透穴刺法对带状疱疹后神经痛5-羟色胺及去甲肾上腺素的影响
摘要
目的:本课题通过观察透穴刺法治疗带状疱疹后神经痛(PHN)的临床疗效,检测分析治疗前后患者血浆中5-HT和NE含量的变化,对透穴刺法治疗带状疱疹后遗神经痛的疗效及其镇痛作用机制进行初步探讨,以期更好地指导临床。
方法:将2009年8月至2010年10月在黑龙江省中医研究院针灸科及皮肤科诊治的带状疱疹后遗神经痛患者60例,随机分为治疗组和对照组,每组各30例,治疗组采用透穴刺法,选取百会透通天(双侧)、前顶透承光(双侧)、正营透承灵(双侧)和皮损相关节段的同侧膀胱经穴向相应夹脊穴和督脉经穴透刺;对照组采用普通针刺法,选取与皮损相应的同侧夹脊穴和背俞穴。疗程结束后观察两组临床疗效,采用VAS评分法作为疗效判定标准,按McGill法计算PPI、PRI分数,采用HAMD、HAMA量表对患者进行心理评估及测定患者治疗前、后血浆中5-HT和NE的含量。
结果:
1.透穴刺法治疗PHN具有显著而肯定的临床疗效,治疗组与对照组总有效率分别为93.3%和73.3%,两组疗效比较,差异有统计学意义(P<0.05);
2.两组患者治疗后VAS积分、McGill疼痛积分、HAMD和HAMA积分的比较具有显著性差异(P<0.05);
3.两组患者治疗后血浆中5-HT和NE的含量比较具有显著性差异(P<0.05)。
结论:
1.透穴刺法治疗带状疱疹后神经痛能明显缓解患者的疼痛程度,降低疼痛积分,提高病人的生活质量,治疗组优于对照组。
2.透穴刺法治疗带状疱疹后神经痛能明显改善病人因PHN所致的精神症状,同时有效改善病人的心理状态。
3.透穴刺法治疗带状疱疹后神经痛可以提高机体5-HT和NE含量,从而改善带状疱疹后遗神经痛抑郁、焦虑状态,缓解疼痛。
Objective:Through the point of this topic by observing the needling post-herpetic neuralgia (PHN) the clinical efficacy testing of patients before and after treatment in 5-HT and NE content changes, the point needling through postherpetic neural Pain and its mechanism of analgesic effect of a preliminary study to better guide clinical.
Methods: To August 2009 to October 2010 in Heilongjiang Province Institute of Traditional Chinese Medicine's acupuncture and dermatology treatment of postherpetic neuralgia 60 patients were randomly divided into treatment group and control group, 30 patients in each group, treatment Point acupuncture group were through, select Baihui through the sky (both sides), the former top through the bearing light (both sides), is operating through the Order of the Spirit (both sides) and ipsilateral segmental lesions related to the corresponding bladder meridian Du Meridian Jiaji and through thorns; control group with ordinary acupuncture, selection and the corresponding ipsilateral lesions Jiaji and back-shu points.After the treatment, clinical efficacy, the use of VAS score as the criteria of efficacy, calculated according to McGill PPI, PRI scores, the use of HAMD, HAMA scale for patients with psychological assessment and determination of patients before and after the plasma 5-HT and NE content.
Results:
1.Tacupuncture points through treatment of PHN was significantly and positively with the clinical efficacy of the treatment group and control group, the total effective rate was 93.3% and 73.3%, compared two groups, the difference was statistically significant (P <0.05);
2.Two points after treatment VAS, McGill pain scores, HAMD and HAMA Integral significant difference compared with (P <0.05);
3.Two groups of patients after treatment, the plasma 5-HT and NE levels significantly compared with (P <0.05).
Conclusions:
1.Point needling through post-herpetic neuralgia patients can relieve pain, reduce pain points, improve the quality of life of patients, the treatment group than the control group.
2.Point needling through post-herpetic neuralgia can significantly improve the patient's psychiatric symptoms caused by PHN, and improve the patient's psychological state.
3.Point needling through post-herpetic neuralgia can improve the body content of 5-HT and NE, thereby improving the postherpetic neuralgia, depression, anxiety state , pain relief.
方法:将2009年8月至2010年10月在黑龙江省中医研究院针灸科及皮肤科诊治的带状疱疹后遗神经痛患者60例,随机分为治疗组和对照组,每组各30例,治疗组采用透穴刺法,选取百会透通天(双侧)、前顶透承光(双侧)、正营透承灵(双侧)和皮损相关节段的同侧膀胱经穴向相应夹脊穴和督脉经穴透刺;对照组采用普通针刺法,选取与皮损相应的同侧夹脊穴和背俞穴。疗程结束后观察两组临床疗效,采用VAS评分法作为疗效判定标准,按McGill法计算PPI、PRI分数,采用HAMD、HAMA量表对患者进行心理评估及测定患者治疗前、后血浆中5-HT和NE的含量。
结果:
1.透穴刺法治疗PHN具有显著而肯定的临床疗效,治疗组与对照组总有效率分别为93.3%和73.3%,两组疗效比较,差异有统计学意义(P<0.05);
2.两组患者治疗后VAS积分、McGill疼痛积分、HAMD和HAMA积分的比较具有显著性差异(P<0.05);
3.两组患者治疗后血浆中5-HT和NE的含量比较具有显著性差异(P<0.05)。
结论:
1.透穴刺法治疗带状疱疹后神经痛能明显缓解患者的疼痛程度,降低疼痛积分,提高病人的生活质量,治疗组优于对照组。
2.透穴刺法治疗带状疱疹后神经痛能明显改善病人因PHN所致的精神症状,同时有效改善病人的心理状态。
3.透穴刺法治疗带状疱疹后神经痛可以提高机体5-HT和NE含量,从而改善带状疱疹后遗神经痛抑郁、焦虑状态,缓解疼痛。
Objective:Through the point of this topic by observing the needling post-herpetic neuralgia (PHN) the clinical efficacy testing of patients before and after treatment in 5-HT and NE content changes, the point needling through postherpetic neural Pain and its mechanism of analgesic effect of a preliminary study to better guide clinical.
