以电针为主的综合疗法治疗单纯性肥胖的病例观察

【作者】 陈昌芝；

【导师】 刘保延；

【作者基本信息】 中国中医科学院 ， 针灸推拿学， 2007， 硕士

【摘要】 研究目的：1．探讨以电针为主的综合疗法对单纯性肥胖相关指标的影响；2．评价以电针为主的综合疗法治疗单纯性肥胖的疗效。研究方法：系列病例观察研究。材料和方法1病例来源78例均系单纯性肥胖患者，2006年10月-2007年4月期间到广安门医院针灸科门诊就诊参与本研究，并签署知情同意书。2治疗方法2．1取穴：主穴：下脘，中脘，肓俞，水分，气海，风市，血海，梁丘，足三里，阴陵泉。背部穴：膀胱俞，肾俞，大肠俞，秩边，承扶长针3.5-4寸。另加委中与承山。上肢：曲池、臂膈及其连线中点。下肢：风市、髀关穴、伏兔穴。经常便秘者取大横，不便秘者取天枢。辩证配穴：胃肠腑热型配内庭，合谷，每次25分钟；脾虚湿盛型配丰隆，阴陵泉；肝郁气滞型配太溪，太冲，肝俞。2．2操作方法：选用30号2-5寸不锈钢针灸针，直刺1-1.5寸，斜刺0.5-1寸时，患者应有酸麻胀重等针感，并在双侧天枢穴(大横穴)、双侧风市穴连接电针电极于针柄上。频率20Hz，连续波，强度以患者觉腹部肌肉轻微颤动为度，留针25分钟，第一疗程，每周治疗5天，每日一次，周六、日休息，共两周。第二疗程，每周治疗2次，共两周。第三疗程，每周治疗1次，共1个月。总疗程共2个月，治疗18次。3疗效评价及标准3．1近期疗效评价通过治疗前、治疗后2个月的临床有效率判定，结合肥胖相关指标体重、臀围、腰围、体重指数(BMI)，来评价以电针为主的综合疗法治疗单纯性肥胖的近期临床疗效。3．2远期疗效评价分别于治疗结束后3个月随访体重、BMI，来评价以电针为主的综合疗法治疗单纯性肥胖的临床远期疗效。3．3评价方法由专人负责，就诊时、治疗后以及随访(治疗结束后3个月)时用皮尺测量患者的腰围、臀围，用体重计(常州市武进衡器厂生产)测量患者的体重。4安全性评价患者基本生命体征的观察。针刺过程中不良反应的观察：如晕针，针刺部位疼痛，针刺部位皮肤红肿，针刺部位皮下出血等。对神经系统的影响：意识状态清醒、朦胧、昏睡；精神状态：正常、兴奋、抑郁等；睡眠：正常、入睡困难、多梦、早醒。对消化系统的影响：食欲，大便正常与否(便秘或泄泻)，饥饿感。5．统计分析采用SPSS 11.5统计分析软件，对于患者治疗前后及随访的体重、臀围、腰围、体质指数进行t检验；对于治疗前后及随访时患者的肥胖分级进行非参数检验。分别统计分析治疗前后各项指标的变化情况，及随访与治疗前各项指标的变化，探讨以电针为主的综合疗法对单纯性肥胖相关指标的影响，并初步评价其临床疗效。结果与分析1．近期疗效治疗后患者体重、腰围、臀围、体重指数都有所减少，经统计分析差异有显著意义(P＜0.05)，表明以电针为主的综合疗法治疗单纯性肥胖有效。全部78例患者中，体重达标4例，占5.12％；显效12例，占15.38％；有效14例，占17.95％；无效48例，占61.54％。总有效率为38.46％。2．远期疗效治疗后患者体重、腰围、臀围、体重指数都有所减少，经统计分析体重、臀围、体重指数差异有显著意义(P＜0.05)，而腰围无明显差异(P＞0.05)，表明以电针为主的综合疗法对于单纯性肥胖患者体重、臀围、体重指数的改变有一定的远期疗效，而对于腰围的改变无明显的远期疗效。全部11例患者中，显效5例，占45.46％；有效4例，占36.36％；无效2例，占18.18％。总有效率为81.82％。3．安全性评价3．1生命体征的观察：所有患者未出现任何生命体征的异常。3．2不良反应的观察：所有患者未出现晕针，针刺部位皮肤红肿，依赖性，后遗反应，部分患者有针刺部位皮下出血。3．3对神经系统的影响：多数患者反映针刺后睡眠改善，睡眠质量提高。意识状态及精神状态未出现异常表现。3．4对消化系统的影响：患者反映针刺后食欲减弱，无饥饿感，大便较针刺前有明显改善，便秘消失。讨论1．单纯性肥胖是一种难治性疾病，目前对于该病尚缺乏满意疗效。本课题研究过程质量控制良好。结果表明：以电针为主的综合疗法治疗单纯性肥胖不但近期疗效显著，而且治疗结束后3个月仍有一定的远期效应。2．有关针刺减肥的安全性尚无研究。通过78例患者针刺治疗过程中及治疗后的安全性评价，所有患者未出现生命体征的异常，也没有出现神经系统、消化系统的异常表现。由此只要取穴、针刺操作恰当，针灸治疗单纯性肥胖是相对安全的。进一步评价有待大样本加以证实。3．主穴中脘是胃之募穴；天枢是大肠之募穴；大横位于足太阴脾经之上，穴性偏泻，常用于便秘的治疗；阴陵泉为足太阴脾经之合穴，足三里是足阳明胃经之合穴。经上诸穴联合运用，可清胃热、利水湿，助脾运，活气血，使体内蕴积的脂肪消解，浊湿排泄，气机通畅，以达到减肥的效果。结论：以电针为主的综合疗法治疗单纯性肥胖近期疗效确切，并且有一定的远期疗效，而且相对安全，值得临床推广应用。今后应采用严格的随机对照试验方法，进一步评价以电针为主的综合疗法治疗单纯性肥胖的近、远期疗效，并进行有关针刺深度、电针刺激参数等与临床疗效关系的研究。更多还原

