针刺治疗缺血性卒中恢复期头痛的疗效观察及机制研究  

Observation on therapeutic effect and mechanism research of acupuncture on headache in the recovery phase of ischemic stroke

作　　者：董桦[1] 赵红义[1] 王建伍 韩景献[1] DONG Hua;ZHAO Hong-yi;WANG Jian-wu;HAN Jing xian(Department of Tuina,First Teaching Hospital Affiliated to Tianjin University of TCM,Tianjin 300193,China)

机构地区：[1]天津中医药大学第一附属医院推拿科

出　　处：《中国针灸》2019年第11期1149-1153,共5页Chinese Acupuncture & Moxibustion

基　　金：天津市教育厅科学技术研究项目：TJJ170129

摘　　要：目的:探讨针刺治疗缺血性卒中恢复期头痛的临床疗效及作用机制。方法:将97例缺血性卒中恢复期头痛患者随机分为针刺组(57例)和西药组(40例)。西药组予盐酸氟桂利嗪胶囊口服,5 mg/次,每日1次。针刺组给予针刺治疗,偏头痛穴取患侧丘墟、足临泣、悬厘、率谷,风池、百会;前额痛穴取冲阳、内庭、解溪、足三里、合谷、攒竹、百会;后头痛穴取京骨、昆仑、天柱、风池、百会、四神聪;巅顶痛穴取太冲、涌泉、三阴交、风池、百会、四神聪,每次30 min,每日1次,每周治疗5 d。两组患者均治疗14 d。观察两组患者治疗前后视觉模拟评分(VAS)、头痛积分变化及治疗后1个月复发率,并评定疗效;ELISA法检测两组患者治疗前后血浆疼痛相关因子P物质(SP)、多巴胺(DA)、五羟色胺(5-HT)及内源性阿片肽α-内啡肽(α-EP)、β-内啡肽(β-EP)含量。结果:与治疗前相比,两组患者治疗后VAS评分、头痛积分,血浆SP、DA、5-HT含量均降低,α-EP和β-EP含量升高(均P<0.01);治疗后针刺组VAS评分、头痛积分、血浆疼痛相关因子含量及血浆内源性阿片肽含量变化幅度大于西药组(均P<0.05)。针刺组总有效率为84.2%(48/57),高于西药组的62.5%(25/40),复发率低于西药组(均P<0.01)。结论:针刺治疗缺血性卒中恢复期头痛疗效优于盐酸氟桂利嗪胶囊,其机制可能与降低患者血浆疼痛相关因子,升高内源性阿片肽含量有关。Objective To explore the clinical therapeutic effect and mechanism of acupuncture on headache in the recovery phase of ischemic stroke. Methods A total of 97 patients with headache in the recovery phase of ischemic stroke were randomized into an acupuncture group(57 cases) and a western medication group(40 cases). In the western medication group, flunarizine hydrochloride capsule was taken orally 5 mg each time, once a day. In the acupuncture group, acupuncture was applied at Qiuxu(GB 40), Zulinqi(GB 41), Xuanli(GB 6), Shuaigu(GB 8), Fengchi(GB 20) and Baihui(GV 20) for migraine;Chongyang(ST 42), Neiting(ST 44), Jiexi(ST 41), Zusanli(ST 36), Hegu(LI 4), Cuanzhu(BL 2) and Baihui(GV 20) for forehead pain;Jinggu(BL 64), Kunlun(BL 60), Tianzhu(BL 10), Fengchi(GB 20), Baihui(GV 20) and Sishencong(EX-HN 1) for occipital headache;Taichong(LR 3), Yongquan(KI 1), Sanyinjiao(SP 6), Fengchi(GB 20), Baihui(GV 20) and Sishencong(EX-HN 1) for parietal headache. The needles were retained for 30 min each time, once a day and 5 times a week. Both of the two groups were given consecutive treatment for 14 days. The visual analogue scale(VAS) and the headache scores before and after treatment and the recurrence rate 1 month after treatment were observed to evaluate the therapeutic effect, before and after treatment, the contents of substance P(SP), dopamine(DA), serotonin(5-HT), alpha-endorphin(α-EP) and beta-endorphin(β-EP) in plasma were determined by ELISA in the two groups. Results Compared before treatment, the VAS scores, the headache scores and the contents of SP, DA and 5-HT in plasma were reduced and the contents ofα-EP andβ-EP in plasma were increased in the two groups(all P<0.01). After treatment, the changes of the VAS score, the headache score and the contents of pain-related factors and endogenous opioid peptides in plasma in the acupuncture group were larger than the western medication group(all P<0.05). The total effective rate in the acupuncture group was 84.2%(48/57), which was superior to 62.5%(25/40) in the w

关 键 词：头痛 缺血性卒中 针刺 疼痛相关因子 内源性阿片肽 

分 类 号：R246.1[医药卫生—针灸推拿学]