施氏砭术综合疗法治疗气滞血瘀型慢性盆腔疼痛的疗效观察
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摘要
目的
本研究旨在观察施氏砭术综合疗法治疗气滞血瘀型慢性盆腔疼痛的疗效,通过观察患者治疗前后在简化McGill疼痛量表、焦虑自评量表(SAS)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)的评分差异及月经改善情况,准确合理评价施氏砭术综合疗法治疗气滞血瘀型慢性盆腔疼痛的疗效、安全性及其对患者焦虑、生存质量等方面的改善情况,从而为临床有效治疗慢性盆腔疼痛开辟新路径、新方法。
方法
本研究采用简单随机平行对照试验,收集自2009年3月至2010年4月在广东省中医院妇科门诊以慢性盆腔疼痛作为主要治疗目的,中医证型为气滞血瘀型的慢性盆腔疼痛患者共86例,随机分为治疗组42例,对照组44例。治疗组予施氏砭术综合疗法治疗方案治疗,对照组予散结镇痛胶囊口服,分别在患者治疗前及治疗3个月经周期后,采用简化McGill疼痛量表、焦虑自评量表、世界卫生组织生存质量测定量表简表对患者进行评分及行一般安全常规检查、妇科检查,记录月经情况,分别比较两组患者在治疗前后各项指标的组内及组间变化情况。
结果
1.治疗组42例,脱落7例,对照组无脱落。两组患者治疗后简化McGill疼痛量表的评分均有下降。各组治疗前后6项疼痛指标评分的比较,均有统计学差异(P<0.05)。组间比较中,PRI感觉分、总PRI、VAS评分差异的比较,有统计学差异(P<0.05),选词阳性数目、PRI情感分、PPI评分差异的比较,无统计学差异(P>0.05)。表明治疗组的镇痛疗效优于对照组。
2.两组患者治疗后焦虑评分水平均有下降。各组治疗前后焦虑评分比较及焦虑程度分级的比较,均有统计学差异(P<0.05)。组间比较中,治疗前后焦虑评分差异的比较,有统计学差异(P<0.05),治疗后焦虑程度分级的比较,无统计学差异(P>0.05)。表明治疗组对焦虑评分水平下降的影响大于对照组。
3.生存质量的比较,主要包括生存质量主观感受、健康情况主观感受及生理领域、心理领域、社会关系领域、环境环境的比较。两组患者经治疗后以上6项的评分较治疗前均有不同程度的提高。治疗组治疗前后各项评分的比较,均有统计学差异(P<0.05)；对照组治疗前后生存质量主观感受、健康情况主观感受、生理领域、心理领域、环境领域评分的比较,均有统计学差异(P<0.05),但治疗前后社会关系领域评分的比较,则无统计学差异(P>0.05)。组间比较中,治疗前后生存质量主观感受、健康情况主观感受、生理领域、心理领域评分差异的比较,均有统计学差异(P<0.05),而环境领域评分差异的比较,无统计学差异(P>0.05)。表明除对照组对社会关系领域无改善外,两组对生存质量的不同项目均有改善,其中治疗组对生存质量主观感受、健康情况主观感受、生理领域、心理领域、社会关系领域的改善水平优于对照组,而两组对环境领域的改善情况无差异。故总体上,治疗组对生存质量的改善情况优于对照组。
4.在纳入观察统计的79例患者中,治疗前月经有异常的25例,其中治疗组10例,对照组15例。经治疗后月经情况恢复正常者,治疗组9例,改善率为90%,对照组4例,改善率为26.7%,改善率的组间比较,有统计学差异(P<0.05)。表明治疗组对月经改善情况优于对照组。
5.比较治疗后两组患者的自我疗效评价,分为无效、好转、显效、痊愈四个等级。治疗组35人,无效1人,好转7人,显效17人,痊愈10人,总有效率97.14%；对照组无效6人,好转15人,显效15人,痊愈8人,总有效率86.36%。两组疗效自评的等级比较,有统计学差异(P<0.05),说明治疗组患者疗效自评优于对照组。
6.两组患者治疗期间均无明显不良反应,在安全性指标方面均无明显异常。说明两组治疗均具有较好的安全性。
结论
施氏砭术综合疗法能有效缓解慢性盆腔疼痛,减轻焦虑,提高生存质量,改善月经情况,经患者自评疗效确切,同时治疗期间无明显不良反应,提示施氏砭术综合疗法是安全有效的,值得临床上进一步推广应用。
Objective
The main purpose of the study is to observe the curative effect on the treatment of chronic pelvic pain with qi and blood stasis by adopting the combined treatment of Shi's stoneneedle. Around through the observation of the changes of the short-form McGill pain questionnaire, Self-Rating Anxiety Scale, WHOQOL-BREF as well as the menstruation. This study approaches the basic prescription of the combined therapy of Shi's stoneneedle used to treat the chronic pelvic pain with qi and blood stasis and evaluates the effect of this treatment on relieving pelvic pain, the security of this treatment, the abatement of anxiety as well as the improvement of the quality of life exactly, thus to find a new way to treat the chronic pelvic pain effectively.
