Name: 穴位肠埋葬治疗盆腔炎后遗症引起的慢性盆腔痛 (视频) | JoVE Journal
Uploaded: 2024-05-03T13:40:00.000+00:00
Duration: 2 min 41 s
Description: 了解穴位肠线埋置疗法治疗盆腔炎后遗症引起的慢性盆腔疼痛。该方法通过将可吸收肠线植入特定穴位，显著改善患者临床症状和生活质量，复发率低且操作简便。

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作者感谢成都中医药大学附属医院妇科的文怡博士及其他医务人员提供的帮助。

本研究的所有操作均按照临床试验注册要求进行，并已获得成都中医药大学附属医院伦理委员会的批准（备案号：2021KL-004）。本研究中所有患者均已知情同意，允许研究人员在试验期间使用其数据、图像及相关视频资料。
1. 操作前准备
<ol>
	<li>纳入标准设定如下：纳入符合西医盆腔炎性疾病诊断标准的患者8,9 中医湿热瘀滞证型10，年龄20至25岁。</li>
	<li>设定以下排除标准：其他原因引起的盆腔疼痛或下腹部疼痛；妊娠、哺乳或近6个月内计划妊娠；患有严重的心、肝、肾及造血系统疾病而无法耐受治疗者；无法或不愿配合者；过敏体质或有瘢痕疙瘩形成倾向者；近一个月内接受过类似药物或物理治疗者。</li>
	<li>准备好以下材料：无菌手套、一次性羊肠线埋线针、一次性埋线包（治疗盘、无菌纱布、无菌棉签、碘伏棉签、镊子） &#34;0&#34; 羊肠线，医用敷料； 图1).</li>
	<li>让患者仰卧，放松，并充分暴露腹部和下肢。</li>
	<li>检查目标穴位处的皮肤状况，若无异常则进行下一步操作。 
	注意：穴位处皮肤有感染、溃疡或疤痕的患者不应接受埋线治疗。患者若处于极度饥饿、疲劳或精神压力较大的状态，不应立即进行该操作。应避免在月经期患者身上实施该操作。</li>
	<li>让医生进行常规手部消毒并佩戴无菌手套。</li>
	<li>检查一次性埋线针的针芯与针管是否匹配顺畅图2A).</li>
	<li>右手持镊子，将肠线放入针管中（图2B). 
	注意：羊肠线必须完全插入针管内。</li>
</ol>
2. 操作步骤
<ol>
	<li>选取以下穴位（国际代码）：中极（RN3）、关元（RN4）、气海（RN6）、归来（ST29）、子宫（EX-CA1）、血海（SP10）、足三里（ST36）、阴陵泉（SP9）和三阴交（SP6；图3）。</li>
	<li>进针操作
	<ol>
		<li>用左手绷紧进针部位的皮肤，右手拇指、食指与中指夹持针管。</li>
		<li>迅速将针垂直刺入皮肤，进针角度为90°（图2C、D）。</li>
		<li>当患者出现得气感（如酸、麻、胀等针感）时，停止进针，推动针芯，退出针管，将羊肠线留置于得气区域。</li>
	</ol>
	</li>
	<li>出针：左手按压穴位皮肤，右手拔出针芯与针管。 
	注意：羊肠线必须完全埋入皮内，不得留于皮下或暴露于皮外。</li>
	<li>用无菌干棉球按压针孔30秒，并在针孔处贴敷医用敷料，持续2天。</li>
</ol>
3. 埋线后注意事项
<ol>
	<li>确保埋线部位在最初48小时内不接触水。</li>
	<li>建议患者在术后7天内避免剧烈体力活动，尤其是埋线部位周围区域。</li>
</ol>
4. 不良反应及处理
<ol>
	<li>患者不适
	<ol>
		<li>疼痛
		<ol>
			<li>应告知患者疼痛是一种常见的不良反应11，且疼痛大多在术后5–7天内自行消失。</li>
			<li>操作过程中应使用细型埋线针及羊肠线。</li>
			<li>对于疼痛敏感且无已知禁忌证的患者，可考虑术前口服镇痛药物11；必要时，可在植入羊肠线前使用利多卡因进行局部麻醉12。</li>
		</ol>
		</li>
		<li>针刺相关性晕厥 
