针刺MTrPs联合药物治疗偏头痛患者的疗效及血液ET、NO水平影响研究

Efficacy of acupuncture MTrPs combined with drugs in the treatment of migraine patients and the effect of blood ET and NO levels

摘要:

目的：探讨偏头痛患者在进行针刺肌筋膜触发（激痛）点 (myofascial trigger point, MTrPs) MTrPs治疗后的疗效和对血液活性物质血浆内皮素 (endothelin ET)、一氧化氮 (nitrogen monoxideNO) 水平的影响。方法：将符合纳入标准的45名偏头痛患者随机数字表法分配为药物组、针刺组及联合组，每组15例。药物组口服尼莫地平片，每次30 mg，每日3次，连续服用2周；针刺组采用针刺头夹肌、上斜方肌和胸锁乳突肌中的MTrPs，每周3次，共治疗2周；联合组口服尼莫地平片，每次30 mg，每日3次，并针刺患者头夹肌、上斜方肌和胸锁乳突肌中的MTrPs，每周3次，共治疗2周。分别对三组患者治疗前后的疼痛和头痛影响评分、血液活性物质ET和NO水平进行比较。结果：治疗前，三组患者基线期各项指标差异无统计学意义；联合组与针刺组在干预后的疼痛视觉模拟评分法(visual analogue scale,VAS) 评分显著低于药物组且显著低于治疗前（P＜ 0.05）；三组患者在干预后的血液ET与NO数值较治疗前显著降低，且联合组在干预后的ET与NO数值显著低于针刺组与药物组（P＜0.05）。结论：针刺MTrPs联合药物能显著降低血液活性物质的水平，减轻偏头痛患者的疼痛程度且不良反应较少，较单一针刺或药物治疗更有效地减少疼痛症状、改善生活质量、降低血液中血管活性物ET、NO的水平。

Abstract:

Objective: To explore the effect of acupuncture myofascial trigger point（MTrPs）on the levels of blood active substances endothelin（ET）and nitrogen monoxide（NO）in patients with migraine. Methods: Forty-five migraine patients who met the inclusion criteria were randomly divided into drug group, acupuncture group and comprehensive group. There were 15 cases in the drug group, 15 cases in the acupuncture group and 15 cases in the comprehensive group. The drug group was treated with nimodipine 30mg 3 times a day for two weeks, the acupuncture group was treated with acupuncture of MTrPs in caput muscle, superior trapezius muscle and sternocleidomastoid muscle 3 times a week for two weeks, and the combined group was treated with nimodipine tablet 30mg 3 times a day and MTrPs in scalp muscle, superior trapezius muscle and sternocleidomastoid muscle 3 times a week for two weeks. The curative effect score and the level of blood active substances in the three groups before and after treatment were compared. Results: Before treatment, there was no significant difference in the baseline indexes among the three groups, but the visual analogue scale (visual analogue scale,VAS) scores of pain after intervention in the combination group and acupuncture group were significantly lower than those in the drug group and before treatment (P < 0.05). The values of blood ET and NO in the three groups after intervention were significantly lower than those before treatment, and the values of ET and NO in the combined group after intervention were significantly lower than those in the acupuncture group and drug group (P < 0.05). Conclusion: acupuncture MTrPs combined with drugs can significantly reduce the level of blood active substances, relieve the degree of pain in patients with migraine and have fewer adverse reactions, which is more effective than single acupuncture or drug therapy in reducing pain symptoms, improving quality of life and reducing the levels of vasoactive substances ET and NO in blood.. Conclusion: Acupuncture MTrPs combined with drugs can significantly reduce the level of blood active substances, reduce the degree of pain in patients with migraine and have fewer adverse reactions, which is more effective than single acupuncture or drug therapy in reducing pain symptoms, improving quality of life and reducing the level of vasoactive substances in blood.