基于根结理论针刺治疗偏头痛的疗效观察

【作者】 张帆；

【导师】 王军；

【作者基本信息】 北京中医药大学 ， 针灸推拿学（专业学位）， 2021， 硕士

【摘要】 目的:本研究通过临床试验观察基于“根结”理论针刺治疗偏头痛(少阳经证)对于患者疼痛程度、发作次数、生活质量、情绪状态的影响,探讨在“根结”理论指导下针刺治疗偏头痛(少阳经证)的有效性和安全性,为进一步丰富针灸经典理论奠定临床研究基础,为临床推广应用提供可靠的研究数据。方法:收集2019年1月～2021年3月东直门医院通州院区针灸科门诊、脑病针灸科门诊就诊的偏头痛(少阳经证)患者,对患者按照诊断、纳入、排除标准,严格筛查,纳入60例,通过Excel生成随机数字,将其随机分为试验组、对照组各30例。1.试验组取穴:足窍阴、听会,均取患侧腧穴。操作:患者取仰卧位,术者在患侧足窍阴处按压探寻疼痛反应点后,常规消毒后,采用随咳进针法,将规格为0.25 × 25 mm的一次性针灸针(苏州东邦生产)刺入腧穴所在皮肤,深度0.2-0.3寸,并快速捻转约2～3 s。再取患侧听会,将规格为0.25 × 25 mm的一次性针灸针(苏州东邦生产)刺入腧穴所在皮肤,深度约0.5～0.8寸,并快速捻转约2～3 s。疗程:留针30 min。隔天治疗1次,每周治疗3次,共治疗2周为一个疗程。2.对照组取穴:参考高树中《针灸治疗学》(新世纪第四版),丝竹空透率谷、太阳、风池、外关、侠溪、阿是穴,均取患侧腧穴。操作:患者取仰卧位,常规消毒后,将规格为0.25 × 40 mm的一次性针灸针(苏州东邦生产)刺入腧穴所在皮肤,得气后行平补平泻法。疗程:同试验组。评分采集时点:(1)嘱患者回忆入组前2周的头痛程度,选取其头痛发作最严重时的相关评分作为治疗前基线评分;(2)疗程结束后,嘱患者继续观察2周,选择在此期间头痛发作最严重时的相关评分作为治疗后评分。患者在治疗前后分别行视觉模拟量表(VAS)评分、发作次数、偏头痛特异性生活质量量表(MSQ)评分、焦虑自评量表(SAS)评分、抑郁自评量表(SDS)评分,并在整个疗程中详细记录其可能出现的所有不良事件。相关数据使用SPSS 20.0进行统计分析,比较两组医治方案的疗效及安全性的差异,并评估它们对患者生活质量的改变,及其对情绪状态的影响。结果:1.一般资料比较:治疗前,两组患者年龄、性别、病程、VAS评分、发作次数、MSQ评分、SAS评分、SDS评分相比较,均P>0.05,均无统计学意义,提示两组间具有可比性。2.VAS评分:两组较治疗前VAS评分均显著降低,差异有统计学意义(P<0.05);试验组总有效率达83.3%,对照组总有效率达70.0%,两组针刺医治方案临床疗效差异不显著,不具有统计学意义(P>0.05)。提示两种方法治疗均能改善偏头痛患者疼痛程度,且疗效相当。3.发作次数:两组较治疗前发作次数均显著减少,差异有统计学意义(P<0.05);两组针刺医治方案在改善发作次数方面差异显著,具有统计学意义(P<0.05),试验组优于对照组。提示两种方法治疗均能减少偏头痛患者发作次数,且试验组疗效更佳。4.偏头痛特异性生活质量量表、焦虑自评量表、抑郁自评量表评分:两组较治疗前诸量表评分均显著改善,具有统计学意义(P<0.05)。试验组在改善偏头痛特异性生活质量量表、焦虑自评量表评分方面优于对照组(P<0.05),在改善抑郁自评量表方面差异无统计学意义(P>0.05)。提示两种方法均有助于改善患者因偏头痛导致的生活质量降低、改善患者因偏头痛诱发的焦虑、抑郁状态,且试验组对提高生活质量,改善焦虑状态效果更佳。5.安全性评价:两组患者均未出现严重不良反应,故可认为两组治疗方案均为安全治疗方案。结论:基于“根结”理论针刺治疗偏头痛(少阳经证),可明显降低患者的VAS评分,并能降低发作次数,改善患者因偏头痛导致生活质量降低和焦虑、抑郁情绪。因其取穴简单,操作便捷,疗效可靠且安全性高,值得进一步临床和基础研究以助于其推广应用。更多还原