Methods
This study uses the simple stochastic balanced check experiment. The 86 cases of chronic pelvic pain with qi and blood stasis are collected from March, 2009 to April,2010 in Guangdong Province Chinese medicine hospital gynecology department outpatient service. All of them are puzzled by the chronic pelvic pain. They are divided into the treated group with 42 cases and the control group with 44 cases stochastically. The treated group are gived the treatment of the combined therapy of Shi's stoneneedle, while the control group are gived the caps of Shanjiezhentong. Before and after the treatments we let the patients do the short-form McGill pain questionnaire, Self-Rating Anxiety Scale, WHOQOL-BREF. Meanwhile, we let the group members to take the woman examine, record their menstruation and carry on some secure target inspections. At last we compare the distinction by analying various targets between two groups and own around in one group.
Result
1. Seven cases of treated group fall off during the observation, but there is none in the control group. Both two groups have the drop in the grading of the short-form McGill pain questionnaire after the treatments. There is statistics significance difference in the group own comparison (P< 0.05). While the groups comparison of the phase contrast also have statistics significance difference (P< 0.05) in SENSATION OF PRI, TOTOIL PRI and VAS, but there have not statistics significance difference (P> 0.05) in SELECTION OF MASCULINE WORDS, AFFECTION OF PRI, PPI. So the treated group is better than the control group in relieving pain.
2. After the treatments, both two groups have the drop in the grading of the Self-Rating Anxiety Scale. And therer is statistics significance difference in the group own comparison (P< 0.05). While the groups comparison of the phase contrast in the anxiety also have statistics significance difference (P< 0.05), but there is not statistics significance difference (P>0.05) in ranking of anxiety. So the treated group is better than the control group in improving the anxiety.
3. About the quality of life, both two groups have the boost in the grading of the WHOQOL-BREF after the treatments. In the group own comparison, the treatded group has statistics significance difference (P<0.05) in all aspects, and the control group also has statistics significance difference (P <0.05) in all aspects except SOCIL. Between two groups comparison of the phase contrast in subjective reception of health and quality of live, PHYS,PSYCH which both have statistics significance difference (P<0.05), but in the opposite direction there is not statistics significance difference (P>0.05) in ENVIR. So the treated group is better than the control group in improving the quality of live.
4. Before the treatment, there were 25 patients who had abnormal menstruation in all, the treated group had 10 patients, the control group had 15 patients. After the treatment,9 patients in the treated group recovered normal menstruation, so the improvement rate is 90%, but only 4 patiens in the control group recovered normal menstruation, so the improvement rate is 26.7%. Compared with two groups of improvement rate, there is statistics significance difference (P< 0.05). The treated group is better than the control group in this aspect.
5. After the treatment, we set 4 classifications of curative effect, which included unavailability, improve, excellence, recovery, then we let the patients choose one as the appreciation of the treatment. The total effective rate of treated group is 97.14%, and the total effective rate of control group is 86.36%. Compared with two groups in this aspect, there is statistics significance difference(P<0.05). So the appreciation of the treatment in the treated group is higher than the control group.
6. There is no obviously change in secure target inspections. So both of two groups have good security.
Conclusion
The combined therapy of Shi's stoneneedle can relieve the chronic pelvic pain, abate the anxiety, improve the quality of life and the menstruation, which has high appreciation among the patients. Meanwhile, during the treatment there is no adverse effect. All of above points prove that the combined therapy of Shi's stoneneedle have good security and utility.
