电针少阳经穴对偏头痛的镇痛作用的临床观察
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摘要
目的:观察电针少阳经穴对偏头痛患者疼痛的镇痛作用及对血浆β-内啡肽(β-EP)的影响,初步探讨电针治疗偏头痛的作用机理,从而为临床上选择最佳的治疗方案治疗偏头痛提供理论依据。
方法:全部61例研究对象均为武汉市中西医结合医院针灸科和神经内科的门诊及病房的患者。诊断标准参照国际头痛协会(IHS)2004版偏头痛诊断标准,经过神经系统检查及本院或外院CT/MRI、多普勒脑血流图(TCD)等理化检查排除其他器质性头痛,结合临床症状及体征,确诊为偏头痛。将纳入的偏头痛患者随机分为少阳经组和阳明经组两组,其中少阳经组31例,阳明经组30例。少阳经组取穴:风池、外关、阳陵泉、丘墟。阳明经组取穴:头维、偏历、足三里、冲阳。针刺方法:两组治疗每次针刺均单侧取穴,左右交替治疗,均采用电针治疗,用LH200H型韩氏穴位神经刺激仪(HANS),疏密波,频率2Hz/100Hz,恒流强度0.1-1.0 mA,以病人能耐受为度,每次留针30分钟,每日针刺1次,5次为1个疗程,疗程间休息2天,共治疗4个疗程。治疗4个疗程后观察患者的头痛程度、发作次数、持续时间和伴随症状的评分情况,并于治疗前和治疗四个疗程后分别测定患者血浆β-EP含量及健康对照组的血浆β-EP含量。
结果:经过四个疗程治疗后,少阳经穴组和阳明经穴组两组患者的头痛程度、发作次数、持续时间和伴随症状的评分情况综合评分较治疗前有明显的降低,治疗后β-EP含量显著升高。治疗前两组的疼痛综合评分经统计学处理(P＞0.05),无显著性差异,具有可比性;电针少阳经穴组和电针阳明经穴组治疗前与治疗后的疼痛综合评分比较,经t检验P＜0.05,差异有显著性意义;治疗后两组的疼痛综合评分经统计学处理(P＜0.05),差异有显著性意义。电针少阳经穴组和电针阳明经穴组治疗前的β-内啡肽含量与健康对照组比较,经t检验有显著性差异(P＜0.05),阳明经穴组治疗后的β-内啡肽含量与健康对照组比较有显著性差异(P＜0.05),少阳经穴组治疗后β-内啡肽含量与健康对照组比较P＞0.05。各组治疗后β-内啡肽含量与治疗前的比较有显著性差异(P＜0.05)。
结果表明两组电针治疗前后疼痛综合评分均有显著下降,且电针少阳经穴组对偏头痛的疼痛的综合评分下降程度高于电针阳明经穴组,证实了电针少阳经穴组对偏头痛有很好的镇痛效果。两组电针治疗后的血浆β-EP含量较治疗前显著升高,且电针少阳经穴组对血浆β-EP含量升高显著,推断偏头痛的机制可能与提高患者血浆β-EP含量有关。
结论:电针少阳经穴组治疗偏头痛对其镇痛作用及提高患者的血浆β-EP含量上,优于电针阳明经穴组。
Objective:To observe analgesic effect and influence on the level of serumβ-EP of electroacupuncture(EA) at meridian point of shaoyang in patients with Migraine which is to approach the mechanism of action preliminarily in order to offer theoretical evidence in select optimal therapeutic regimen for patients with Migraine in clinically.
Methods:All 61 cases studied were came from Department of Acupuncture-Moxibustion and Neural medical of Wuhan Hospital of Integrated Traditional and Western Medicine,that were hospital patients and out-patient treatment.According to 2004 edition of migraine diagnostic criteria in International Headache Society (IHS),all patients were through many tests such as neurologic check、CT/MRI in native hospital or extrinsic hospital、transcranial Doppler rheo-encephalogram and etc,in order to eliminate other organic headache,and combined with clinical symptom and physical sign,final diagnosis as Migraine,were divided by centre random into two groups,EA at meridian point of shaoyang with 31 cases and at meridian point of yangming with 30 cases. Meridian point of shaoyang were treated by Fengchi,Waiguan, Yanglingquan,Qiuxu;Meridian point of yangming were treated by Touwei,Pianli,Zusanli,Chongyan.The two groups were treated by EA with the type of HANS-LH200H,then electric stimulation was given by HANS EA apparatus with the parameters of frequency of 100Hz and 2Hz,strength of current is 0.1mAto 1.0mA that strength patients could tolerated,Each group chose one side of the body' s acupoint, two sides alternated.Every treatment course last for 30 minutes, once a day,five times for a course of treatment,a total of four weeks,among two courses of treatment can rest two days.After four courses of treatment,observe the score condition of the pain extent, attack times,lasting time and accompanied symptoms headache were investigated before treatment and after treatment of 4 weeks.The level of serumβ-EP was measured before and after treatment,and the level of serumβ-EP with the control group of health.
