摘要目的:观察针灸推拿联合腰椎牵引治疗腰椎间盘突出症的近期疗效及其对患者应激反应的影响。方法:选取义乌市第二人民医院2016年4月至2018年5月收治的腰椎间盘突出症患者150例为研究对象，采用随机数字表法分为对照组75例、观察组75例。对照组采用腰椎牵引治疗，观察组在腰椎牵引基础上联合针灸推拿治疗，两组疗程均为10 d。比较两组患者的近期疗效、治疗前后血清应激反应指标及视觉模拟疼痛(VAS)评分的变化。结果:观察组总有效率为96.0%(72/75)，显著高于对照组的84.0%(63/75)(χ 2＝5.258， P<0.05)。治疗前，两组患者的肢体功能、VAS评分及血清应激反应指标差异均无统计学意义(均 P>0.05)；治疗后，观察组VAS评分[治疗后1个月(1.8±0.8)分、治疗后2个月(1.5±0.6)分、治疗后3个月(1.1±0.3)分]均显著低于对照组[治疗后1个月(2.8±1.3)分、治疗后2个月(2.2±1.6)分、治疗后3个月(2.1±1.2)分]( t＝16.391、16.125、16.935，均 P<0.05)；观察组肿瘤坏死因子、白细胞介素1β、金属基质蛋白酶3分别为(0.80±0.27)μg/L、(0.12±0.02)μg/L、(21.12±7.81)ng/L，对照组分别为(1.35±0.24)μg/L、(0.12±0.02)μg/L、(30.35±7.25)ng/L，两组差异均有统计学意义( t＝6.732、9.531、7.863，均 P<0.05)；观察组Osweatry功能障碍指数、直腿抬高角度分别为(4.8±3.6)、(76.1±10.8)°，对照组分别为(9.6±3.1)、(53.3±10.2)°，两组差异均有统计学意义( t＝8.648、19.543，均 P<0.05)。 结论:针灸推拿联合腰椎牵引对腰椎间盘突出症患者具有良好的近期临床疗效，可减轻患者的疼痛，提高肢体功能水平，改善应激反应水平。

abstractsObjective:To observe the short-term effect of acupuncture and moxibustion combined with lumbar traction on lumbar disc herniation, and its influence on stress response.Methods:A total of 150 patients with lumbar disc herniation admitted to the Second People's Hospital of Yiwu from April 2016 to May 2018 were enrolled in the study.They were divided into control group and observation group according to the random digital table method, with 75 patients in each group.The control group was treated with lumbar traction.The observation group was treated with acupuncture and moxibustion on the basis of lumbar traction.The two groups were treated for 10 days.The short-term efficacy, the serum stress response indicators before and after treatment, and visual analog pain (VAS) scores were compared between the two groups.Results:The total effective rate of the observation group was 96.0% (72/75), which was significantly higher than that of the control group[84.0%(63/75)](χ 2=5.258, P<0.05). Before treatment, there were no statistically significant differences in limb function, VAS score and serum stress response between the two groups (all P>0.05). After treatment, the VAS scores of the observation group[1 month after treatment (1.8±0.8)points, 2 months after treatment (1.5±0.6)points and 3 months after treatment (1.1±0.3)points]were significantly lower than those of the control group[1 month after treatment (2.8±1.3)points, 2 months after treatment (2.2±1.6)points, 3 months after treatment (2.1±1.2)points]( t=16.391, 16.125, 16.935, all P<0.05). The levels of tumor necrosis factor, interleukin-1β, metalloproteinase-3 in the observation group were (0.80±0.27)μg/L, (0.12±0.02)μg/L, (21.12±7.81)ng/L, respectively, which in the control group were (1.35±0.24)μg/L, (0.12±0.02)μg/L, (30.35±7.25)ng/L, respectively, the differences between the two groups were statistically significant ( t=6.732, 9.531, 7.863, all P<0.05). The Osweatry dysfunction index and the straight leg elevation angle of the observation group were (4.8±3.6), (76.1±10.8)°, respectively, which of the control group were (9.6±3.1), (53.3±10.2)°, respectively, the differences between the two groups were statistically significant ( t=8.648, 19.543, all P<0.05). Conclusion:Acupuncture and moxibustion combined with lumbar traction has good clinical effect on patients with lumbar disc herniation, which can alleviate pain, improve limb function and improve stress response.