		注：指在穴位埋线治疗过程中突然出现头晕、视物模糊、心悸、恶心，甚至晕厥的现象。
		<ol>
			<li>若患者发生晕厥，应立即停止羊肠线植入，并观察患者生命体征。对于症状较轻者，嘱其平卧休息片刻，并给予温水或含糖饮料；若症状未缓解，应采取现代急救措施。</li>
		</ol>
		</li>
		<li>出血或局部血肿
		<ol>
			<li>若术后埋线部位出现出血，可用干燥棉签在局部轻压止血。</li>
			<li>若形成血肿，应在24小时内进行冷敷，24小时后改为热敷，以促进血肿吸收。 
			注：若出血持续或量较大，可能提示血管损伤，需考虑外科干预。</li>
		</ol>
		</li>
	</ol>
	</li>
	<li>羊肠线排异反应
	<ol>
		<li>发热 
		注：一般发热在1周内可自行消退。
		<ol>
			<li>嘱患者多饮水；持续发热者可采用物理降温或口服解热药物治疗。</li>
			<li>若出现持续高热，应及时降温，并由外科专科医师取出已植入的羊肠线。</li>
		</ol>
		</li>
		<li>过敏反应
		<ol>
			<li>注意观察局部红肿、皮疹、瘙痒等过敏症状；可给予抗组胺药物（如马来酸氯苯那敏、西替利嗪、氯雷他定）或糖皮质激素（如地塞米松）进行抗过敏处理，必要时应将已植入的羊肠线取出。</li>
		</ol>
		</li>
		<li>结节或肿块
		<ol>
			<li>小的结节通常可自行吸收；对于局部较硬的肿块，可采用艾灸或穴位注射等方法处理13。</li>
		</ol>
		</li>
		<li>线材外溢
		<ol>
			<li>可通过修剪或取出外露的羊肠线后重新埋置来处理。</li>
		</ol>
		</li>
		<li>感染
		<ol>
			<li>羊肠线植入后前5天，局部可能出现不同程度的炎症反应。若埋线部位分泌物增多或出现化脓迹象，应使用抗生素控制感染；必要时需寻求外科干预。</li>
		</ol>
		</li>
	</ol>
	</li>
</ol>
5. 观察指标
<ol>
	<li>临床疗效评价14
	<ol>
		<li>将痊愈定义为所有相关症状和体征（如盆腔疼痛）均得到改善，且评分下降≥95%。</li>
		<li>显效定义为评分降低70% ≤ 降低幅度 &#60; 95%。</li>
		<li>有效定义为评分降低30% ≤ 降低幅度 &#60; 70%。</li>
		<li>无效定义为评分降低 &#60;30%。</li>
	</ol>
	</li>
	<li>采用简化版麦吉尔疼痛问卷（SF-MPQ）15评估治疗前后疼痛情绪和疼痛程度，评分越高表示疼痛越严重。</li>
	<li>采用中医湿热瘀结证评分量表对中医证候进行评分16，评分越高，症状越严重。</li>
	<li>采用盆腔体征评分量表17评估治疗前后腹部压痛或反跳痛、子宫压痛、宫颈举痛和摇摆痛以及附件压痛，评分越高，盆腔疼痛越严重。</li>
	<li>采用世界卫生组织生存质量简表（WHOQOL-BREF）18评估患者生存质量，各维度得分正向计分，即评分越高，生存质量越好。</li>
</ol>
6. 统计分析
<ol>
	<li>正态分布的测量数据以均值 ± 标准差（SD）表示。</li>
	<li>组间比较采用独立样本 t-检验，治疗前后比较采用配对样本 t-检验。</li>
	<li>非正态分布的数据以中位数 M（25%, 75%）表示。</li>
	<li>组间比较采用秩和检验，治疗前后比较采用配对秩和检验。</li>
	<li>计数资料或等级资料以构成比表示。</li>
	<li>组间比较采用 Fisher 精确概率法或卡方检验。</li>
	<li>前后对照采用配对设计 t-检验；进行双侧假设检验，检验水准 α = 0.05；当 P &#60; 0.05 时，认为差异具有统计学意义。</li>
</ol>

