刺血拔罐治疗带状疱疹后遗神经痛的疗效与机制研究
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摘要
目的：通过刺血拔罐治疗带状疱疹后遗神经痛(PHN)的临床研究,综合地评价其临床疗效,并初步探索刺血拔罐治疗PHN的作用机制。
方法：1.采用随机对照研究,将符合纳入标准的64例PHN患者随机分为治疗组和对照组。2.治疗组(32例)采用刺血拔罐疗法。取穴：局部阿是穴；针具：一次性使用无菌注射针(0.7×32TW LB)；罐具：负压拔罐器：操作：局部皮肤常规消毒,左手舒张皮肤,以注射针快速多次点刺患处,深度为3～5mm,每针间隔1.0cm左右,每个罐口面积内点刺5～7次,迅速抽吸拔罐,每次拔3～6罐,总出血量10～20m],在出血未凝固前用吸管吸取3m1至试管待检,留罐15～20min后起罐。隔日一次,8次为一疗程,一疗程后评价疗效。对照组(32例)采用普瑞巴林(乐瑞卡)治疗,口服每次150mg,每日两次，连续服用16天后评价疗效。3.观察指标：综合疗效,疼痛量表-视觉模拟量表(VAS评分),疼痛开始缓解时间,睡眠量评分,抑郁评分SDS,外周血及局部血(治疗组)中P物质(SP)水平。
结果：
1.综合疗效比较,治疗组总有效率100%,愈显率87.50%；对照组总有效率87.50%,愈显率40.63%。两组综合疗效比较,差异有统计学意义(P<0.01)。
2.疼痛改善情况比较,治疗前两组VAS评分比较无统计学差异(P>0.05)；治疗前后VAS评分比较两组都有显著差异(P<0.01)；治疗后VAS评分两组比较,治疗组低于对照组,有显著性差异(P<0.01)；疼痛开始缓解时间治疗组明显短于对照组,有显著性差异(P<0.01)。
3.睡眠质量改善情况比较,治疗组优于对照组(P<0.01)。
4.情绪状态改善情况比较,治疗组优于对照组(P<0.01)。
5.血中SP含量变化比较,治疗组局部血SP含量治疗后较治疗前有显著性下降(P<0.01)；外周血SP含量两组治疗前后均有显著性下降,而下降程度治疗组高于对照组(P<0.01)。
结论：刺血拔罐疗法可明显缓解PHN患者疼痛,明显提高睡眠效率,改善情绪状态。与口服普瑞巴林治疗相比,刺血拔罐疗法综合疗效更好,止痛更快,改善生活质量更明显,安全无副作用,值得在临床进一步推广应用。刺血拔罐疗法可降低局部血P物质(SP)的含量,这可能是其缓解疼痛的作用机制之一。
Purpose:Evaluate the clinical efficacy of blood-letting punturing and cupping therapy in treating PHN synthcticly through clinical research and explore the mechanism.
Method:
1. Introduction randomized control trial,all64patients were divided into treatment group and control group randomly.2.Treatment group(32):Method:blood-letting punturing and cupping therapy.Acupoints:A shi point.Needles:Disposable sterile syringes.Cups:Negative pressure cupping.Manipulations:Sterilize and expand the skin, prick the points multiple-superficially.1.Ocm far from the other needle.Take5-7pricks for each cup area with the depth of3-5mm.Take5-7cupping for12-20minites and gain the blood every other day,8times as a course of treatment. Control group (32):Pregabalin (Lyrica)150mg po, bid, for16days. Observe the effect after1course of treatment.3.Indicators:Comprehansive therapeutic effect,Pain scale-a visual analog scale(VAS), Self-Rating Depression Scale(SDS), Substance P(SP) in peripheral and local blood.
Results:
1.Comprehensive therapeutic effect:The total effective rate of treatment group is100%,while curative and marked effective rate87.50%; The total effective rate of control group is87.50%,while curative and marked effective rate40.63%.The difference was statistically significant(P<0.01).
2.Pain assesment:Pain assessment compared to pre-treatment VAS score was no statistical difference between the two groups(P>0.05);Two of their respective VAS score after treatment compared with before treatment were significantly diffecrent(P<0.01);the two groups after treatment compared to treatment group VAS score was significantl lower than the control group(P <0.01);the time of the pain started to ease of treatment group is significantly shorter than the control group,the difference is statistically significant(P<0.01).
3.After treatment,insomnia took a significant better turn in treatment group,exerting efficacy difference between the two groups(P<0.01).
4. After treatment,emotion took a significant better turn in treatment group,exerting efficacy difference between the two groups(P<0.01).
5.The level of SP in local blood reduced significantly after treatment in treatment group; The level of SP in peripheral blood reduced significantly after treatment in both group, exerting efficacy difference between the two groups(P<0.01).
Conclusion:Blood-letting punturing and cupping therapy can obviously relieve the pain of PHN patients,improve the patients'sleep efficiency,improve their imotion states,with better curative and marked effective rate and time of the pain started to ease. It has no side effects,is Safe and worthy of clinical application. Blood-letting punturing and cupping therapy can significantly reduce the level of SP in pain area,which could be one of the mechanisms of pain relief.
