颈三针治疗紧张型头痛的临床研究

发布时间：2018-06-16 00:33

本文选题：颈三针 + 紧张性头痛　；参考：《广州中医药大学》2016年硕士论文

【摘要】：目的：靳三针疗法是岭南针灸大师靳瑞教授根据传统体针疗法而总结出的特色针灸疗法,其涉及的范围广泛,内有40多个穴组。本研究选取其中的一个穴组“颈三针”治疗紧张性头痛。观察“颈三针”疗法治疗紧张性头痛的临床疗效,与常规针刺作对照,观察两组疗法治疗紧张性头痛的临床疗效,探讨“颈三针”治病的可能机理。方法：本研究共纳入符合紧张性头痛诊断标准的患者60例,按照随机对照的分组方法,将60例患者分成治疗组30例和对照组30例。治疗组在常规针刺选穴的基础上配合颈三针。具体选穴为颈三针(百劳、大杼、天柱)、太阳、头维、风池、颈夹脊、太冲、足三里、三阴交,再根据头痛部位的不同进行分经加减取穴。穴位常规消毒后进行针刺,风池穴针尖朝向鼻尖方向,进针不宜过深,约0.8-1.2寸,颈部夹脊穴针尖刺向脊柱,进针约1寸,其余穴位采用常规针刺,进针后分别行提插捻转手法,待各穴得气后,采用电针治疗仪(G-6805,Ⅱ型,上海医疗器械厂),选用连续波,频率120次／分,每次治疗30分钟,隔日治疗一次。每周三次,2周为一个疗程,共治疗2个疗程。观察治疗前后两组患者的VAS评分、头痛积分和PSQI评分的变化进行疗效评估。临床数据的统计分析采用SPSS19.0进行分析。结果：1.VAS评分比较：治疗前,治疗组的VAS评分为7.04--+2.37,对照组的VAS评分为6.89±±2.52,经t检验,差异无统计学意义(P0.05),说明两组患者VAS评分无明显差异,具有可比性,两组患者治疗前疼痛程度相当。接受本研究的治疗方案后,治疗组VAS评分2.21±1.34,对照组VAS评分为3.87±1.58；采用t检验分析两组患者较治疗前,VAS评分均明显下降(P0.05),两组患者治疗后进行VAS评分比较,发现治疗组下降更为明显(P0.01),说明针灸能够有效改善紧张性头痛患者的VAS评分,缓解患者疼痛,但是结合颈三针疗法,效果更显著。2.头痛积分：治疗前,治疗组头痛总积分15.32±3.62,对照组头痛总积分16.01±3.18,经t检验分析,差异不显著,而且两组患者在头痛程度积分、发作次数积分、持续时间积分和伴随症状积分上都没有明显的差异,具有可比性。治疗后,治疗组患者的头痛总积分为5.03±1.53,对照组头痛总积分为8.95±1.81,经统计学分析,进行组内的治疗前后比较,两组患者的头痛总积分、头痛程度积分、发作次数积分、持续时间积分和伴随症状积分均明显下降,差异显著,治疗后组间比较,在头痛总积分、头痛程度和持续时间的比较上,治疗组较对照组明显下降(P0.01),有统计学意义,但是在头痛的发作次数和出现的伴随症状方面,治疗组和对照组没有明显差异(P0.05)。说明治疗组和对照组的治疗方法都可以明显改善紧张性头痛患者的头痛程度、头痛的发作次数、持续时间和相应的伴随症状,在改善头痛程度和持续时间上,治疗组明显优于对照组,而在改善伴随症状和发作次数上,两组疗效相当。3睡眠情况比较：接受治疗前,治疗组患者有睡眠障碍和无睡眠障碍的患者各为15例,而对照组有睡眠障碍和无睡眠障碍的患者分别为14例、16例。经统计学分析,差异无统计学意义,有可比性。经治疗后,治疗组有睡眠障碍的患者为6例,无睡眠障碍患者24例；而对照组有失眠障碍患者为8例,无睡眠障碍患者22例,治疗前后组内进行比较,均有统计学意义(P0.05)；但治疗后组间比较,无明显差异(P0.05)。说明两种治疗方案均能明显改善患者的睡眠情况,且在改善睡眠情况上,两种方法的疗效相当。4临床疗效比较：经过2个疗程,为期一个月的治疗,治疗组30例患者中临床治愈的有8例(26.67%),显效的患者有15例(50.00%),有效患者5列(16.67%),无效患者2例(6.66%),对照组患者中临床治愈4例(13.33%),显效的患者有10例(33.33%),有临床效果的患者有10例(13.33%),无效患者6例(20.00%)。治疗组的临床总有效率93.33%,而对照组总有效率80.00%,经统计学分析,提示治疗组的临床疗效显著优于对照组(P0.05)。结论：靳三针疗法是岭南针灸大师靳瑞教授发明的针灸组穴配方,是岭南针灸的一个具有代表性的流派。它简单、易学、而且实用有效。颈三针作为靳三针疗法中的一组常用穴组,在临床上运用广泛。本研究观察颈三针治疗紧张性头痛的临床疗效,研究结果证实,颈三针治疗能够有效的改善患者的VAS评分,减轻疼痛的程度,减少发作次数和每次持续的时间,缓解畏光、呕吐等伴随症状,且能改善患者的睡眠情况,疗效切确,值得临床推广。
[Abstract]:Objective: Jin three needle therapy is the characteristic acupuncture therapy of Professor Jin Rui, a master of acupuncture and moxibustion in south of the Five Ridges. It has a wide range of acupuncture and moxibustion therapy in accordance with the traditional body acupuncture therapy. There are more than 40 acupoints in this study. This study selected one of the acupoint group "neck three needles" to treat tension headache. The clinical effect of "neck three needle" therapy on tension headache was observed. Compared with the conventional acupuncture, the clinical effect of two groups of therapy for tension headache was observed and the possible mechanism of "neck three needle" treatment was discussed. Methods: 60 patients were included in this study, and 60 patients were divided into treatment group (30 cases) and control group (30 cases) according to the randomized controlled grouping method. On the basis of the acupuncture point selection, the acupuncture points are combined with the neck three needles. The specific points are selected as the three needles of the neck (hundred labor, the Tianzhu), the sun, the head dimension, the wind pond, the neck pinch ridge, the Tai Chung, the three li and the three yin cross, and then the acupoints are added and reduced according to the different headaches. The acupuncture points of the acupoints are routinely sterilizing, the tip of the acupoint of the Feng Chi point faces the nose tip, and the needle should not be too deep, about 0.8-1. 2 inches, neck pint point needle point pricking to the spine, entering the needle about 1 inches, the rest of the acupuncture point is conventional acupuncture, after entering the needle to insert twisting and twisting, after each point to get gas, the use of electroacupuncture therapy instrument (G-6805, type II, Shanghai medical equipment factory), the use of continuous wave, frequency 120 times / minutes, each treatment for 30 minutes each time. Three times a week, 2 weeks for one, 2 weeks for one A total of 2 courses of treatment were treated. The VAS score of two groups of patients before and after treatment, the change of headache score and PSQI score were evaluated. The statistical analysis of clinical data was analyzed by SPSS19.0. Results: the 1.VAS score was compared: before treatment, the VAS score of the treatment group was 7.04-- +2.37, the VAS score of the control group was 6.89 + 2.52, and the t examination was performed by t. The difference was not statistically significant (P0.05), indicating that there was no significant difference in VAS score between the two groups. The pain degree of the two groups was equal before treatment. After the treatment of this study, the VAS score of the treatment