Acupoint Catgut Embedding for Chronic Pelvic Pain Management

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<li>Hu, J., Li, J. B., Sheng, Y., Xu, B. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Professor+SHENG+Can-ruo%27s+experience+of+acupuncture+for+chronic+pelvic+pain+of+sequelae+of+pelvic+inflammatory+diseases%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">Professor SHENG Can-ruo's experience of acupuncture for chronic pelvic pain of sequelae of pelvic inflammatory diseases.</a> Zhongguo Zhen Jiu. 42 (10), Chinese 1155-1158 (2022).</li>
<li>Lee, I. S., Cheon, S., Park, J. Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Central+and+peripheral+mechanism+of+acupuncture+analgesia+on+visceral+pain%3A+a+systematic+review%5BTitle%5D)+AND+%22Evid+Based+Complement+Alternat+Med%22%5BJournal%5D)">Central and peripheral mechanism of acupuncture analgesia on visceral pain: a systematic review.</a> Evid Based Complement Alternat Med. 2019, 1304152(2019).</li>
<li>Du, K., Wang, X., Chi, L., Li, W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Role+of+sigma-1+receptor%2Fp38+MAPK+inhibition+in+acupoint+catgut+embedding-mediated+analgesic+effects+in+complete+Freund%27s+adjuvant-induced+inflammatory+pain%5BTitle%5D)+AND+%22Anesth+Analg%22%5BJournal%5D)">Role of sigma-1 receptor/p38 MAPK inhibition in acupoint catgut embedding-mediated analgesic effects in complete Freund's adjuvant-induced inflammatory pain.</a> Anesth Analg. 125 (2), 662-669 (2017).</li>
<li>Yang, F. X., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+efficacy+of+acupuncture+at+Bahui+point+in+the+treatment+of+chronic+fatigue+syndrome+and+its+impact+on+the+immune+function+of+patients+%5BJ%5D%5BTitle%5D)+AND+%22Chinese+Journal+of+Traditional+Chinese+Medicine%22%5BJournal%5D)">The efficacy of acupuncture at Bahui point in the treatment of chronic fatigue syndrome and its impact on the immune function of patients [J].</a> Chinese Journal of Traditional Chinese Medicine. 28 (09), Chinese 1904-1905 (2010).</li>
<li>Wang, Q. C., Chen, Y. M., Jia, M. J., Zhai, H. L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Efficacy+observation+of+chronic+pelvic+inflammation+of+different+differentiated+patterns%2Fsyndromes+treated+with+acupoint+embedding+therapy%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">Efficacy observation of chronic pelvic inflammation of different differentiated patterns/syndromes treated with acupoint embedding therapy.</a> Zhongguo Zhen Jiu. 32 (12), Chinese 1081-1083 (2012).</li>
<li>Huang, G., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((A+systematic+review+of+the+cost+of+chronic+pelvic+pain+in+women%5BTitle%5D)+AND+%22J+Obstet+Gynaecol+Can%22%5BJournal%5D)">A systematic review of the cost of chronic pelvic pain in women.</a> J Obstet Gynaecol Can. 44 (3), 286-293 (2022).</li>
<li>Wang, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Analysis+of+adverse+reactions+of+acupoint+catgut+embedding+therapy%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">Analysis of adverse reactions of acupoint catgut embedding therapy.</a> Zhongguo Zhen Jiu. 40 (2), Chinese 193-196 (2020).</li>
<li>Xue, H. Q., Ma, L., Zhang, Y. Q., Shi, X. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Analysis+of+the+selection+pattern+of+acupuncture+points+for+chronic+pelvic+pain+in+the+sequelae+of+pelvic+inflammatory+diseases+%5BJ%5D%5BTitle%5D)+AND+%22Guangming+Traditional+Chinese+Medicine%22%5BJournal%5D)">Analysis of the selection pattern of acupuncture points for chronic pelvic pain in the sequelae of pelvic inflammatory diseases [J].</a> Guangming Traditional Chinese Medicine. 38 (15), 2950-2953 (2023).</li>
<li>Wu, X. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effect+of+electroacupuncture+on+pain+threshold+and+expression+of+pain-related+factors+cyclooxygenase-2%2C+prostaglandin+E2+and+%CE%B2-endorphin+in+rats+with+chronic+pelvic+pain+syndrome%5BTitle%5D)+AND+%22Zhen+Ci+Yan+Jiu%22%5BJournal%5D)">Effect of electroacupuncture on pain threshold and expression of pain-related factors cyclooxygenase-2, prostaglandin E2 and β-endorphin in rats with chronic pelvic pain syndrome.</a> Zhen Ci Yan Jiu. 47 (6), Chinese 531-536 (2022).</li>
<li>Liu, Y. H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Acupuncture+combined+with+western+medication+on+chronic+pelvic+pain+after+pelvic+inflammatory+disease%3A+a+multi-center+randomized+controlled+trial%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">Acupuncture combined with western medication on chronic pelvic pain after pelvic inflammatory disease: a multi-center randomized controlled trial.</a> Zhongguo Zhen Jiu. 41 (1), Chinese 31-35 (2021).</li>
<li>Xiang, D. F., Sun, Q. Z., Liang, X. F. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Effect+of+abdominal+acupuncture+on+pain+of+pelvic+cavity+in+patients+with+endometriosis%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">Effect of abdominal acupuncture on pain of pelvic cavity in patients with endometriosis.</a> Zhongguo Zhen Jiu. 31 (2), PMID: 21442808 Chinese 113-116 (2011).</li>
</ol>