Results:After four courses of treatment,the combined scores condition of the pain extent,attack times,lasting time and accompanied symptoms headache of the patients of meridian point of shaoyang and yangming had evidently degression before treatment, and the level of serumβ-EP rised significant.Before treatment the combined scores of pain in two groups had no significant difference,that is to say had comparability(P＞0.05 ).In each group, the comparison of combined scores of pain between before and after treatment had significance defference by t-test(P＜0.05).After treatment the comparison of combined scores of pain in two groups had significant difference by statistical treatment(P＜0.05).The level of serumβ-EP of two groups before treatment compared with the control group of health had significant difference by t-test (P＜0.05).The level of serumβ-EP of group in acupoints of Shaoyang after treatment had no significant difference compared with the control group of health.But the group of acupoints of Yangming after treatment had significant difference(P＜0.05).In each group,the comparison of the level of serumβ-EP between before and after treatment had significance defference(P＜0.05).
The consequence indicated that two groups' combined scores in pain had evidently degression,and the group of acupoint of Shaoyang decreased extent were significant higher than the group of acupoint of Yangming,which was confirmed that EA at acupoint of Shaoyang had commendably analgesia effect.The level of serumβ-EP in patients with migraine of the two groups after treatment were significance rised than before treatment,and the group of acupoint of Shaoyang rised higher,to conclude that the mechanism of migraine may relate to raise the level of serumβ-EP in patients.
Conclusion:EA treatment at the group of acupoint of Shaoyang of patients with migraine in analgesic effect and raise the level of serumβ-EP in patients were superior to EA treatment at the group of acupoint of Yangming.
方法:全部61例研究对象均为武汉市中西医结合医院针灸科和神经内科的门诊及病房的患者。诊断标准参照国际头痛协会(IHS)2004版偏头痛诊断标准,经过神经系统检查及本院或外院CT/MRI、多普勒脑血流图(TCD)等理化检查排除其他器质性头痛,结合临床症状及体征,确诊为偏头痛。将纳入的偏头痛患者随机分为少阳经组和阳明经组两组,其中少阳经组31例,阳明经组30例。少阳经组取穴:风池、外关、阳陵泉、丘墟。阳明经组取穴:头维、偏历、足三里、冲阳。针刺方法:两组治疗每次针刺均单侧取穴,左右交替治疗,均采用电针治疗,用LH200H型韩氏穴位神经刺激仪(HANS),疏密波,频率2Hz/100Hz,恒流强度0.1-1.0 mA,以病人能耐受为度,每次留针30分钟,每日针刺1次,5次为1个疗程,疗程间休息2天,共治疗4个疗程。治疗4个疗程后观察患者的头痛程度、发作次数、持续时间和伴随症状的评分情况,并于治疗前和治疗四个疗程后分别测定患者血浆β-EP含量及健康对照组的血浆β-EP含量。
结果:经过四个疗程治疗后,少阳经穴组和阳明经穴组两组患者的头痛程度、发作次数、持续时间和伴随症状的评分情况综合评分较治疗前有明显的降低,治疗后β-EP含量显著升高。治疗前两组的疼痛综合评分经统计学处理(P＞0.05),无显著性差异,具有可比性;电针少阳经穴组和电针阳明经穴组治疗前与治疗后的疼痛综合评分比较,经t检验P＜0.05,差异有显著性意义;治疗后两组的疼痛综合评分经统计学处理(P＜0.05),差异有显著性意义。电针少阳经穴组和电针阳明经穴组治疗前的β-内啡肽含量与健康对照组比较,经t检验有显著性差异(P＜0.05),阳明经穴组治疗后的β-内啡肽含量与健康对照组比较有显著性差异(P＜0.05),少阳经穴组治疗后β-内啡肽含量与健康对照组比较P＞0.05。各组治疗后β-内啡肽含量与治疗前的比较有显著性差异(P＜0.05)。
结果表明两组电针治疗前后疼痛综合评分均有显著下降,且电针少阳经穴组对偏头痛的疼痛的综合评分下降程度高于电针阳明经穴组,证实了电针少阳经穴组对偏头痛有很好的镇痛效果。两组电针治疗后的血浆β-EP含量较治疗前显著升高,且电针少阳经穴组对血浆β-EP含量升高显著,推断偏头痛的机制可能与提高患者血浆β-EP含量有关。
结论:电针少阳经穴组治疗偏头痛对其镇痛作用及提高患者的血浆β-EP含量上,优于电针阳明经穴组。
Objective:To observe analgesic effect and influence on the level of serumβ-EP of electroacupuncture(EA) at meridian point of shaoyang in patients with Migraine which is to approach the mechanism of action preliminarily in order to offer theoretical evidence in select optimal therapeutic regimen for patients with Migraine in clinically.
