手足温针灸联合步行阶梯训练对老年糖尿病周围神经病变患者步态异常、血流动力学和感觉及运动神经传导的影响

摘要 目的：观察手足温针灸联合步行阶梯训练对老年糖尿病周围神经病变（DPN）患者步态异常、血流动力学和感觉及运动神经传导的影响。方法：按照随机数字表法将上海市第六人民医院2020年3月~2022年1月期间收治的119例老年DPN患者分为对照组（n=59，步行阶梯训练）和研究组（n=60，手足温针灸联合步行阶梯训练）。对比两组疗效、步态异常、血流动力学、临床症状改善情况和感觉及运动神经传导变化情况。结果：研究组91.67%的临床总有效率高于对照组72.88%（P<0.05）。研究组干预后的密歇根糖尿病神经病变评分（MDNS）和多伦多临床评分系统（TCSS）评分低于对照组（P<0.05）。研究组干预后的腓总神经及胫神经的感觉神经传导速度（SNCV）、运动神经传导速度（MNCV）高于对照组（P<0.05）。研究组干预后的全血黏度、血浆比黏度、纤维蛋白原低于对照组（P<0.05）。研究组足底压力中心轨迹（COP）曲线异常、全足平衡性曲线异常、全足压力变化曲线异常例数少于对照组（P<0.05）。结论：手足温针灸联合步行阶梯训练可促进老年DPN患者步态异常、血流动力学和感觉及运动神经传导恢复，疗效较好。

Effects of Hand Foot Warm Acupuncture Combined with Walking Ladder Training on Gait Abnormalities, Hemodynamics, Sensory and Motor Nerve Conduction in Elderly Patients with Diabetes Peripheral Neuropathy

ABSTRACT Objective: To observe the effects of hand foot warm acupuncture combined with walking ladder training on gait abnormalities, hemodynamics, sensory and motor nerve conduction in elderly patients with diabetes peripheral neuropathy (DPN). Methods: 119 elderly patients with DPN who were treated in Shanghai Sixth People''s Hospital from March 2020 to January 2022 were divided into control group (n=59, walking step training) and study group (n=60, hand and foot warm acupuncture combined with walking step training) by the random number table method. The curative effect, gait abnormality, hemodynamics, improvement of clinical symptoms and changes of sensory and motor nerve conduction were compared between the two groups. Results: The total clinical effective rate of 91.67% in the study group was higher than 72.88% in the control group (P<0.05). After the intervention, the Toronto clinical scoring system (TCSS) and Michigan Diabetes Neuropathy Score (MDNS) scores of the study group were lower than those of the control group (P<0.05). After the intervention, the motor nerve conduction velocity (MNCV) and sensory nerve conduction velocity (SNCV) of the common peroneal nerve and tibial nerve in the study group were higher than those in the control group (P<0.05). After the intervention, the whole blood viscosity, plasma specific viscosity and fibrinogen of study group were lower than those of control group (P<0.05). The number of abnormal plantar pressure center locus (COP) curve, abnormal full foot balance curve and abnormal full foot pressure change curve in the study group was less than that in the control group (P<0.05). Conclusion: Hand foot warm acupuncture combined with walking ladder training can promote the recovery of gait abnormalities, hemodynamics, sensory and motor nerve conduction in elderly patients with DPN, and has a good effect.