針灸對腕隧道症候群之影響~ 一個隨機試驗; Acupuncture in patients with Carpal tunnel syndrome ~ A randomized control trial

• Main Author: 楊鈞百; Chun-Pai Yang
• Other Authors: 中國醫藥大學：中西醫結合研究所碩士班
• Format: Thesis
• Language: Chinese; English
• Published: 2009
• Subjects: 針灸; 腕隧道症候群; 類固醇; 內關穴; 大陵穴; Acupuncture; Carpal tunnel syndrome; Steroid; Neiguan (PC6); Daling (PC7); DML
• Online Access: http://ir.cmu.edu.tw/ir/handle/310903500/319; http://ir.cmu.edu.tw/ir/bitstream/310903500/319/1/cmu-98-9667002-1.pdf; http://ir.cmu.edu.tw/ir/bitstream/310903500/319/-1/index.html

目的: 本研究的目的是希望藉由客觀的神經電生理學檢查以及主觀的症狀量表來探討輕到中度症狀腕隧道症候群的病人藉由隨機分配於針灸治療或類固醇治療的臨床療效與安全性比較。 方法: 這是一個前瞻性及連續性的試驗，總共收納了77位經由神經傳導檢查確診的腕隧道症候群病人。排除正中神經感覺異常持續不變及魚際肌萎縮的病人。這77位病人被隨機分成兩組:(1) 39位病人接受2星期每日20毫克的口服類固醇治療接著2星期每日10毫克的口服類固醇治療 (2) 38位病人在4個星期內接受8次針灸治療。全般性症狀分數評估問卷當作標準且可靠的評估方法；此評估問卷包含5個主要症狀 (疼痛，麻木，感覺異常，無力/笨拙，夜間覺醒)，每個症狀從0分(沒有症狀) 到10分(症狀最嚴重)。病人在治療前及治療2星期後及4星期後分別完成一次問卷。分析全般性症狀分數前後的改變來分析是否有統計學上的意義。神經傳導檢查在治療前及治療結束後各做一次當作客觀的評估。所有的統計方法均採意圖對待分析(intent-to-treat)的統計方法。 結果: 總共有77位病人符合輕到中度症狀腕隧道症候群的納入條件而參與本試驗。在針灸組有38位病人而在類固醇組有39位病人。兩組的全般性症狀分數在治療二星期後及四星期後均有大幅度的進步(P<0.01)，雖然兩組間的差異並不大(P=0.15)。在五個主要的症狀評估 (疼痛，麻木，感覺異常，無力/笨拙，夜間覺醒) 分數中，只有夜間覺醒這個項目，針灸組相對於類固醇組在治療4星期後有明顯的改善 (P =0.03)。接受針灸治療的病人相對於接受類固醇治療的病人在治療4星期後遠端運動神經潛時(distal motor latency, DML) 有明顯的改善 (P =0.012)。病人對於針灸治療接受度高且副作用小。 結論: 對於輕到中度症狀的腕隧道症候群的病人，短期針灸治療的療效和短期低劑量類固醇治療的效果相當。對於無法忍受類固醇的副作用或對類固醇有禁忌症的患者，及不願意提早開刀的病人，針灸治療提供了另一項治療的選擇。 Objectives: To investigate the efficacy of acupuncture compared with steroid treatment in patients with mild-to-moderate carpal tunnel syndrome (CTS) as measured by objective changes in nerve conduction studies (NCS) and subjective symptoms assessment in a randomized, controlled study. Methods: A total of 77 consecutive and prospective CTS patients confirmed by NCS were enrolled in the study. Those who had fixed sensory complaint over the median nerve and thenar muscle atrophy were excluded. (A decrease of CMAP amplitude is grouped into moderate, not exclusion criteria). The CTS patients were randomly divided into two treatment arms: (1) two weeks of prednisolone 20 mg daily followed by two weeks of prednisolone 10 mg daily (n =39), and (2) acupuncture administered in 8 sessions over 4 weeks (n=38). A validated standard questionnaire as a subjective measurement was used to rate the five major symptoms (pain, numbness, paresthesia, weakness/clumsiness, and nocturnal awakening) on a scale from 0 (no symptoms) to 10 (very severe). The total score in each of the five categories was termed the global symptom score (GSS). Patients completed standard questionnaires at ...