Methods:All 61 cases studied were came from Department of Acupuncture-Moxibustion and Neural medical of Wuhan Hospital of Integrated Traditional and Western Medicine,that were hospital patients and out-patient treatment.According to 2004 edition of migraine diagnostic criteria in International Headache Society (IHS),all patients were through many tests such as neurologic check、CT/MRI in native hospital or extrinsic hospital、transcranial Doppler rheo-encephalogram and etc,in order to eliminate other organic headache,and combined with clinical symptom and physical sign,final diagnosis as Migraine,were divided by centre random into two groups,EA at meridian point of shaoyang with 31 cases and at meridian point of yangming with 30 cases. Meridian point of shaoyang were treated by Fengchi,Waiguan, Yanglingquan,Qiuxu;Meridian point of yangming were treated by Touwei,Pianli,Zusanli,Chongyan.The two groups were treated by EA with the type of HANS-LH200H,then electric stimulation was given by HANS EA apparatus with the parameters of frequency of 100Hz and 2Hz,strength of current is 0.1mAto 1.0mA that strength patients could tolerated,Each group chose one side of the body' s acupoint, two sides alternated.Every treatment course last for 30 minutes, once a day,five times for a course of treatment,a total of four weeks,among two courses of treatment can rest two days.After four courses of treatment,observe the score condition of the pain extent, attack times,lasting time and accompanied symptoms headache were investigated before treatment and after treatment of 4 weeks.The level of serumβ-EP was measured before and after treatment,and the level of serumβ-EP with the control group of health.
Results:After four courses of treatment,the combined scores condition of the pain extent,attack times,lasting time and accompanied symptoms headache of the patients of meridian point of shaoyang and yangming had evidently degression before treatment, and the level of serumβ-EP rised significant.Before treatment the combined scores of pain in two groups had no significant difference,that is to say had comparability(P＞0.05 ).In each group, the comparison of combined scores of pain between before and after treatment had significance defference by t-test(P＜0.05).After treatment the comparison of combined scores of pain in two groups had significant difference by statistical treatment(P＜0.05).The level of serumβ-EP of two groups before treatment compared with the control group of health had significant difference by t-test (P＜0.05).The level of serumβ-EP of group in acupoints of Shaoyang after treatment had no significant difference compared with the control group of health.But the group of acupoints of Yangming after treatment had significant difference(P＜0.05).In each group,the comparison of the level of serumβ-EP between before and after treatment had significance defference(P＜0.05).
The consequence indicated that two groups' combined scores in pain had evidently degression,and the group of acupoint of Shaoyang decreased extent were significant higher than the group of acupoint of Yangming,which was confirmed that EA at acupoint of Shaoyang had commendably analgesia effect.The level of serumβ-EP in patients with migraine of the two groups after treatment were significance rised than before treatment,and the group of acupoint of Shaoyang rised higher,to conclude that the mechanism of migraine may relate to raise the level of serumβ-EP in patients.
Conclusion:EA treatment at the group of acupoint of Shaoyang of patients with migraine in analgesic effect and raise the level of serumβ-EP in patients were superior to EA treatment at the group of acupoint of Yangming.
引文
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