【摘要】 目的:观察单纯应用针灸人迎、水突穴,加用中药1和2号口服、实施星状神经节阻滞,以及3种方法并用对脑损伤、脑震荡及血管神经性顽固性头痛治疗的效果及复发率的影响。方法:纳入大连市中心医院1992-09/2004-12收治的脑损伤、脑震荡及血管神经性慢性顽固性头痛患者68例。①针灸治疗:68例患者先给针刺人迎穴、水突穴,隔日1次,7次为1个疗程,1个疗程不见明显好转的改用星状神经节阻滞或中药治疗。②星状神经节阻滞:18例患者针灸后采用星状神经节阻滞,7d为1个疗程,两三个疗程不见明显好转的改用中药治疗。③中药治疗:50例患者有脑损伤、脑震荡后顽固性头痛给配合口服1号中药(羚羊粉1g,全蝎10g,当归25g,川芎20g,桃仁12g,红花20g,赤芍25g,丹皮10g,菊花10g,曼荆子10g,甘草5g),有血管神经性顽固性头痛给配合口服2号中药(珍珠粉10g,羚羊粉3g,朱砂0.5g,远志15g,山枣仁10g,石菖蒲20g,百合20g,琥珀15g,当归20g,白芍20g,红花10g,川芎15g,鹿茸10g,红参10g,黄芪25g,茯苓25g,细辛3g,蜈蚣5g,甘草5g),2次/d,10d为1个疗程,两个疗程间隔20d,共6个疗程,三四个疗程不见明显好转的改用星状神经节阻滞。治疗效果及3年复发率评估:①疼痛缓解及疗效评价:使用目测类比评分法,0～2分为“优”;3～4分为“良”;5～6分为“可”;>7分为“差”。②抑郁评估:应用汉密顿抑郁量表,最低0分,最高52分,得分越高说明病情越严重,20分以上者为抑郁状态,经过治疗后降到7分以下为效果满意,正常人为2～5.5分。③比较治疗时间。④比较2.0～3.0年复发率。结果:按实际处理分析,纳入患者68例,均进入结果分析。①目测类比评分结果:治疗后低于治疗前[(2.13±1.28),(7.26±2.61)分,P<0.05]。②抑郁评分结果:治疗后低于治疗前[(2.35±1.21),(33.83±4.11)分,P<0.05]。③治疗时间比较:单纯星状神经阻滞和单纯中药治疗均长于中西医结合治疗[(29.85±3.94),(122.35±13.57),(18.57±3.21)d,P<0.05]。④2.0～3.0年复发率比较:单纯星状神经阻滞和单纯中药治疗均高于中西医结合治疗(86%,65%,6%,P<0.05)。结论:星状神经节阻滞配合针灸和中药治疗可提高慢性头痛的治疗效果,延长疗效维持的时间,复发率较低。更多还原

【Abstract】 AIM: To observe the effects of purely application of acupuncture and moxibustion at Renying and Shuitu (ST 10) points, adding traditional Chinese medicine No.1 and No.2 taking orally, stellate ganglion block was performed, and combination of the three methods on the therapeutic effect and relapse rate of cerebral trauma, commotion cerebri and obstinate blood vessel nerve headache. METHODS: Sixty-eight patients with cerebral trauma, commotion cerebri and chronical obstinate blood vessel nerve headache were selected from Dalian Central Hospital from September 1992 to December 2004. ① Treatment of acupuncture and moxibustion: Sixty-eight patients was treated with acupuncture at Renying and Shuitu, once every other day, 7 times as a course. Those who did not take a turn for the better after the first course were changed to treat with stellate ganglion block or traditional Chinese medicine. ② The stellate ganglion block: After taking acupuncture and moxibustion, 18 patients were treated with stellate ganglion block, 7 days as a course. Those who did not take a turn for the better after two or three courses were changed to treat with traditional Chinese medicine. ③ Treatment of traditional Chinese medicine: Fifty patients with cerebral trauma, commotion cerebri and post-obstinate headache were matched with No.1 traditional Chinese medicine taking orally (1 g antelope powder, 10 g scorpion, 25 g Chinese angelica, 20 g Szechwan lovge rhizome, 12 g peach seed, 20 g safflower, 25g red peony root, 10 g paeonol, 10 g chrysanthemum, 10 g shrub chastetree fruit and 5 g liquorice root). Those who had obstinate nerve headache were treated with the No.2 traditional Chinese medicine taking orally (10 g pearl powder, 3 g antelope powder, 0.5 g cinnabar, 15 g Siberian milkwort root, 10 g spine date seed, 20 g Rhizoma Acoori Graminei, 20 g lily bulb, 15 g amber, 20 g Chinese angelica, 20 g white peony root, 10 g safflower, 15 g Szechwan lovge rhizome, 10 g velvet, 10 g radix ginseng rubra, 25 g membranous milkvetch root, 25 g India bread, 3 g asarum, 5 g centipede and 5 g liquorice root), twice a day, 10 days as a course, and there was a 20 days’ interval between two courses, totally 6 courses. Those who did not take a significant turn for the better after three or four courses were changed to treat with stellate ganglion block. Therapeutic efficacy and three-year relapse rate evaluation: ① Easement of pain and evaluation of therapeutic efficacy: The visual inspection analogue score method, 0-2 points for "excellent"; 3-4 points for "good"; 5-6 points for "so-so"; >7 points for "bad". ② Evaluation of depression: Hamilton Depression Scale(HAMD)was applied, 0 point minimum, 52 points maximum, and the higher the score, the severe the patient’s condition. Above 20 points for depression, after treatment decreased to less than 7 points for satisfactory effect, 2-5.5 points of normal people. ③ The therapeutic time was compared. ④ The relapse rate of 2.0-3.0 years was compared. RESULTS: According to the intention-to-treat analysis, 68 patients were all involved in the result analysis. ① The result of visual inspection analogue score: It was lower after treatment than that before treatment [(2.13 ±1.28), (7.26±2.61) points, P < 0.05]. ② Result of depressive score: It was lower after treatment than that before treatment [(2.35±1.21),(33.83 ±4.11) points, P < 0.05]. ③ Comparison of therapeutic time: It was longer of pure stellate ganglion block and pure traditional Chinese medicine than that of the combination of traditional Chinese medicine and western medicine [(29.85±3.94), (122.35±13.57), (18.57±3.21) days, P < 0.05]. ④ Comparison of relapse rate at 2.0-3.0 years: It was higher of pure stellate ganglion block and pure traditional Chinese medicine than that of the combination of traditional Chinese medicine and western medicine [86%, 65%, 6%, P < 0.05]. CONCLUSION: The treatment of stellate ganglion block matching acupuncture and moxibustion and traditional Chinese medicine can enhance the therapeutic efficacy of chronic headache, and prolong the lasting effective time with low relapse rate.更多还原