【作者】 钟素珊；

【导师】 罗颂平；

【作者基本信息】 广州中医药大学 ， 中医妇科学， 2012， 博士

【摘要】 痛经是妇科常见病,多发于月经前或月经期,临床表现为下腹疼痛为主要症状,也可放射至腰骶,并可伴其它全身症状,包括恶心、呕吐、畏寒、头痛、头晕、面色苍白、大汗淋漓,严重者可出现昏厥,以致影响生活和工作。痛经分为原发性和继发性两种,盆腔有器质性病变的属继发性痛经。原发性痛经与子宫平滑肌过度收缩而导致疼痛有关。近年的研究发现白三烯(LTs)可引致子宫收缩及令子宫血流下降,所以与痛经的发生有关,研究亦指子宫组织能产生LTs,而且有LTs受体并能刺激子宫收缩,引起痛经。对于体育工作者而言,痛经可严重影响运动员女性训练与比赛时的表现,然而,赛事中的运动员为避免违反禁药条例,都不敢随便服用药物控制痛经,很多时只有忍痛进行训练和比赛,以致影响体育成绩,甚至因痛经而缺席训练或比赛。现时没有香港妇女及运动员女性痛经发病率的数据及治疗痛经的研究。国内研究指耳穴贴压对痛经有良好的治疗作用,而且属非侵入疗法,操作简单方便且安全,故此选择耳穴贴压治疗运动员原发性痛经。目的：研究旨在探讨耳穴贴压对治疗香港女性运动员原发性痛经的疗效,观察耳穴贴压后对尿中LTE4水平的影响及痛经与焦虑感的关系。方法：从香港女性精英运动员中选取有原发性痛经者,并参考1993年国家卫生部颁布的《中药新临床研究指导原则》(第一辑)选取气滞血瘀型痛经的女性运动员共20名作为研究对象并进行耳穴贴压治疗痛经。随机选取没有痛经的相同运动项目女性运动员作对照。耳穴取内生殖器、内分泌、交感、肝、神门,用粘有王不留行籽的胶布贴压,于月经来潮前最少一周开始治疗,至月经首天结束。每次每穴按压15下,至耳有微热、发胀感,每穴每日按压3次,以三个月经周期为一疗程。观察疗效以痛经症状及焦虑自评的积分改变及量度尿LTE4水平作为主要观察指标。耳穴组停止治疗后再随访三个周期,并记录痛经症状评分。运用SPSS (version19)软件包进行统计分析,并将所得结果分别进行组间及组内比较。结果：本研究成功完成20例患有气滞血瘀型原发性痛经的香港运动员耳穴贴压治疗。1.耳穴贴压治疗运动员气滞血瘀型原发性痛经具有显著疗效,总有效率达100%,而治疗减轻疼痛感的有效率也是100%。并具有调整月经周期的效果。2.痛经运动员晨尿LTE4水平显著高于对照组,可能与子宫收缩令子宫血流下降而出现痛经有关。3.痛经运动员焦虑自评积分显著高于对照组,而且在治疗后明显下降,显示舒缓痛经有助减轻焦虑。结论：耳穴贴压治疗运动员原发性痛经的优势是既有效且可避免触犯禁药条例,对运动员可以说是治疗痛经的最佳的方法,值得推广。耳穴贴压治疗痛经的操作简便、非入侵性、治疗过程快速、价廉、无明显副作用、无须服药,故此运动员用得安心。更多还原

【Abstract】 Dysmenorrhea is a common gynecological disorder, often occurs before or during menstruation. Major clinical symptom is lower abdominal spasms and the pain can spread to lower back. Other whole body manifestations can be seen like nausea, vomiting, coldness, headache, dizziness, paleness in the face, sweating, and even collapse, as a result lifestyle and work are often affected. There are two types of dysmenorrhea, primary and secondary. Secondary dysmenorrhea is presented with pelvic organ pathology. Primary dysmenorrhea i s associated with uterine smooth muscle contraction leading to pai n. Recently research studies found leukotrienes (LTs) may lead to uterine muscle contraction and decreased blood flow and therefore is related to dysmenorrhea. Studies also pointed out that uterine tissue can generate LTs and the uterus also have LT receptors which are related to the stimulation of uterine contraction leading to dysmenorrhea. To the sports related personnel, dysmenorrhea can seriously affect sports women’s training and competition performance, however, sports women often avoid taking medication due to the fear of contravening the doping regulation, therefore, most of them train and compete with menstrual pain which may affect their sports performance and even cannot compete or train due to menstrual pain. Up to now, there is no data about the prevalence and treatment dysmenorrhea in Hong Kong women and sports women. Studies in China found auricular plaster therapy is an effective treatment in dysmenorrhea and it is considered as a non-invasive, simple and safe method. Therefore, auricular plaster therapy is used to treat dysmenorrhea in Hong Kong sports women.ObjectiveTo investigate the effectiveness of auricular plaster therapy in treating Hong Kong sports women with primary dysmenorrhea. To observe the effect of auricular plaster therapy on urinary LTE4and the relationship between dysmenorrhea and anxiety. Methods:Sports women with primary dysmenorrhea are selected and with reference to the "Clinical Research’s Instruction Doctrine of the new Chinese Medicine"(1st edition) published in1993, twenty sports women with qi-stagnancy and blood stasis type dysmenorrhea were selected to receive auricular plaster therapy as treatment. Sports women without dysmenorrhea from the same sport groups were randomly selected to the control group. The auricular points are internal genitals, endocrine, sympathesis, liver, shemen. Seeds of cowherb were put onto plasters and stick onto the auricular points for treatment at least one week before menstruation until the first day of menstruation. Subjects were instructed to press each point15times until ear is slightly warm and distended, repeat3times a day. Treatment is completed after three menstrual cycles. Menstrual symptoms, self-rated anxiety score and urinary LTE4are evaluated. Treatment group is followed for another three cycles after completion of treatment and menstrual symptoms are recorded. Statistical analyses between and within groups are performed by SPSS (version19).ResultsTwenty Hong Kong sports women subjects with qi-stagnancy and blood stasis type primary dysmenorrhea successfully completed the auricular plaster therapy.1. Auricular plaster therapy is effective in treating qi-stagnancy and blood stasis type primary dysmenorrhea in sports women, with a total effective rate of100%. The effective rate in pain control is also100%. Menstrual cycle is also normalized.2. Morning urine LTE4is significantly higher in the dysmenorrhea group when compared with the control group. This may be related to uterine contraction leading to decreased blood flow which resulted in menstrual pain.3. The self-rated anxiety score of sports women with dysmenorrhea was also significantly higher than the control group and the score decreased after treatment which may indicate alleviation of menstrual pain leads to decreased anxiety.ConelusionAuricular plaster therapy maybe the best treatment of dysmenorrhea in sports women. It is effective and will not contravene the doping regulation, therefore, should be promoted. Using auricular plaster therapy to treat dysmenorrhea is simple, non-invasive, fast, economical, has no apparent side effect, and no need to take medication, therefore, is good for sports women.更多还原