针灸改善糖尿病周围神经病变的诊疗特点文献分析

摘要

Objective:To study the characteristics of the treatment for diabetic peripheral neuropathy (DPN) by analyzing the literature of acupuncture and moxibustion.Methods:The literature of DPN was searched through CNKI and VIP medical resource data (VIP),Wanfang database and PubMed.The types of acupoints,characteristics of acupuncture,acupuncture methods,frequency,periods of treatment,the treatment interval,curative effect and follow-up period,safety and other factors were analyzed.Results:A total of 57 articles with acupuncture treatment alone,acupuncture plus medicine,and acupuncture plus other related interventions were included.The literatures showed that Plum-blossom needle therapy was superior to manual acupuncture and acupoint injection;some studies of acupuncture considered the needle depth and needling sensation could be influential during the treatment.And 85.96％ of the clinical studies chose the acupuncture points depending on the symptoms and disease of DPN.Common acpoints mainly include limbs acupoints such as ST 36,SP 6,LI 4,LI ll and GB 34;The treatment frequency was usually once a day,accounting for 73.68％ and the treatment courses were often 4 weeks or 30 days,accounting for 41.18％.The effective rate of acupuncture therapy was 62.5％ to 100％.Most of efficacy evaluation was subjective assessment,including the changes of the clinical symptoms and the improvement of signs.Objective evaluation mainly included the improvement of nerve conduction velocity.No recurrence and adverse events were reported during treatment and follow-up periods.The results showed that the acupuncture is safe and reliable.Conclusion:The effect of acupuncture for DPN is obvious and reliable,which should be widely used in clinical practice.%目的:分析针灸改善糖尿病周围神经病变的文献,探讨其诊疗特点.方法:电子检索中国知网(CNKI)、维普医学资源数据(VIP)、万方数据库以及PubMed中针灸治疗糖尿病周围神经病变的文献,分析总结针灸的选穴特点、针灸方法、频次、疗程、疗程间隔、疗效、随访和安全性等.结果:共纳入57篇文献,针灸治疗以针药结合和针灸结合治疗为主,梅花针叩刺虽不常见,但是文献显示其疗效要优于毫针和穴位注射;部分临床研究考虑针刺的深度、针感在治疗中的影响;针灸临床治疗糖尿病周围神经病变常用的取穴方式为辨症状和辨病位取穴,占85.96％;常用穴位以足三里、三阴交、合谷、曲池、阳陵泉等四肢部位的穴位为主;治疗频次1次/d常被使用,占73.68％,治疗时间以4周或30 d常见,占41.18％;针灸疗法临床有效率为62.5％ ～ 100％,疗效评价以主观评价为主,多数以临床症状明显减轻,阳性体征改善,神经传导速率较前增加为有效;随访中均无症状反复,疗效具有稳定性;所有文献无不良事件报道,说明针灸治疗安全可靠.结论:针灸改善糖尿病周围神经病变疗效可靠,值得临床推广应用.