择期艾灸治疗原发性痛经的临床随机对照试验

发布时间：2018-03-11 16:26

本文选题：艾灸　切入点：择期治疗　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的：对比观察经前和经期艾灸治疗对原发性痛经(Primary dysmenorrhea, PD)患者的症状和血清前列腺素PGF2a、PGE2水平的影响,评价不同时期艾灸治疗PD的临床疗效和可能机制,为艾灸治疗PD优势方案的筛选提供研究证据。方法：本研究共纳入140例PD患者,按照随机数字表随机分为两组,经前治疗组(A组)和经期治疗组(B组),每组70例。两组均选取双侧三阴交穴和关元穴,采用艾条灸温和灸连续治疗5-7天,连续治疗3个月经周期。A组于经前5-7天开始治疗,B组于经期第1天开始治疗。采用COX痛经症状量表(the Cox Menstrual Symptom Scale, CMSS)和视觉模拟评分量表(Verbal Analog Scales, VAS)分别于基线期、治疗期和随访期的每一个月经周期结束后评价临床疗效；分别于入组首次月经来潮48小时内和治疗三个月经周期结束后第四次月经来潮48小时内抽取肘部静脉血检测患者血清前列腺素PGF2a、PGE2浓度变化。结果：1.共有132例PD患者完成本项研究,其中A组64例,B组68例。2.两组在人口学特征、生命体征、病情资料和血清前列腺素PGE2、PGF2a浓度上基线情况一致,差异无统计学差异(P0.05)。3.治疗后两组受试者总有效率分别为A组：92.18%；B组：86.76%。4.择期艾灸对PD患者临床症状影响：(1)组内比较结果显示,与治疗前相比,两组CMSS时间总分和严重程度评分、小腹痛时间总分和严重程度评分、VAS评分在治疗后均有显著改善,差异具有统计学意义(P0.05)；(2)组间比较结果显示：与B组相比,A组在治疗期、随访期VAS评分、CMSS时间总分和严重程度评分、小腹痛时间总分和严重程度评分均有显著改善,差异具有统计学意义(P0.05)5.择期艾灸对PD患者血清前列腺素PGE2、PGF2a浓度的影响：(1)组内比较结果显示,与艾灸治疗前相比,两组患者治疗后血清前列腺素PGF2、PGF2a浓度均有显著变化,差异具有统计学差异(P0.05)；(2)组间比较结果显示：与B组相比,A组治疗后血清前列腺素PGF2a浓度有显著变化,差异具有统计学意义(P0.05)6.两组不良事件情况比较无统计学差异(P0.05)结论：1.经前、经期艾灸治疗PD均具有确切疗效,经前艾灸治疗在减轻疼痛、缩短腹痛及伴随症状发作时间、降低腹痛及伴随症状的严重程度方面优于经期治疗组。2.经前、经期艾灸均可影响患者血清前列腺素PGE2、PGF2a浓度,且经前治疗组在降低PD患者血清前列腺素PGF2a浓度上优于经期治疗组,这提示影响血清前列腺素PGE2、PGF2a浓度,缓解子宫平滑肌痉挛可能是艾灸治疗PD的作用机制。3.艾灸治疗PD安全,患者依从性较好。
[Abstract]:Objective: to compare the effects of moxibustion on primary dysmenorrheaemia (PD2) and serum prostaglandin PGF2a PGE2 levels in patients with primary dysmenorrhea (PDD), and to evaluate the clinical efficacy and possible mechanism of moxibustion in treating PD in different periods. Methods: 140 patients with PD were randomly divided into two groups according to random digital table. Group A (Group A) and Group B (70 cases in each group) were treated with moxibustion and mild moxibustion for 5-7 days. Group A began treatment on the first day of menstrual period 5-7 days before menstruation. The Cox Menstrual Symptom scale (COX) and visual analogue scale (VAS) were used in the baseline period, respectively. Clinical efficacy was evaluated at the end of each menstrual cycle during treatment and follow-up. The changes of serum prostaglandin PGF2aI PGE2 concentration were detected within 48 hours of the first menstrual onset in the group and 4th times within 48 hours after the end of the three menstrual cycles. Results: 1. A total of 132 patients with PD were diagnosed. Who completed the study, There were 64 cases in group A and 68 cases in group B. the baseline data of demographic characteristics, vital signs, disease status and serum prostaglandin PGE2a PGF2a concentration were consistent between the two groups. After treatment, the total effective rate of the two groups was: group A: 92.1818 and group B: 86.76.4.The results of comparison of the clinical symptoms of PD patients with selective moxibustion showed that the total score of CMSS time and severity of the two groups were higher than those before treatment. The total score of abdominal pain time and severity score and VAS score were significantly improved after treatment, and the difference was statistically significant (P 0.05). The results showed that: compared with group B, group A was in the treatment period. During the follow-up period, the total score and severity score of VAS, the total score of time and severity of abdominal pain were significantly improved. The effect of selective moxibustion on serum prostaglandin PGE2a concentration in PD patients was significantly different from that before moxibustion treatment. The results showed that the serum prostaglandin PGF2a concentration in group A was significantly different from that in group B, and the difference was statistically significant (P 0.05). There was no significant difference in adverse events between the two groups (P 0.05). Conclusion: 1. Before menstruation, there was no significant difference in the adverse events between the two groups. Moxibustion in menstrual period has definite curative effect on PD. Premenstrual moxibustion treatment is superior to that of menstrual period treatment group in alleviating pain, shortening the time of abdominal pain and accompanying symptoms, and reducing the severity of abdominal pain and associated symptoms. Moxibustion during menstrual period can affect the serum prostaglandin PGE2a concentration, and the premenstrual treatment group is superior to the menstrual period treatment group in decreasing the serum prostaglandin PGF2a concentration, which suggests that the serum prostaglandin PGE2a concentration is affected. Relieving uterine smooth muscle spasm may be the mechanism of moxibustion in the treatment of PD. 3. Moxibustion is safe and patient compliance is good.
【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.3

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