本研究旨在观察施氏砭术综合疗法治疗气滞血瘀型慢性盆腔疼痛的疗效,通过观察患者治疗前后在简化McGill疼痛量表、焦虑自评量表(SAS)、世界卫生组织生存质量测定量表简表(WHOQOL-BREF)的评分差异及月经改善情况,准确合理评价施氏砭术综合疗法治疗气滞血瘀型慢性盆腔疼痛的疗效、安全性及其对患者焦虑、生存质量等方面的改善情况,从而为临床有效治疗慢性盆腔疼痛开辟新路径、新方法。
方法
本研究采用简单随机平行对照试验,收集自2009年3月至2010年4月在广东省中医院妇科门诊以慢性盆腔疼痛作为主要治疗目的,中医证型为气滞血瘀型的慢性盆腔疼痛患者共86例,随机分为治疗组42例,对照组44例。治疗组予施氏砭术综合疗法治疗方案治疗,对照组予散结镇痛胶囊口服,分别在患者治疗前及治疗3个月经周期后,采用简化McGill疼痛量表、焦虑自评量表、世界卫生组织生存质量测定量表简表对患者进行评分及行一般安全常规检查、妇科检查,记录月经情况,分别比较两组患者在治疗前后各项指标的组内及组间变化情况。
结果
1.治疗组42例,脱落7例,对照组无脱落。两组患者治疗后简化McGill疼痛量表的评分均有下降。各组治疗前后6项疼痛指标评分的比较,均有统计学差异(P<0.05)。组间比较中,PRI感觉分、总PRI、VAS评分差异的比较,有统计学差异(P<0.05),选词阳性数目、PRI情感分、PPI评分差异的比较,无统计学差异(P>0.05)。表明治疗组的镇痛疗效优于对照组。
2.两组患者治疗后焦虑评分水平均有下降。各组治疗前后焦虑评分比较及焦虑程度分级的比较,均有统计学差异(P<0.05)。组间比较中,治疗前后焦虑评分差异的比较,有统计学差异(P<0.05),治疗后焦虑程度分级的比较,无统计学差异(P>0.05)。表明治疗组对焦虑评分水平下降的影响大于对照组。
3.生存质量的比较,主要包括生存质量主观感受、健康情况主观感受及生理领域、心理领域、社会关系领域、环境环境的比较。两组患者经治疗后以上6项的评分较治疗前均有不同程度的提高。治疗组治疗前后各项评分的比较,均有统计学差异(P<0.05)；对照组治疗前后生存质量主观感受、健康情况主观感受、生理领域、心理领域、环境领域评分的比较,均有统计学差异(P<0.05),但治疗前后社会关系领域评分的比较,则无统计学差异(P>0.05)。组间比较中,治疗前后生存质量主观感受、健康情况主观感受、生理领域、心理领域评分差异的比较,均有统计学差异(P<0.05),而环境领域评分差异的比较,无统计学差异(P>0.05)。表明除对照组对社会关系领域无改善外,两组对生存质量的不同项目均有改善,其中治疗组对生存质量主观感受、健康情况主观感受、生理领域、心理领域、社会关系领域的改善水平优于对照组,而两组对环境领域的改善情况无差异。故总体上,治疗组对生存质量的改善情况优于对照组。
4.在纳入观察统计的79例患者中,治疗前月经有异常的25例,其中治疗组10例,对照组15例。经治疗后月经情况恢复正常者,治疗组9例,改善率为90%,对照组4例,改善率为26.7%,改善率的组间比较,有统计学差异(P<0.05)。表明治疗组对月经改善情况优于对照组。
5.比较治疗后两组患者的自我疗效评价,分为无效、好转、显效、痊愈四个等级。治疗组35人,无效1人,好转7人,显效17人,痊愈10人,总有效率97.14%；对照组无效6人,好转15人,显效15人,痊愈8人,总有效率86.36%。两组疗效自评的等级比较,有统计学差异(P<0.05),说明治疗组患者疗效自评优于对照组。
6.两组患者治疗期间均无明显不良反应,在安全性指标方面均无明显异常。说明两组治疗均具有较好的安全性。
结论
施氏砭术综合疗法能有效缓解慢性盆腔疼痛,减轻焦虑,提高生存质量,改善月经情况,经患者自评疗效确切,同时治疗期间无明显不良反应,提示施氏砭术综合疗法是安全有效的,值得临床上进一步推广应用。
Objective
The main purpose of the study is to observe the curative effect on the treatment of chronic pelvic pain with qi and blood stasis by adopting the combined treatment of Shi's stoneneedle. Around through the observation of the changes of the short-form McGill pain questionnaire, Self-Rating Anxiety Scale, WHOQOL-BREF as well as the menstruation. This study approaches the basic prescription of the combined therapy of Shi's stoneneedle used to treat the chronic pelvic pain with qi and blood stasis and evaluates the effect of this treatment on relieving pelvic pain, the security of this treatment, the abatement of anxiety as well as the improvement of the quality of life exactly, thus to find a new way to treat the chronic pelvic pain effectively.