Methods: To August 2009 to October 2010 in Heilongjiang Province Institute of Traditional Chinese Medicine's acupuncture and dermatology treatment of postherpetic neuralgia 60 patients were randomly divided into treatment group and control group, 30 patients in each group, treatment Point acupuncture group were through, select Baihui through the sky (both sides), the former top through the bearing light (both sides), is operating through the Order of the Spirit (both sides) and ipsilateral segmental lesions related to the corresponding bladder meridian Du Meridian Jiaji and through thorns; control group with ordinary acupuncture, selection and the corresponding ipsilateral lesions Jiaji and back-shu points.After the treatment, clinical efficacy, the use of VAS score as the criteria of efficacy, calculated according to McGill PPI, PRI scores, the use of HAMD, HAMA scale for patients with psychological assessment and determination of patients before and after the plasma 5-HT and NE content.
Results:
1.Tacupuncture points through treatment of PHN was significantly and positively with the clinical efficacy of the treatment group and control group, the total effective rate was 93.3% and 73.3%, compared two groups, the difference was statistically significant (P <0.05);
2.Two points after treatment VAS, McGill pain scores, HAMD and HAMA Integral significant difference compared with (P <0.05);
3.Two groups of patients after treatment, the plasma 5-HT and NE levels significantly compared with (P <0.05).
Conclusions:
1.Point needling through post-herpetic neuralgia patients can relieve pain, reduce pain points, improve the quality of life of patients, the treatment group than the control group.
2.Point needling through post-herpetic neuralgia can significantly improve the patient's psychiatric symptoms caused by PHN, and improve the patient's psychological state.
3.Point needling through post-herpetic neuralgia can improve the body content of 5-HT and NE, thereby improving the postherpetic neuralgia, depression, anxiety state , pain relief.
引文
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[3]Pappagallo M,Haldey EJ.Pharmacological management of postherpetic Neuralgia.CNS Drugs,2003,17(11):771
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[5]Odom RB.Viral Diseases.In Odom RB,Javaes WD,Berger TG,eds.Andrews Diseases of Skin.9th ed.Beijing:Science Press.Harcount Asia Pte.Ltd,2001,473-476
[6]莫世湟.带状疱疹后神经痛[J].现代医院,2004,4(4):28-31
[7]宋文阁,傅志俭,谢珺田.带状疱疹后神经痛的治疗[J].中国临床医生,2003,31(5):10-14
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[9]Rice AS,Maton S.Postherpetic Neuralgia Study Group.Gabapentin in postherpetic neuralgia:a randomised,double blind,placebo controlled study[J].Pain,2001,94(2): 215-224
[10]Quan D,Wellish M,Gilden DH.Topical ketamine treatment of postherpetic neuralgia[J]. Neurology,2003,60(8):E6-7
[11]Hayashida M,Fukuda K,Fukunaga A.Analgesic effect of intravenous ATP on postherpetic neuralgia in comparison with responses to intravenous ketamine and lidocaine[J].Anesth,2005,19(1):31-35
[12]Argoff CE.A focused review on the use of botulinum toxins for neuropathic pain Clin J Pain,2002,18(6 Suppl):S177-181
[13]Rowbothan MC,Galer BS,Perander J,et al.Topical lidocaine patch relieves postherpetic neuralgia more effectively than a vehicle topical patch:results of an enriched enrollment study[J].Pain,1999,80:533-538
[14]Davies PS.Galer BS.Review of lidocaine patch 5% studies in the treatment ofpostherpetic neuralgia[J].Drugs,2004,64(9):937-947
[15]Volmink J,Lancaster T,Gray S,et al.Treatments for postherpetic neuralgia- asystematic review of randomized conliolled trials[J].Fam Pract,1996,13:84-91
[16]Harke H,Gretenkort P,Ladleif HU,et al.Spinal cord stimulation in postherpetic neuralgia and in acute herpes zoster pain[J].Anesth Analg,2002,94:694-700
[17]曾庆利.针刺治疗带状疱疹后神经痛19例[J].实用中医药杂志,2001,17(7):36
[18]宋八恺.刺血涂墨法治疗带状疱疹后神经痛18例[J].针灸推拿,2001,22(4):34
[19]王明如.解毒活血汤加味治疗带状疱疹后神经痛46例[J].宁波医学,1999,11(6):291
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