颈源性头痛针刺治疗方案的初步优选

The Preliminary Optimization of Acupuncture Therapeutic Regimen on Cervical Headache

目的对颈源性头痛针刺治疗方案进行初步优选。方法 90例颈源性头痛患者随机分为脑空透风池、脑户透风府组,风池、风府直刺组,颈夹脊平刺组,每组30例。根据4因素3水平(穴位及针刺方向、角度:脑空透风池、脑户透风府,风池风府直刺,颈夹脊平刺;针刺深度:浅,中,深;针数:1根,2根,排针;留针时间:0.5h,1h,6h)的不同组合方案再分为9组进行治疗,隔日1次,3次为1个疗程,2个疗程后根据各组视觉模拟评分(VAS)加权值,应用正交设计直观分析、方差分析、多重比较进行分析后确定优选方案。结果直观分析显示,选取脑空透风池、脑户透风府,采取中刺深度,排针,留针6h,可以获得颈源性头痛相对最佳的针刺疗效。方差分析显示,穴位及针刺方向、角度和针数这2个因素在改善头痛的近期疗效上均为显著因素。多重比较显示,脑空透风池、脑户透风府疗效优于风池、风府直刺;排针疗效优于其他两个水平。结论颈源性头痛优选针刺治疗方案为脑空透风池、脑户透风府,排针法,中等刺深(1寸),留针6h。

Objective To preliminarily optimize the acupuncture therapeutic regimen on cervical headache. Methods Ninety cases of cervical headache were randomized into the Naokong （GB19） -through-Fengchi （GB20） and Naohu （DU17） -through-Fengfu （DU16） group, perpendicular insertion at Fengchi （GB20） and Fengfu （DU16） group, and horizontal insertion at cervical paravertebral points group, with 30 in each. Then the patients were divided into 9 sub-groups based on four factors and three levels such as acupuncture points and angles, depth of acupuncture, number of needles and time of needle retention. The patients were subjected to a needling once every other day and three times as a course of treatment. The preferred option was determined according to the weight value of visual analog scale （VAS）, orthogonal design, intuitive analysis, analysis of variance （ANOVA） and multiple comparisons after two treatment courses. Results The visual analysis showed that the efficacy of Naokong-through- Fengehi and Naohu-through-Fengfu with a medium depth, row needle and 6-hour retention was the relatively best. The ANOVA showed that acupuncture points, angles and number of needles were significant factors in improving short-term effect on headache. The multiple comparisons showed that the efficacy of Naokong-through-Fengchi and Naohu-through- Fengfu was superior to that of perpendicular insertion at Fengehi and Fengfu, and the efficacy of row needles was better than that of one or two needles. Conclusion The preferred acupuncture regimen on cervical headache is Naokong- through-Fengchi and Naohu-through-Fengfu with a medium depth, row needles and 6-hour retention.