Methods
This study uses the simple stochastic balanced check experiment. The 86 cases of chronic pelvic pain with qi and blood stasis are collected from March, 2009 to April,2010 in Guangdong Province Chinese medicine hospital gynecology department outpatient service. All of them are puzzled by the chronic pelvic pain. They are divided into the treated group with 42 cases and the control group with 44 cases stochastically. The treated group are gived the treatment of the combined therapy of Shi's stoneneedle, while the control group are gived the caps of Shanjiezhentong. Before and after the treatments we let the patients do the short-form McGill pain questionnaire, Self-Rating Anxiety Scale, WHOQOL-BREF. Meanwhile, we let the group members to take the woman examine, record their menstruation and carry on some secure target inspections. At last we compare the distinction by analying various targets between two groups and own around in one group.
Result
1. Seven cases of treated group fall off during the observation, but there is none in the control group. Both two groups have the drop in the grading of the short-form McGill pain questionnaire after the treatments. There is statistics significance difference in the group own comparison (P< 0.05). While the groups comparison of the phase contrast also have statistics significance difference (P< 0.05) in SENSATION OF PRI, TOTOIL PRI and VAS, but there have not statistics significance difference (P> 0.05) in SELECTION OF MASCULINE WORDS, AFFECTION OF PRI, PPI. So the treated group is better than the control group in relieving pain.
2. After the treatments, both two groups have the drop in the grading of the Self-Rating Anxiety Scale. And therer is statistics significance difference in the group own comparison (P< 0.05). While the groups comparison of the phase contrast in the anxiety also have statistics significance difference (P< 0.05), but there is not statistics significance difference (P>0.05) in ranking of anxiety. So the treated group is better than the control group in improving the anxiety.
3. About the quality of life, both two groups have the boost in the grading of the WHOQOL-BREF after the treatments. In the group own comparison, the treatded group has statistics significance difference (P<0.05) in all aspects, and the control group also has statistics significance difference (P <0.05) in all aspects except SOCIL. Between two groups comparison of the phase contrast in subjective reception of health and quality of live, PHYS,PSYCH which both have statistics significance difference (P<0.05), but in the opposite direction there is not statistics significance difference (P>0.05) in ENVIR. So the treated group is better than the control group in improving the quality of live.
4. Before the treatment, there were 25 patients who had abnormal menstruation in all, the treated group had 10 patients, the control group had 15 patients. After the treatment,9 patients in the treated group recovered normal menstruation, so the improvement rate is 90%, but only 4 patiens in the control group recovered normal menstruation, so the improvement rate is 26.7%. Compared with two groups of improvement rate, there is statistics significance difference (P< 0.05). The treated group is better than the control group in this aspect.
5. After the treatment, we set 4 classifications of curative effect, which included unavailability, improve, excellence, recovery, then we let the patients choose one as the appreciation of the treatment. The total effective rate of treated group is 97.14%, and the total effective rate of control group is 86.36%. Compared with two groups in this aspect, there is statistics significance difference(P<0.05). So the appreciation of the treatment in the treated group is higher than the control group.
6. There is no obviously change in secure target inspections. So both of two groups have good security.
Conclusion
The combined therapy of Shi's stoneneedle can relieve the chronic pelvic pain, abate the anxiety, improve the quality of life and the menstruation, which has high appreciation among the patients. Meanwhile, during the treatment there is no adverse effect. All of above points prove that the combined therapy of Shi's stoneneedle have good security and utility.
引文
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