颈椎旁神经阻滞联合针刺治疗颈源性头痛临床疗效及其机制  

CLINICAL EFFICACY AND MECHANISM OF CERVICAL PARAVERTEBRAL NERVE BLOCK COMBINED WITH ACUPUNCTURE IN THE TREATMENT OF CERVICOGENIC HEADACHE

作　　者：高珊[1] 王飞[1] GAO Shan;WANG Fei(Department of Acupuncture and Moxibustio,Wuhan First Hospital,Wuhan 430022,China)

机构地区：[1]武汉市第一医院针灸科

出　　处：《中国疼痛医学杂志》2019年第6期426-431,共6页Chinese Journal of Pain Medicine

基　　金：武汉市中西医结合医院课题:针刺结合神经阻滞治疗颈源性头痛的研究(2016Y05)

摘　　要：目的:探究颈椎旁神经阻滞联合针刺治疗颈源性头痛(cervicogenic headache,CEH)的临床疗效及机制。方法:选取2015年3月至2016年9月武汉市第一医院收治的60例颈源性头痛病人。随机数字分组法将其分为A、B两组,每组30例。A组采用传统针刺治疗,B组采用颈椎旁神经阻滞联合针刺治疗。比较治疗前及治疗3周后两组病人的疼痛视觉模拟评分(visual analogue scale,VAS)、生活质量评分(life quality score)情况;比较两组病人的临床总治疗有效率、总不良反应情况;分别采用ELISA法和RT-PCR法检测治疗前、治疗1周及治疗3周后B组病人血浆中β-内啡肽、ACTH及皮质醇的含量,以及细胞因子TNF-α,IL-1,IL-6,IL-8的水平。结果:与治疗前相比,治疗3周后,两组病人VAS评分均显著下降(P<0.01),且两组病人生活质量评分均显著上升(P<0.01);比较A、B两组病人治疗有效率,其差异有统计学意义(63.33%v s.86.67%,X^2=4.356,P=0.037);而两组不良反应率差异无统计学意义(16.67%v s.13.33%,X^2=0.131,P=0.718);与治疗前相比,治疗1周及治疗3周后B组病人血浆中细胞因子TNF-α,IL-1,IL-6,IL-8表达水平,ACTH及皮质醇含量均显著降低(P<0.01),而β-内啡肽含量显著升高(P<0.01)。结论:颈椎旁神经阻滞联合针刺治疗颈源性头痛疗效显著,优于单一针刺治疗,值得临床推广;其作用机制可能与炎症细胞因子下调、β-内啡肽上调及下丘脑-垂体-肾上腺(hypothalamus-pituitary-adrenal,HPA)轴功能的调控有关。Objective:To investigate the clinical efficacy and mechanism of cervical paravertebral nerve block combined with acupuncture in the treatment of cervicogenic headache.Methods:A total of 60 patients with cervicogenic headache were selected from March 2015 to September 2016 in Wuhan First Hospital.These patients were divided into two groups by random number grouping,30 cases in each group.Group A was treated with traditional acupuncture,while group B with cervical paravertebral nerve block combined with acupuncture.The visual analogue scale(VAS)and life quality score were compared between the two groups before and after treatment for 3 weeks.Total effective rate and total adverse event rate were compared between the two groups.The levels ofβ-endorphin,ACTH,cortisol and the levels of cytokines TNF-α,IL-1,IL-6 and IL-8 in B group were measured by ELISA and RT-PCR before and 1 and 3 weeks after treatment,respectively.Results:Compared with pre-treatment,the VAS scores of the two groups were significantly decreased 3 weeks after treatment(P<0.01),and the quality of life scores of the two groups were significantly increased(P<0.01).There was statistically significant difference between the two groups in the effective rate of treatment(63.33%vs.86.67%,X^2=4.356,P=0.037)and no difference in adverse reaction rate(16.67%vs.13.33%,X^2=0.131,P=0.718).Compared with pre-treatment,the levels of TNF-α,IL-1,IL-6,IL-8,ACTH and cortisol in group B were significantly decreased(P<0.01),whileβ-endorphin content was significantly increased(P<0.01)in after 1 and 3 weeks.Conclusions:The clinical efficacy of cervical paravertebral nerve block combined with acupuncture in the treatment of cervicogenic headache is remarkable and better than that of a single acupuncture treatment,which is worthy of clinical promotion.The mechanism may be related to down-regulation of inflammatory cytokines,up-regulation ofβ-endorphin and the regulation the function of hypothalamus-pituitary-adrenal(HPA)axis.

关 键 词：颈椎旁神经阻滞 针刺 颈源性头痛 

分 类 号：R246.9[医药卫生—针灸推拿学]