作者声明不存在利益冲突。

古代中医典籍中并无慢性盆腔疼痛的明确记载，根据其症状特点，可与痛经、带下病、癥瘕等疾病互为参阅。 &#34;腹痛，&#34; &#34;女性腹痛，&#34; 和 &#34;痛经&#34; 根据中医理论，当血脉开放时，若调护不当，可能导致湿邪、热邪等病邪侵入，滞留于胞宫及其经络，引起正邪相争，表现为盆腔炎性疾病。若盆腔炎性疾病未及时治疗或治疗不当，病情可能迁延不愈，发展为盆腔炎性疾病后遗症。盆腔炎性疾病后遗症的核心病机为血瘀，阻滞胞宫及血脉。湿热瘀结证是常见的证型之一，多因盆腔炎性疾病后期湿热之邪留恋，或脏腑功能失调所致。湿热内生，阻滞气机与血液运行，湿热与血瘀交织，导致病程缠绵、难以痊愈，因而慢性盆腔痛持续存在。
慢性盆腔疼痛（CPP）是一种慢性、长期且持续性的疾病，其病因复杂19。疼痛的发生涉及多种机制，包括神经系统、内分泌系统和免疫系统20,21,22</s...

慢性盆腔痛（CPP）是指持续超过6个月、非周期性且对非阿片类药物无反应的盆腔疼痛。最新研究表明，全球CPP的发病率约为5%–26%1。继发性盆腔炎（SPID）是导致CPP的主要病因之一，占女性慢性盆腔痛病例的23%–30%2。由于现有镇痛药物在缓解此类疼痛方面的疗效有限，超过50%的CPP患者可能寻求非药物治疗3。目前主要的非药物治疗方法包括盆底物理治疗、心理治疗、神经调节治疗和饮食疗法。然而，这些方法也存在局限性，例如镇痛效果不理想以及难以实现长期控制。大多数患有CPP的SPID女性因疼痛反复发作而出现焦虑、抑郁及生活质量下降4。因此，寻找一种能够有效缓解患者疼痛症状的治疗方法已成为迫切的临床问题。
针灸和艾灸是中医主要的外治疗法之一，在治疗与疼痛相关的疾病方面已显示出良好的疗效，并在临床实践中得到广泛应用，尤其在缓解慢性疼痛方面，其疗效优于其他非药物疗法治疗慢性盆腔疼痛（CPP）5,6。一项关于中医治疗CPP的横断面研究显示，7.63%的慢性疼痛患者接受了针灸和艾灸治疗，取得了优异的治疗效果7。本文所介绍的穴位埋线疗法是针灸与艾灸的延伸与发展，是指采用特殊设计的一次性医疗器械，将可吸收的羊肠线植入相应穴位，从而实现对穴位持久而持续的刺激，以达到镇痛效果的一种中医外治技术。作者团队已应用该技术治疗由慢性盆腔炎性疾病（SPID）引起的女性反复发作且难以治愈的盆腔疼痛，获得了积极成效。该疗法既可作为独立治疗手段，也可作为中医综合治疗方案或中西医结合治疗的重要组成部分。本文以SPID中最常见的中医证型（湿热瘀结型）患者为例，详细演示穴位埋线操作的具体步骤。

<table><tbody><tr><td>一次性羊肠线埋线针</td><td>扬州君邦科技发展有限公司</td><td>20212200112</td><td></td></tr><tr><td>一次性埋线包</td><td>山东威高瑞新医疗器械有限公司</td><td>20182140148</td><td></td></tr><tr><td>SPSS26.0&amp;nbsp;</td><td></td><td></td><td>统计分析软件&amp;nbsp;</td></tr><tr><td>无菌手套</td><td>广东Fitone乳胶制品有限公司</td><td>20172140158</td><td></td></tr></tbody></table>

