摘要
研究目的：
通过规范的临床随机对照试验,以偏头痛患者为对象,观察透刺头部腧穴治疗偏头痛与常规针刺治疗偏头痛的即时镇痛疗效和总疗效的差异,以探讨透刺头部腧穴治疗偏头痛的临床应用有效性和可行性。
方法：
采用随机、对照、单盲的研究方法,将符合入选标准的偏头痛病例70例随机分为治疗组和对照组。治疗组35例选用百会、神庭、头维、角孙、太阳等穴,采用透刺疗法,神庭透百会、头维透率谷、角孙透太阳；对照组35例采用常规针刺,穴选太阳、率谷、风池、外关、太冲、足临泣等,两组针刺得气后加用电针,疏密波,频率2Hz/100Hz,电流强度的范围在0.1～1.0mA,以患者耐受为度。两组每次治疗30min,5次/周,共治疗4周。于治疗前、治疗后分别记录两组患者偏头痛发作的次数、发作程度、头痛强度、持续时间、伴随症状、VAS评分(视觉模拟评分)、生存质量评分,以判定近期疗效,治疗结束1个月后随访观察各项指标,比较两组远期疗效。
结果：
(1)近期疗效：①治疗组总有效率(91.18%)明显高于对照组(78.13%),两组有显著性差异(P<0.01)：②治疗组头痛发作次数、持续时间、伴随症状、发作程度、VAS计分以及头痛强度治疗后明显优于治疗前(P<0.05),治疗后组间比较显示,除持续时间评分外,治疗组其它各项评分均优于对照组(P<0.05)。(2)远期疗效：①治疗组总有效率(94.1%)高于对照组(84.38%)(P<0.01)：②入组8周治疗组头痛发作次数、持续时间、伴随症状、发作程度、VAS计分及头痛强度均优于治疗前(P<0.05),入组8周两组间比较显示,治疗组优于对照组(P<0.05)。③对两组生存质量WHOQOL-BREF各维度得分治疗前后自身进行比较,治疗后,两组在生理领域得分、心理领域得分评分比较上差异具有明显统计学意义(成组t检验,P<0.01),两组在环境领域得分评分比较上差异具有统计学意义(成组t检验,P<0.05),而其他3个维度的评分比较无统计学意义(成组t检验,P>0.05),可认为试验组可以更好地改善生理领域、心理领域和环境领域三个维度的得分。
结论：
对治疗组与对照组的临床总疗效、中医证候总疗效进行比较,结果表明两种治疗方法对改善偏头痛及中医症状上均有较好疗效。而透刺法在改善头痛发作次数、头痛程度、伴随症状(恶心、呕吐、畏光、畏声等)上疗效要优于对照组。
对生存质量WHOQOL-BREF各维度得分的分析结果显示,两组均可有效改善生存质量,但试验组在改善生理领域、心理领域和环境领域三个维度上较优。
Objective:
To standardize the clinical randomized controlled trials, targeted to patients with migraine. Observe the difference of immediate and total analgesic efficacy between penetration acupuncture at the head acupoints and conventional treatment of migraine acupuncture. Migraine of effect of the difference. Acupoints of the head penetration needling treatment of migraine effectiveness and feasibility of clinical application.
Methods:
A randomized, controlled, single blind study methods to meet the inclusion criteria of the 70 cases of migraine patients were randomly divided into treatment and control groups.35 patients treated with penetration acupuncture therapy,35 patients in control group with routine acupuncture, each treatment 30min,5 times/week, were treated for 4 weeks. Before treatment, both groups were recorded after treatment of migraine attack frequency, attack level, headache intensity, duration, accompanying symptoms, VAS score (visual analogue scale), quality of life score, to determine the curative effect, the end of treatment 1 months after the follow-up observation of the indicators, long-term efficacy were compared.
Results:
(1) the short-term curative effect:①The total effective rate in treatment group (91.18%) was significantly higher than those in the control group (78.13%), significant difference between the two groups (P<0.01);②the number of treated migraine attacks, duration, accompanying symptoms, onset of the degree, VAS and the headache intensity score after treatment was significantly better than before treatment (P<0.05), after treatment between the two groups, other than the duration of the score, the treatment group Other scores were better than the control group (P<0.05).
(2) long-term effect:①the treatment group total effectiveness (94.1%) higher than those in the control group (84.38%) (P<0.01);②into group 8 weeks after onset of treatment group, headache frequency, duration, accompanying symptoms, onset of the degree, VAS score and headache intensity than before treatment (P<0.05), into the group of eight weeks between the two groups showed that the treatment group better than the control group (P <0.05).
(3) two groups of the WHOQOL-BREF quality of life scores were compared before and after treatment itself, after treatment, two groups in physical field score, psychological field comparative differences scoring rating has obvious statistical significance (group t-test, P<0.01), two groups in environment field score ratings on a statistically significant difference compared (group t-test, P<0.05), and the other three dimensional ratings comparison group was not statistically significant (group t-test,P>0.05), but that can be better improve physical fields, psychological field and the environment of the three dimensions of scoring.
Conclusion:
The treatment group and control group overall clinical efficacy, the total effect of TCM were compared, the results show that the two treatment methods to improve the symptoms of migraine and Chinese have good results. And penetration acupuncture in improving the frequency of migraine attacks, headache level, associated symptoms (nausea, vomiting, sensitivity to light, fear the sound, etc.) on the efficacy is superior to the control group.
WHOQOL-BREF for quality of life analysis of the scores showed that both groups can effectively improve the quality of life, but in improving physical field, the group psychological field and the environment is superior in three dimensions.
引文
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