【Abstract】 Objective:In this study,clinical trials were conducted to observe the effects of acupuncture treatment of migraine(shaoyang meridian syndrome)based on "root knot" theory on pain degree,attack times,quality of life and emotional state of patients,and to explore the effectiveness and safety of acupuncture treatment of migraine(shaoyang meridian syndrome)under the guidance of "root knot" theory,so as to lay a foundation for clinical research and provide reliable research data for clinical popularization and application.Methods:From January 2019 to March 2021,patients with migraine(shaoyang meridian syndrome)who visited the acupuncture clinic and the acupuncture clinic of e ncephalopathy in Tongzhou District of Dongzhimen Hospital were collected.According to the criteria of diagnosis,inclusion and exclusion,60 patients were strictly screened and included.Random numbers were generated by Excel,and they were randomly di vided into experimental group and control group with 30 cases each.1.test groupAcupoint selection:acupoints on the affected side are selected for yin deficiency and hearing.Operation:The patient was in supine position,and the operator pressed the vagin a of the affected foot to explore the pain reaction point.After routine disinfection,a disposable acupuncture needle(produced by Suzhou Dong Bang)with a specification o f 0.25 × 25 mm was inserted into the skin where the acupoints were located,with a depth of 0.2～0.3 inch,and twisted quickly for about 2～3 seconds.After listening to the affected side,a disposable acupuncture needle(made in Dong Bang,Suzhou)wit h a size of 0.25 × 25 mm was inserted into the skin where the acupoints were locate d,with a depth of about 0.5～0.8 inch,and it was quickly twisted for about 2～3 se conds.Treatment course:needle retention for 30 min.Treatment is once every other day,three times a week,and a course of treatment is two weeks in total.2.control groupSelection of acupoints:refer to "Acupuncture Therapeutics"(the fourth edition of the new century)in Gaoshu,and select the acupoints on the affected side,such as the valley of air permeability,Sun,Fengchi,Waiguan,Xiaxi and Ashi.Operation:Patients were taken in supine position,and after routine disinfection,di sposable acupuncture needles(made in Dong Bang,Suzhou)with specifications of 0.25 × 40 mm were punctured into the skin where the acupoints were located,and the method of calming the spleen and purging the diarrhea was performed after getting an gry.Course of treatment:the same as the experimental group.Score collection time:(1)ask the patient to recall the headache degree two weeks before entering the group,and select the relevant score when the headache is the most serious as the baseline score before treatment;(2)After the course of treatment,instruct the patient to continue to observe for 2 weeks,and select the relevant score when the headache is the most serious during this period as the post-treatment score.Patients were scored with visual analogue scale(VAS),attack times,migraine specific quality of life scale(MSQ),self-rating anxiety scale(SAS)and self-rating depression scale(SDS)before and after treatment,and all possible adverse events were recorded in detail during the whole course of treatment.The related data were statistically analyzed by SPSS 20.0,and the differences of curative effect and safety between the two groups were compared,and their changes on patients’ quality of life and their influence on emotional state were evaluated.Results:1.Comparison of general data:before treatment,the age,sex,course of disease,VAS score,attack times,MSQ score,SAS score and SDS score of the two groups were all P>0.05,which showed no statistical significance,suggesting that the two groups were comparable.2.VAS score:VAS scores of the two groups were significantly lower than those before treatment,with statistical significance(P<0.05).The total effective rate was 83.3%in the experimental group and 70.0%in the control group.There was no significant difference in clinical efficacy between the two groups(P>0.05).It is suggested that both methods can improve the pain degree of migraine patients,and the curative effect is equivalent.3.Attack frequency:Compared with those before treatment,the number of attacks in both groups decreased significantly(P<0.05).There is a significant difference in improving attack frequency between the two groups(P<0.05),and the experimental group is superior to the control group.It is suggested that both methods can reduce the attack frequency of migraine patients,and the experimental group has better curative effect.4.Migraine-specific Quality of Life Scale,Self-rating Anxiety Scale and Self-rating Depression Scale:The scores of the two groups were significantly improved compared with those before treatment(P<0.05).The experimental group was superior to the control group in improving migraine specific quality of life scale and self-rating anxiety scale(P<0.05),but there was no significant difference in improving self-rating depression scale(P>0.05).It is suggested that both methods are helpful to improve the quality of life,anxiety and depression caused by migraine,and the experimental group has a better effect on improving the quality of life and anxiety.5.Safety evaluation:No serious adverse reactions occurred in the two groups of patients,so it can be considered that the two groups of treatment schemes are safe treatment schemes.Conclusion:Acupuncture treatment of migraine(shaoyang meridian syndrome)based on"root knot" theory can significantly reduce the VAS score of patients,reduce the number of attacks,and improve the quality of life,anxiety and depression caused by migraine.Because it has the characteristics of simple acupoint selection,convenient operation,reliable curative effect and high safety,it is worthy of further clinical and basic research to help its popularization and application.更多还原