穴位埋线治疗盆腔炎后遗症所致慢性盆腔痛

Acupoint Catgut Embedding for Treatment of Chronic Pelvic Pain Due to the Sequelae of Pelvic Inflammatory Disease

由盆腔炎性疾病后遗症引起的慢性盆腔痛是女性盆腔痛常见的临床病症。目前，该病治疗的主要挑战在于镇痛效果有限以及症状反复发作，显著影响患者的生活质量，并带来较大的心理负担，属于临床难治性疾病。在总结多年治疗经验的基础上，作者团队发现穴位埋线疗法在治疗盆腔炎性疾病后遗症所致的慢性盆腔痛方面具有显著的临床疗效。与现有的西医治疗方法相比，穴位埋线具有镇痛效果好、复发率低、经济实惠以及操作相对简便等优势。本文系统介绍了将可吸收羊肠线植入患者穴位以治疗女性因盆腔炎性疾病后遗症所致慢性盆腔痛的完整操作指南。

在本项临床研究中，最初共招募了88名受试者，其中8例脱落（治疗组和另一组各4例）。剩余80名受试者通过随机数字表法分为治疗组和对照组，每组各40名。治疗方案为每隔10天进行一次羊肠线埋植，避开月经期，连续治疗3个月。治疗组患者同时每日服用一剂中药，月经期间停用，连续服用3个月。所用口服中药为加减四逆四妙失笑散方，其组成成分如下： 醋北柴胡 10 g 红芍药 15 g, 炸橙皮糠 15 g, 麸炒白术 10 g 传牛溪 15 g 薏苡仁 30 g, 盐黄柏 10 g, 炒五灵脂 15 g 生蒲公英 20 g, 忍冬藤 20 g, 蒲公英 15 g, 甘草 6 g，煎煮后每日服用一次，分三次给药。对照组仅使用中药治疗，方剂的选择、加减及疗程均与治疗组保持一致。
在本研究中，对照组出现两例胃肠道反应，均表现为腹泻，可能与服用中药有关。由于这两例患者存在脾胃虚弱的情况，我们加用...

本文概述了针对由盆腔炎性疾病后遗症引起的慢性盆腔疼痛的穴位埋线疗法。

由盆腔炎后遗症引起的慢性盆腔痛是女性盆腔痛的一种常见临床病症。目前，主要……

我们的研究致力于开发针对因盆腔炎性疾病恶化所致慢性盆腔痛的有效治疗方法。研究发现，针灸穴位变异疗法可改善患者的临床症状及生活质量。与系统性西医治疗方案相比，穴位埋线疗法具有疗效显著、复发率低、经济实惠以及操作相对简便等优势。我们将重点关注外用中药对女性慢性盆腔疼痛的缓解效果以及治疗方案的进展。首先，准备好无菌手套、一次性羊肠线埋线针和一次性埋线包。指导患者仰卧，放松身体，并充分暴露腹部和下肢。然后检查目标穴位处的皮肤状况，若无异常则继续操作。确保医师进行常规手部消毒，对目标穴位进行消毒，并佩戴无菌手套。随后确认一次性埋线针的针芯与针管是否顺畅对齐。用右手镊子将羊肠线放入针管中。选择穴位后，用左手绷紧针刺部位的皮肤，右手拇指、食指和中指握住针管，迅速将针垂直刺入皮肤，进针角度为90度。随后，推进针芯并抽出针管，使羊肠线留置于得气部位。拔针时，左手按压穴位皮肤，右手同时拔出针芯和针管，然后用无菌干棉球按压针孔30秒，并在针孔处贴敷医用敷料，持续两天。

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术中检测微小子宫内膜异位症：一种针对腹膜完整性缺失相关盆腔疼痛检测与治疗的新范式

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穴位埋线疗法在中医治疗过敏性鼻炎中的应用

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穴位埋线疗法治疗腹部肥胖

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一种用于治疗肥胖的穴位埋线疗法

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子宫骶韧带悬吊大鼠模型的建立

了解穴位肠线埋置疗法治疗盆腔炎后遗症引起的慢性盆腔疼痛。该方法通过将可吸收肠线植入特定穴位，显著改善患者临床症状和生活质量，复发率低且操作简便。

穴位埋线治疗盆腔炎后遗症所致慢性盆腔痛

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