급성 충수염의 진단에 있어서 경혈 압통 측정의 유용성

Abstract

Background : Acute appendicitis is one of the common surgical diseases which urgent diagnosis is needed in emergency or primary practice. But its diagnosis can be complicated because acute appendicitis has diverse clinical manifestations. Moreover facilities for accurate diagnosis are limited in most primary practice, so we investigated the usefulness of acupoints in the diagnosis of acute appendicitis as the more accurate, easy and simple method.

Methods : The number of appendicitis patients group were 26, whose diagnosis was confirmed by pathology after operation (appendicitis patients group). For the control groups, we selected 20 patients of acute abdominal pain whose clinical diagnosis were other than acute appendicitis (nonappendicitis patients group). Another 20 persons were selected for healthy control group. The subjects of each group were measured the pressure pain threshold by pressure algometer at four acupoints of right lower leg. The four acupoints were Joksamni, Nanmi, Sangeoher, Jogu. We analysed the mean pressure of pain threshold and the order of pain intensity at each acupoint and group.

Results : There was no statistical difference of age and sex in each group. The mean pressure of pain threshold at the Nanmi acupoint ; in appendicitis patients 2.98±0.93㎏/㎠, in nonappendicitis patients 3.79±1.04㎏/㎠, in healthy control 5.08±1.05㎏/㎠, The appendicitis patients' pressure of pain threshold was lower than other groups(p<0.001). The mean pressure of pain threshold in appendicitis patients at each acupoint were as following : nanmi acupoint 2.98±0.93㎏/㎠, Joksamni 4.08±1.61㎏/㎠, Sangeoher 4.75±1.43㎏/㎠, Jogu 5.58±1.47㎏/㎠. The Nanmi acupoint was lower than other acupoints(p<0.001). The diagnostic values of the Nanmi acupoint by the pressure of pain threshold were as following: if the pressure was lower than 3.0㎏/㎠, the sensitivity of diagnosis was 76.9%, specificity was 82.5%, if the pressure was lower than 3.5㎏/㎠, the sensitivity and specificity was 88.5%, 75.0% respectively. The diagnostic value by the order of pain inthnsity; in the most painful acupoint was the Nanmi, the sensitivity was 92.2% and the specificity was 70.0%. The diagnostic alue by the combination of pressure and order of pain intensity : if the most painful acupoint was the Nanmi and the pressure threshold was lower the 3.5㎏/㎠ at the Nanmai, the sensitivity and specificity were 80.1%, 80.0% respectively.

Conclusion : If the pressure threshold was lower than 3.5㎏/㎠ at the Nanmi acupoint and the most painful acupoint was the Nanmi acupoint, acute appendicitis could be diagnosed in sensitivity 80.1% and specificity 80.0%.