方法：1.采用随机对照研究,将符合纳入标准的64例PHN患者随机分为治疗组和对照组。2.治疗组(32例)采用刺血拔罐疗法。取穴：局部阿是穴；针具：一次性使用无菌注射针(0.7×32TW LB)；罐具：负压拔罐器：操作：局部皮肤常规消毒,左手舒张皮肤,以注射针快速多次点刺患处,深度为3～5mm,每针间隔1.0cm左右,每个罐口面积内点刺5～7次,迅速抽吸拔罐,每次拔3～6罐,总出血量10～20m],在出血未凝固前用吸管吸取3m1至试管待检,留罐15～20min后起罐。隔日一次,8次为一疗程,一疗程后评价疗效。对照组(32例)采用普瑞巴林(乐瑞卡)治疗,口服每次150mg,每日两次，连续服用16天后评价疗效。3.观察指标：综合疗效,疼痛量表-视觉模拟量表(VAS评分),疼痛开始缓解时间,睡眠量评分,抑郁评分SDS,外周血及局部血(治疗组)中P物质(SP)水平。
结果：
1.综合疗效比较,治疗组总有效率100%,愈显率87.50%；对照组总有效率87.50%,愈显率40.63%。两组综合疗效比较,差异有统计学意义(P<0.01)。
2.疼痛改善情况比较,治疗前两组VAS评分比较无统计学差异(P>0.05)；治疗前后VAS评分比较两组都有显著差异(P<0.01)；治疗后VAS评分两组比较,治疗组低于对照组,有显著性差异(P<0.01)；疼痛开始缓解时间治疗组明显短于对照组,有显著性差异(P<0.01)。
3.睡眠质量改善情况比较,治疗组优于对照组(P<0.01)。
4.情绪状态改善情况比较,治疗组优于对照组(P<0.01)。
5.血中SP含量变化比较,治疗组局部血SP含量治疗后较治疗前有显著性下降(P<0.01)；外周血SP含量两组治疗前后均有显著性下降,而下降程度治疗组高于对照组(P<0.01)。
结论：刺血拔罐疗法可明显缓解PHN患者疼痛,明显提高睡眠效率,改善情绪状态。与口服普瑞巴林治疗相比,刺血拔罐疗法综合疗效更好,止痛更快,改善生活质量更明显,安全无副作用,值得在临床进一步推广应用。刺血拔罐疗法可降低局部血P物质(SP)的含量,这可能是其缓解疼痛的作用机制之一。
Purpose:Evaluate the clinical efficacy of blood-letting punturing and cupping therapy in treating PHN synthcticly through clinical research and explore the mechanism.
Method:
1. Introduction randomized control trial,all64patients were divided into treatment group and control group randomly.2.Treatment group(32):Method:blood-letting punturing and cupping therapy.Acupoints:A shi point.Needles:Disposable sterile syringes.Cups:Negative pressure cupping.Manipulations:Sterilize and expand the skin, prick the points multiple-superficially.1.Ocm far from the other needle.Take5-7pricks for each cup area with the depth of3-5mm.Take5-7cupping for12-20minites and gain the blood every other day,8times as a course of treatment. Control group (32):Pregabalin (Lyrica)150mg po, bid, for16days. Observe the effect after1course of treatment.3.Indicators:Comprehansive therapeutic effect,Pain scale-a visual analog scale(VAS), Self-Rating Depression Scale(SDS), Substance P(SP) in peripheral and local blood.
Results:
1.Comprehensive therapeutic effect:The total effective rate of treatment group is100%,while curative and marked effective rate87.50%; The total effective rate of control group is87.50%,while curative and marked effective rate40.63%.The difference was statistically significant(P<0.01).
2.Pain assesment:Pain assessment compared to pre-treatment VAS score was no statistical difference between the two groups(P>0.05);Two of their respective VAS score after treatment compared with before treatment were significantly diffecrent(P<0.01);the two groups after treatment compared to treatment group VAS score was significantl lower than the control group(P <0.01);the time of the pain started to ease of treatment group is significantly shorter than the control group,the difference is statistically significant(P<0.01).
3.After treatment,insomnia took a significant better turn in treatment group,exerting efficacy difference between the two groups(P<0.01).
4. After treatment,emotion took a significant better turn in treatment group,exerting efficacy difference between the two groups(P<0.01).
5.The level of SP in local blood reduced significantly after treatment in treatment group; The level of SP in peripheral blood reduced significantly after treatment in both group, exerting efficacy difference between the two groups(P<0.01).
Conclusion:Blood-letting punturing and cupping therapy can obviously relieve the pain of PHN patients,improve the patients'sleep efficiency,improve their imotion states,with better curative and marked effective rate and time of the pain started to ease. It has no side effects,is Safe and worthy of clinical application. Blood-letting punturing and cupping therapy can significantly reduce the level of SP in pain area,which could be one of the mechanisms of pain relief.
引文
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