下关穴不同深度针刺治疗肝阳上亢型三叉神经痛:随机对照研究

Trigeminal neuralgia of hyperactive of liver yang type treated with acupuncture at Xiaguan(ST 7) at different depth:a randomized controlled trial

目的:观察深刺及浅刺下关穴治疗肝阳上亢型原发性三叉神经痛(PTN)的疗效差异。方法:选择肝阳上亢型原发性三叉神经痛63例,随机分为深刺组(32例)和浅刺组(31例),两组均取患侧下关,双侧合谷、太冲及与病变神经干分支相应的攒竹、四白、夹承浆穴。深刺组针刺下关至蝶腭神经节(SPG),攒竹、四白、夹承浆分别刺入眶上孔、眶下孔、颏孔;浅刺组行常规针刺,针刺后均接G6805电针仪,每次通电30min,隔日1次。治疗2个疗程后,观察患者疼痛指标、中医证候指标及临床疗效。结果:深刺组患者疼痛视觉模拟评分(VAS)、中医证候各项评分(疼痛程度、疼痛次数、心烦、目赤、口苦、胁痛)均较治疗前明显降低(均P<0.01);浅刺组除胁痛(P>0.05)以外,其余以上指标均明显降低(P<0.01,P<0.05);两组治疗后比较,深刺组VAS评分、中医证候中疼痛程度、目赤及总分减少更显著(均P<0.05)。深刺组、浅刺组疾病总有效率分别为93.8%(30/32)和87.1%(27/31),深刺组疗效优于浅刺组(P<0.05)。两组均未观察到不良反应。结论:电针治疗肝阳上亢型三叉神经痛疗效显著,深刺下关透蝶腭神经节较常规针刺下关疗效更佳。

Objective To observe the differences of therapeutic effect in primary trigeminal neuralgia（PTN） of hyperactive of liver yang type treated by deep and shallow puncturing at Xiaguan（ST 7）.Methods Sixty-three cases of PTN of hyperactive of liver yang type were randomly divided into a deep puncturing group（32 cases） and a shallow puncturing group（31 cases）.Xiaguan（ST 7） of affected region,Hegu（LI 4） and Taichong（LV 3） of bilateral sides,Cuanzhu（BL 2）,Sibai（ST 2） and Jiachengjiang（Extra） relevant to the affected branch of nerve stem were selected in both groups.In deep puncturing group,Xiaguan（ST 7） was punctured to the depth of spheno-palatine ganglion（SPG）;Cuanzhu（BL 2）,Sibai（ST 2） and Jiachengjiang（Extra） were respectively punctured to the depth of supraorbital foramen,infraorbital foramen and mental foramen.In shallow group,routine puncturing was applied;the needles were connected with G6805 electric acupuncture apparatus,and switched on for 30 min every time;the treatment was applied every other day.Pain index,traditional Chinese medicine symptoms index and clinical therapeutic effect were observed after 2 courses of treatment.Results In deep puncturing group,the VAS scores and the traditional Chinese medicine symptoms scores（pain degree,pain frequency,upsetting,conjunctival congestion,bitter mouth and hypochondriac pain） after treatment were much more lower than those before treatment（all P0.01）;in shallow puncturing group,except hypochondriac pain（P0.05）,other indices above after treatment were obviously lower than those before treatment（P0.01,P0.05）.Compared with the indices in both groups after treatment,the VAS scores,the pain degree,conjunctival congestion and total scores of traditional Chinese medicine symptoms in deep puncturing group were more significant（all P0.05）.The total effective rate was 93.8%（30/32） in deep puncturing group,superior to that of 87.1%（27/31） in shallow puncturing group（P0.05）.No any adverse reaction was observed in both groups.Conclusion The therapeutic effect of trigeminal neuralgia of hyperactive of liver yang type treated with electroacupuncture is remarkable,and deep puncturing at Xiaguan（ST 7） to SPG is more effective than routine puncturing.