针刺治疗原发性痛经即刻镇痛作用时效规律的研究

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1、提要目的：选取治疗痛经常用而有效的两组穴位处方，观察其对原发性痛经镇痛作用随时间变化的规律，并比较两组处方的差异，为确定最佳留针时间、针刺频次及完善优化方案提供临床依据。方法：采用中央随机系统进行分组，将符合纳入标准的568例患者分为五组，选取其中两组共188例，单穴（十七椎穴）即刻针刺组95例，多穴（十七椎、次髎、地机、三阴交穴）即刻针刺组93例，剔除2例，脱落14例，脱落率7.45%。观察针刺前后两组的疼痛视觉模拟评分(VisualAnalogueScale,VAS)随时间的变化，并比较两组之

2、间的差异。结果：治疗后，单穴组及多穴组VAS读数与治疗前差异有显著统计学意义(P<0.01)；单穴组与多穴组间治疗前后VAS读数无差异(P>0.05)。针刺效应从针刺5min即开始显现，随着留针时间的持续，针刺镇痛效应逐渐增强，到针刺30min时出现最大峰值。起针30min后镇痛效应有所下降，至起针后60min、120min镇痛效应再度加强。针刺单穴组和多穴组的时效规律曲线具有相似性。结论：1.疼痛时针刺十七椎及多穴均对原发性痛经患者有镇痛效应，且该效应有临床意义。2.针刺单穴组或者多穴组针刺效应

3、到30min达到峰值，最佳诱导期可能是30min。留针时间以不短于30min为宜。3.在留针30min的条件下，单刺十七椎时，镇痛作用优于留针短于30min的镇痛效果；留针30min条件下的半衰期较短，对于痛经持续时间在1d左右或更长的患者，单刺十七椎的频次以每天针刺2次为宜。4.从优化方案角度考虑，针刺治疗原发性痛经即刻镇痛单取十七椎穴即可。5.针刺镇痛时效规律与原发性痛经患者疼痛程度无明显相关性。关键词针刺；原发性痛经；时效规律；临床研究ResearchofTimeEffectRegulari

4、tyofAcupunctureforPrimaryDysmenorrheaSpeciality：AcupunctureandMoxibustionAuthor:LiZhaofengTutor:GaoShuzhongAbstractObjective:Toobservetheroleoftimeinacupuncturetreatingprimarydysmenorrheaandtocomparethedifferencesbetweentwodifferentacupointprescriptio

5、nsastoprovideclinicalevidenceforbestneedle-retainingtime,acupuncturefrequencyandprioritizationschemeimprovement.Methods:568patientsofprimarydysmenorrheafrom5differentclinicaltrialcenterswererandomlydividedintofivedifferentgroups,twogroupswith188patien

6、tsamongtheabovefivegroupswerechosen.Single-Pointgroup(Shiqizhui(EX-B8))with95patientsandMulti-Pointgroup(Shiqizhui(EX-B8),Ciliao(BL32),Diji(SP8),Sanyinjiao(SP6))with93patients,2patientswereexcludedand14patientsweredropped.Toobservethechangesofpainvisu

7、alanaloguescale(VisualAnalogueScale,VAS)withtimeoftwogroupsbeforeandafteracupunctureandtocomparethedifferencesbetweentwogroups.Results:TherewasnodifferenceofVASbetweentwogroupsbothbeforeandaftertreatment.Bothgroupsweresignificantlydifferent(P<0.01)inV

8、ASaftertreatmentcomparingbeforetreatment.Analgesiceffectshowedafter5-minuteneedling,andtheeffectrisingwithneedle-retainingtimeupto30minutes.Therewasadeclineinanalgesiceffectafterremovingneedlesfor30minutes,butanalgesiceffectreinforcingafterrem