【Abstract】 Objective: 1．to evaluate the effect on the indicate number, regarding the electric acupoints combine with other treatments to cure the simple obesity.2．To evaluate the cure effect regarding the electric acupoints combine with other treatments towards the simple obesity.Design: Series case observation studyMaterials and methods1．Case source: The 78 patients with simple obesity problem, from October, 2006 to April, 2007 were all volunteers of entering into this study also sign the informed consent.2．Treatment2．1 Acupoints: Main points:xiawan, Zhongwan, Huangshu, Shuifen, Qihai, Fengshi, Xuehai, Liangqiu , Zusanli, Yinlingquan etc.Upper Back: Pangguangshu , Shenshu , Dachangshu , Zhibian , Chengfu with longneedle 3．5-4 inch. Plus Weizhong with ChengshanArm: On biceps m. of the arm bellows Ashi acupoints.Leg: Fengshi and Ashi to form an equal side triangleThe patients with constant constipation acupoints with DahengThe patients without constipation acupoints with TianshuDiagnosis:Stomach-intestine hot patients will add acupoints with Neiting, Hegu;Spleen weak cause the water stuck inside will add acupoints with Fenglong,Yinlingquan;Liver stock with air the patients will add with Taixi, Taichong, and Ganshu.Each time stay for 25min.2．2 Manipulation: Using 30# 2-5inch needles which were made of stainless steel, puncture perpendicularly 1-1．5 inch, puncture obliquely 0．5-1 inch, the patients should feel aching and distending at local place, also connect the two electrodes of electronic acupunctoscope with the needle handles at Tianshu and Fengshi points. Frequency was set at 20 Hz, continuous wave, the tension is appropriate when the abdominal muscles quiver slightly. Retain the needles for 25 min, once a day, five times per week from Monday to Friday, two weeks for one course of treatment. Second course of treatment, twice a week for two weeks. Third course of treatment, once a week for one month. Total course of treatment is 2 month for 18 times.3．Outcome measures3．1 Short-term effectThroughout before and after two month of the treatment then combine all the results like weight, buttocks length, waist length and BMI to evaluate the short-term effect regarding the electric acupoints combine with other treatments towards the simple obesity.3．2 Long-term effectFollow-up survey in the 3 month after treatment, follow up weights, BMI to evaluate the long term effect regarding the electric acupoints combine with other treatments towards the simple obesity.3．3 The method to evaluateOne person in charge with all the investigate work including before, after and follow up all the numbers which are weights, waist length, buttocks lengths.4．Safety evaluationsObserve the basic life appearance. Observation and note the adverse reactions during the treatment such as ache dizziness, reddish and swelling, bleeding around the needle points, addicted, or Sid effect reaction ect. The effect on nerve system: clear mind, confuse, sleepy; appearance: normal, exciting, and depressing; sleeping: normal, hard to fall into sleep, dream a lot, and wake up too early. Digestion: appetite, stool situation, hungry feeling.5．StatisticsWe used SPSS 12．0 to analyze data such as the outcome number regarding the weights, buttocks length, and waist length, BMI with T test; regarding the fatness degree separation before and after the treatment used NPar Tests to statistics all the changing situation including before, after and follow up the treatment in order to evaluate the cure effect on the indicate number regarding the electric acupoints combine with other treatments towards the simple obesity, and to evaluate the cure effect. Outcome and analysis1．