【摘要】 目的 观察神经松动术配合夹脊电针对糖尿病周围神经病变（DPN）患者平衡功能的影响及治疗安全性。方法 本文为前瞻性研究，病例纳入禹州市人民医院2020年1月至2023年1月收治的110例DPN患者，采用电脑随机分组法将入组患者分为两组，分别列为电针组（55例）和联合组（55例），电针组予以常规夹脊电针治疗，联合组采用神经松动术配合夹脊电针治疗，比较两组患者治疗前后的神经电生理学指标、神经营养因子、平衡功能改善情况，治疗后的相关并发症发生情况及治疗安全性。结果 治疗前，两组患者的神经电生理学指标、神经营养因子及平衡功能差异无统计学意义（P>0.05）；治疗后，联合组正中神经传导速度（MCV）为（50.33±10.25） m/s，感觉传导速度（SCV）为（52.33±10.41） m/s，腓总神经MCV为（53.11±10.46） m/s,SCV为（52.47±10.28） m/s，均高于电针组[（44.16±10.27） m/s、（46.24±10.15） m/s、（47.25±10.62） m/s、（45.11±10.36） m/s]，差异有统计学意义（P<0.05）。治疗后，联合组的脑源性神经营养因子（BDNF）为（11.45±3.27）μg/L，神经生长因子（NGF）为（44.29±10.37）pg/mL，神经营养因子3(NT-3)为（172.44±20.76） pg/mL，均高于电针组[（9.44±2.28）μg/L、（38.45±10.16） pg/mL、（158.44±20.18） pg/mL]，差异有统计学意义（P<0.05）。在不同治疗方案下，联合组治疗1 d后的Berg平衡量表（BBS）评分为（35.33±5.25）分，治疗7 d后的BBS评分为（42.77±10.32）分，治疗14 d后的BBS评分为（49.15±10.36）分，均高于电针组[（32.41±5.16）分、（36.15±10.41）分、（42.26±10.35）分]，差异有统计学意义（P<0.05）。治疗后，联合组的DPN相关并发症发生率为7.27%(4/55)，低于电针组18.18%(10/55)，差异有统计学意义（P<0.05）。两组均未发生不良反应。结论 神经松动术配合夹脊电针治疗DPN能有效改善患者神经电生理活动并上调神经营养因子表达，对促进患者平衡功能恢复并降低DPN相关并发症发生风险均有积极意义，安全性高。更多还原

【Abstract】 【Objective】 To observe the effect of nerve loosening surgery combined with spinal electroacupuncture on balance function and treatment safety in diabetes peripheral neuropathy(DPN) patients. 【Methods】 This is a prospective cohort study. The cases were included from January 2020 to January 2023. The study subjects were 110 patients with DPN. The enrolled patients were randomly divided into two groups by computer, namely, the electroacupuncture group(55 cases) and the combined group(55 cases).The electroacupuncture group was treated with conventional Jiaji electroacupuncture, and the combined group was treated with nerve mobilization combined with Jiaji electroacupuncture. The neurological electrophysiology indicators, neurotrophic factors, and improvement of balance function before and after treatment, incidence of related complications after treatment, and treatment safety were compared between the two groups. 【Results】 Before treatment, there was no statistical difference in the neurological electrophysiology indexes, neurotrophic factors and balance function between the two groups(P>0.05). After treatment, the motor conduction velocity(MCV) of the median nerve in the combined group was 50.33±10.25 m/s, the sensory conduction velocity(SCV) was 52.33±10.41 m/s, the MCV of the common peroneal nerve was 53.11±10.46 m/s, and the SCV was 52.47±10.28 m/s;compared with the electroacupuncture group(44.16±10.27 m/s, 46.24±10.15 m/s, 47.25±10.62 m/s, and 45.11±10.36 m/s), the above indicators were higher(P<0.05). After treatment, the brain-derived neurotrophic factor(BDNF) of the combination group was 11.45±3.27 μg/L, nerve growth factor(NGF) was 44.29±10.37 pg/mL, neurotrophins-3(NT-3) was 172.44±20.76 pg/mL; compare with the electroacupuncture group(9.44±2.28 μg/L, 38.45±10.16 pg/mL, and 158.44±20.18 pg/mL), above indicators were all higher(P<0.05). Under different treatment regimens, the Berg Balance Scale(BBS) score of the combination group after 1 day of treatment was 35.33±5.25 points, the BBS score after 7 days of treatment was 42.77±10.32 points, and the BBS score after 14 days of treatment was 49.15±10.36 points; compared with the electroacupuncture group(32.41±5.16 points, 36.15±10.41 points, and 42.26±10.35 points), the above BBS score was higher(P<0.05). After treatment, the incidence of DPN related complications in the combination group was 7.27%(4/55), which was lower compared with the electroacupuncture group [18.18%(10/55)](P<0.05). No adverse reactions occurred in both groups. 【Conclusion】 Nerve mobilization combined with Jiaji electroacupuncture treatment of DPN can effectively improve the patients’ nerve electrophysiological activity and up regulate the expression of neurotrophin, which has positive significance in promoting the recovery of patients’ balance function and reducing the risk of DPN related complications,with high safety.更多还原