穴位注射治疗所产生的局部疼痛不适感,在穴注后当下最为明显。2.三组穴位在穴注后当下蚁行感上,差异有统计学意义(P<0.05)。。肾俞组与足三里组、曲池组比较,差异有统计学意义。可认为肾俞组在穴位射当下出现蚁行感的比率高于足三里组、曲池组；而足三里组与曲池组相比,差异无统计学意义(P>0.05)。其蚁行感主要的走向是以肾俞穴为中点,向左右各以半径3cm为爬行范围。与带脉的循行路线一致。所以肾俞穴针感可经由带脉,达到调理全身脏腑气血阴阳的功能。3.三组穴位在穴位注射后15分其他感觉上,差异有统计学意义(P<0.05)。足三里组与肾俞组、曲池组比较,差异有统计学意义。可认为足三里组在穴位注射后15分出现的其他感觉比例高于肾俞组、曲池组；而肾俞组与曲池组相比,差异无统计学意义(P>0.05)。足三里组的其他感觉以循经感传为主(从穴注足三里穴处至冲阳穴处),而足三阳的经气走向正是由头走足。此后续针感也较其他二穴为久,这种针后余感觉可以起到温和而持久的刺激作用,促进穴位注射起针后,延续经穴的刺激,达到后续治疗效应。结论一、穴注注射当下肾俞组蚁行感出现率最高,。所以笔者在此以研究结果上推论：通过肾俞穴的穴位注射,可调节全身气血阴阳,而起到治疗先天秉赋不足引起的相关疾病优于其它二个(曲池穴、足三里穴)的作用。二、足三里组是在穴位注射后15分钟其他反应的出现率最多,因足三里穴针感较持久且明显,故对于足三里穴位注射复方当归注射液的患者,在穴位注射后医者应嘱其稍作休憩,待15分钟后评估患者的其他反应的情况,视情况是否予以处理；而患者的其他主观感受于穴注后当下至穴位注射后15分内最为明显,并随时间递减。三、在本研究的大量临床实践下,对于穴位注射疗法出现的疼痛是患者可以接受的范围内,且疼痛感随着时间的增加而递减。但患者对针具仍存在恐惧心理,笔者建议,注射前应,注重与患者的沟通,予适当的安慰、解释,消除患者紧张与恐惧的心理,进针手法宜快,但推药速度宜和缓。更多还原

【Abstract】 Acupoint injection therapy is a therapy integrated the acupuncture with the drug pharmacological actions on the acupoints along the meridians. According to the different cases and the indications of the acupoints, the acupoints, ashi points or the response points are selected. With the pharmacological actions of the solutions, it performs the double functions of drugs and acupoints hence regulates the functional and pathological situations. Due to the wide ranges of indications, this therapy could be applied to most of the cases during the acupuncture treatments. The diameters of the syringes are much larger than that of the filiform needles, and the stimulations from the acupoints and the drugs are usually stronger than that of the simple needling. Hence, the response and acceptance of the patients to the amounts of stimulation affects the obedience to the acupoint injection therapy, which is of significance to the medical stuffs in the clinicalpractice.In the present study, the retention time of the local distention feeling after acupoint injection therapy, the ranges covered, whether the feeling affects the daily activities, other responses, etc, were observed, and the influence of the drug stimulation and acupoint sensitivity to the acceptance of the patients to this therapy was explored. For the patients with sensitivity to pain, the proper selection of acupoints could reduce the anxiety of the patients hence it could be better acceptable and is worthy of being further popularized and applied.Objective In the present research, the correlative reactions of acupoints and drugs, the stimulation of the drugs to the acupoints, the immediate response and the retention duration of the distention feeling after the acupoint injection, whether this therapy could affect the acceptance of the patients to this therapy, etc, were explored and discussed.Methods90 cases which were accordance with the diagnosis and inclusion criteria were enrolled. According to the different acupoints, they were randomly assigned into Quchi (LI 11) group, Shenshu (BL 23) group and Zusanli (ST 36) group, with 30 cases in each group. The drug applied was compound Danggui solution. With the patients sitting, after disinfection around the acupoint, the syringes were swiftly inserted through the skin. With the slow lifting, thrusting and rotating techniques, after the qi arrival, the solution was inserted. After the withdrawal of the syringes, the acupoints were pressed for a moment to prevent the bleeding. According to the different constitutions of the patients and the locations of acupoints, the depths of the insertion were determined. The amount of drug applied each time was 2 ml. The general situation, the ranges of the distention feeling covered when and 15 minutes after the therapy, the retention of the distention duration, whether the distention feeling affects the daily activities were tested and recorded. The pain was assessed with the MeGill answers method of pain.48 hours, the telephone questionnaires as the following-up were applied.Results1. There was significant difference of the immediate sensation of ant-moving when the therapy was applied (P<0.05). Compared with that in the Quchi (LI 11) group and the Zusanli (ST 36) group, the sensation in the Shenshu (BL 23) group was the strongest, with significant difference (P<0.05).2. There was significant difference of the other reactions 15 minutes after the therapy was applied (P<0.05). Compared with that in the Quchi (LI 11) group and the Shenshu (BL 23) group, the reactions in the Zusanli (ST 36) group was the strongest, with significant difference (P<0.05). Conclusion1. The heaviest immediate distention sensation when the therapy was applied was in the Quchi (LI 11) group; the highest rate of immediate sensation of ant-moving was in the Shenshu (BL 23) group; and the highest rate of the other reactions 15 minutes after the therapy was administered was in the Zusanli (ST 36) group. Hence, for the patients who were applied with the acupoint injection of compound Danggui solution at ST 36, it is crucial to ask the patients to have a rest after the therapy, evaluate the situation of the other reactions after 15 minutes and tackle with the problems in case. The other subjective sensation of the patients obviously appears most within 15 minutes after the administration of the therapy and reduces later.2. The present study of the different time sections such as the immediate, 15 minutes and 48 hours after the administration indicated that for most of the patients, the reactions produced by the therapy would not affect the daily activities of the patients, but also should take some sensitive patients into consideration, which is of significance in the acupoint and drug selections in clinic according to different constitutions.3. With the MCGill answers method of pain scoring assessment, the local pain caused by this therapy from the immediate to 15 minutes after the administration was reduced from 2.12±0.97 to 0.06±0.23, indicating that the pain caused by the acupoint injection therapy was acceptable among the patients.更多还原