【作者】 简嘉良；

【导师】 符文彬；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2011， 博士

【摘要】 研究目的原发性痛经即功能性痛经,不伴明显的盆腔器质性疾病,因其病因复杂,容易反复而成为妇科的疑难病症之一,给妇女的身心健康和工作学习带来了严重的影响,而目前对其防治尚无重大突破,针灸治疗痛经,疗效确切、操作简便、价格低廉、无毒副作用,易于被广大患者接受。但目前针灸临床治疗痛经选穴笼杂、规范的穴位研究较少,给临床治疗痛经的选穴带来一定的难度。通过与中药对照组治疗原发性痛经疗效的比较,初步观察通过电针治疗原发性痛经的疗效,为运用针灸治疗原发性痛经提供科学的研究基础。研究方法治疗组：电针穴位处方：三阴交、气海、关元、合谷、太冲,电针频率采用疏密波,疏波频率为2HZ,密波频率100HZ,疏密交替频率5Hz；强度以患者耐受为度,留针30分,经前7天开始治疗,连续10天,连续3个月经周期；对照组：采用活血化瘀、行气止痛的少腹逐瘀汤为主。药物组成：当归9g、川芎6g、赤芍6g、、五灵脂6g(炒)、小茴香(炒)7粒,干姜(炒)0.6g、没药(研)6g、蒲黄9g。将上述中药煎煮成药汁后,再加以浓缩干燥制成药粉,加上适量赋型剂(淀粉)制成科学中药。经前7天服药开始服用至月经第3天,每次50g/包,每日3次,水冲服,连服3个月经周期。两组患者分别于治疗前后进行疼痛调查问卷(MQP)评分、血浆PGF2α及PGE2检测、健康调查简表(SF-36)评分,计量资料采用t检验或方差分析,计数资料采用X2检验,临床等级资料比较采用Ridit分析。所用计量资料均用表示,所有数据采用SPSS统计软件(SPSS12)进行分析。研究结果两组治疗后患者疼痛感觉方面总分、疼痛情感方面总分、疼痛总分VAS评分、现在疼痛状况评分均降低,与治疗前比较,均P<0.01,差异均有统计学意义；治疗后两组间患者疼痛感觉方面总分、疼痛情感方面总分、疼痛总分、VAS评分、现在疼痛状况评分比较,P<0.05,差异均有统计学意义；治疗后两组血浆PGF2。值均有明显下降,两组间比较,P<0.01,差异有统计学意义；治疗后两组血浆PGE2值均有明显升高,两组间比较,P<0.01,差异有统计学意义。治疗组治疗后SF-36精神健康及身体健康评分与治疗前比较,均P<0.01,差异均有统计学意义；对照组SF-36精神健康及身体健康评分与治疗前比较,均P<0.01,差异均有统计学意义；治疗后治疗组SF-36精神健康及身体健康评分与对照组治疗后比较,均P<0.05,差异均有统计学意义。研究结论1.电针和少腹逐瘀汤均可改善痛经患者疼痛感觉、情感等症状,降低疼痛的程度,减轻患者痛苦,且电针效果更佳。2.电针和少腹逐瘀汤均可降低痛经患者PGF2α水平,升高PGE2水平,改善患者激素分泌异常状况,且电针效果优于少腹逐瘀汤。3.电针和少腹逐瘀汤均能提高痛经患者SF-36精神及身体健康评分,改善痛经患者生存质量,且治疗组作用优于对照组。更多还原