group was 2.21 + 1.34 and the control group was 3.87 + 1.58 in the control group, and the t test was used to analyze the VAS score of the two groups before the treatment. Drop (P0.05), two groups of patients after the treatment of VAS score comparison, found that the treatment group decreased more significantly (P0.01), indicating that acupuncture can effectively improve the VAS score of patients with tension headache and relieve pain, but combined with neck three acupuncture therapy, the effect is more significant.2. headache score: before treatment, the total score of headache in the treatment group is 15.32 + 3.62, the control group head The total pain score was 16.01 + 3.18. The difference was not significant by t test, and there was no significant difference between the two groups in the degree of headache, the score of the attack, the integral of duration and the integral of symptoms. After treatment, the total headache of the patients in the treatment group was 5.03 + 1.53, and the total score of the headache in the control group was 8.95 + 1.81, and the total score of the headache was 8.95 + 1.81. Statistical analysis, before and after the treatment in the group, the total score of headache, the score of the headache, the score of the frequency of the attack, the integral of the duration of the two groups, the integral of the duration of the symptoms were obviously decreased, and the difference was significant. The comparison between the groups after the treatment was compared with the total score of headache, the degree of headache and the duration of the headache, and the treatment group was significantly lower than the control group. The reduction (P0.01) was statistically significant, but there was no significant difference between the treatment group and the control group (P0.05). The treatment group and the control group could significantly improve the degree of headache, the times of headache, the duration of the headache, the duration of the headache, and the corresponding accompanying symptoms. In the improvement of the degree of headache and duration, the treatment group was significantly better than the control group, while in the improvement of the symptoms and the number of episodes, the two groups were comparable to the.3 sleep situation: before the treatment, the patients in the treatment group had 15 patients with sleep disorders and no sleep disorders, while the control group had sleep disorders and no sleep disorders. After treatment, there were 6 cases of sleep disorders in the treatment group, 24 cases without sleep disorder, 8 patients with insomnia and 22 patients without sleep disorders in the control group, and there were statistical significance (P0.05) in the treatment group before and after treatment (P0.05); but the treatment was statistically significant. There was no significant difference between the two groups (P0.05). It showed that all two treatments could significantly improve the patient's sleep condition, and in improving the sleep situation, the effect of the two methods was comparable to the clinical curative effect of.4: after 2 courses of one month, 8 cases (26.67%) were cured in the treatment group and 15 of the patients were clinically cured, and 15 of the effective patients. Cases (50%), effective patients 5 (16.67%), invalid 2 cases (6.66%), 4 cases in the control group, 4 cases (13.33%), 10 patients (33.33%), 10 patients (13.33%) and invalid patients (20%). The total effective rate of the treatment group was 93.33%, and the control group was effective. The clinical effect of the treatment group is significantly better than that of the control group (P0.05). Conclusion: Jin's three needle therapy is an acupuncture group point formula invented by Professor Jin Rui of South of the Five Ridges acupuncture and moxibustion. It is a representative school of acupuncture and moxibustion in south of the Five Ridges. It is simple, easy to learn and practical and effective. The neck three needle is used as a group of commonly used acupoints in Jin's three needles, which is widely used in clinical practice. The results of this study were to observe the clinical efficacy of three cervical needles in the treatment of tension headache. The results of the study proved that the three needle treatment can effectively improve the patient's VAS score, reduce the degree of pain, reduce the number of episodes and duration, alleviate the symptoms of photophobia, vomiting and other symptoms, and can improve the patient's sleep, the curative effect is accurate and worthy of clinical push. Wide.
【学位授予单位】：广州中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R246.6

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