Short-term effectAfter the treatment the patients’ weight, waist length, buttocks length BMI are all reduced. The statistics (p<0．05) are meaningful which represent that electric acupoints can reduce the simple obesity problem. In the 78 patients, 4 patients’ weights become normal, accounting for 5．12%; 12 recovered in treatment, accounting for 15．38%; 14 patients had effective effect, accounting for 17．95%; 48 had no effect, accounting for 61．54%. The total effective rate is 38．46%2．Long-term effectAfter treatment the patients’ weights, waist length, buttocks length, BMI are all reduced, the statistics (p<0．05> are meaningful but the waist length did not have obvious change (p>0．05) , which indicate that the electric acupoints combine with other treatments towards the simple obesity’s patients have certain long-term effect on weights, buttocks length, BMI but not with the waist length. In 11 patients, 5 patients recovered in treatment, accounting for 45．46%; 4 patients had effective effect, accounting for 36．36%; 2 patients had no effect, accounting for 18．18%. The total effective rate is 81．82%3．Safety evaluations3．1 The observation for patients overall appearance: all patients are showing normal3．2 The observation for abnormal: all patients did not show any dizziness, reddish, swelling, addicted or side effect reaction, only small par of patients have some under skin bleeding.3．3 The influence on nerve system: most of patients say that during the treatment the quality of sleeping had been improved and without any abnormal spiritual problem.3．4 The influence on digest system: The patients reflect that after the treatment their appetite is lower; did not feel hunger; bowel movement becomes normal without constipation.Conclusion1．The simple obesity is a disease which is very hard to be cured, till now all the treatment is not very safe. Under very well control, the results suggested that the electric acupoints combine with other treatments are not just effect in short-term but also has after effect after 3 months which means it has obvious predominance. 2．There did not have any study regarding the security of the acupuncturing with fatness, throughout 78 patients’ treatment, all the patients without showing any abnormal with nerve system or digest system. These means acupuncturing to cure the simple obesity is quite safe, as long as choosing the right points and with skillful person.3．Main points: Zhongwan is stomach’s Mu acupoint; Tianshu is large intestine’s-Mu acupoint; Daheng is on the spleen Meridian of foot Taiyin, often use to cure constipation ; Yinlingquan is the sea acupoint of the spleen meridian of foot Taiyin; Zusanli is the sea acupoint of the stomach meridian of foot Yangming; the above acupoints combine together can cool down the stomach, improve the spleen function so the water and blood can circulate well then the fatness can be consumed, so the patients can lose weights.Results: electric acupoints combine with other treatments has short-term and long-term effect also it is a safe alive natural therapy, worthy of being generalized in clinic.In the future we should adapt with restricked randonized controlled trials method, one step futher research regarding the electric acupoints combine with other treatments towards the simple obesity both in short-term and long-term, also proceed with the dose-effect relationship, best stimulation parameter on acupuncture for losing weights’ research.更多还原