【Abstract】 ObjectivePrimary dysmenorrhea which refers to functional dysmenorrheal, is not associated with significant pelvic organic diseases. Due to its complex causes and easy relapse, it has become a difficult gynecological disease and brings serious impact on women’s physical and mental health as well as their work and study. So far, there is still no major breakthrough in its prevention and treatment. Acupuncture has proved to be effective in treating dysmenorrhea, what is more, acupuncture is not expensive, easy to perform and has no side effects, therefore, it can be easily accepted by most patients. But many acupoints have been used to treat dysmenorrhea, and there is few relative standardized study about acupoints, which has caused difficulty in selecting acupoints for clinical treatment of dysmenorrheal.Treating primary dysmenorrhea by applying EA on Sanyinjiao together with other acupoints based on differentiation, and was compared with control group treated by traditional Chinese medicine. To initially observe the therapeutic effect of Sanyinjiao and to further investigate the specificity of acupuncture points in treating dysmenorrheal.Object and Methods:60 patients who met the diagnostic criteria of primary dysmenorrhea were included in the study in order, and they were randomly divided into two groups:treatment group treated by electroacupuncture on sanyinjiao and control group treated by Chinese medicine, there were 30 patients in each group, and they were given either Chinese medicine or electroacupuncture according to stochastic programs.MethodTreatment group:Patients were given EA on Sanyinjiao together with other acupoints based on Differential Treatment of primary dysmenorrheal. Points that were selected were as follows:Sanyinjiao, Ciliao, seventeenth vertebra, Hegu, Taichong, if the patient had nausea and vomiting, gong-sun and Neiguan would be added, if the patient’s limbs were not warm, and had a pale countenance, Shenshu and Yaoyangguan would be added; if the patient suffered foot fatigue and dizziness, Geshu, Pishu would be added. EA frequency was 2/100HZ, and its degree of intensity was mainly determined by the patient’s tolerance. The treatment lasted for 30 minutes each time, starting 7 days before menstruation, and lasted for 10 consecutive days for three consecutive menstrual cycles.Control group:Patients were given Gexiazhuyutang which had the function of activating blood circulation, transforming blood stasis and relieving pain by activating movement of qi. Drugs contained in the formula were as follows: Angelica, Chuanxiong, red peony, Danpi, peach kernel (smashed), safflower, Yuan Hu, aggregata, Wulingzhi (fried), Cyperus rotundus, Citrus aurantium, licorice.if the patient had nausea and vomiting, pinellia and ginger would be added, if the patient’s limbs were not warm, and had a pale countenance, Aiye and cumin would be added; if the patient suffered foot fatigue and dizziness, Radix and Millettia would be added. Decoction of those herbs was dried and made into concentrated powder. Then the powder was made into scientific medicine by adding appropriate excipients (starch). Patients started taking medicine 7 days before the menstruation until the third day of the menstruation,50g (one bag) each time,3 times a day, for three menstrual cycles. Patients in both groups before and after treatment were scored by MQP, SF-36 and given plasma PGF2a and PGE2 detection. The measured data given t test or analysis of variance while count data was given X2 test, clinical grade Data was given Ridit analysis. All the data was analyzed by SPSS statistical software (SPSS12).ResultsAfter treatment, patients’total pain score, total emotional score, VAS score and present pain scores all decreased compared with that before treatment, with P<0.01, the differences were statistically significant; compared total pain score, total emotional score, VAS score and present pain scores between the two groups, the differences were statistically significant,with P<0.05;After treatment, the value of plasma PGF2a of patients in two groups all decreased significantly, the difference between the two groups was statistically significant, P<0.01, the values of plasma PGE2 were significantly higher after treatment, the difference between the two groups was statistically significant P<0.01. Comparing the SF-36 score in treatment group before and after treatment, the differences were all statistically significant P<0.01; Comparing the SF-36 score in control group before and after treatment, the differences were all statistically significant P<0.01; The comparison of SF-36 score of patients in two groups after treatment, the differences were statistically significant, P<0.05.Conclusion1.Electroacupuncture and Gexiazhuyutang both can improve pain feeling and emotional discomfort of patients with dysmenorrhea, and they can reduce their pains. EA was better.2.Electroacupuncture and Gexiazhuyutang can reduce the level of PGF2a in patients with dysmenorrhea, and can increase PGE2 levels therefore can improve abnormal hormone secretion, and EA was better than Gexiazhuyutang.3.Electroacupuncture and Gexiazhuyutang can improve SF-36 scores of patients with dysmenorrheal, therefore can improve the quality of their life and the treatment group had better effect than the control group.更多还原