针刺联合雷火灸对寒凝血瘀型痛经患者疗效、镇痛效应及子宫动脉血流动力学影响

Effect of Acupuncture Combined with Thunder-fire Moxibustion on Curative Effect,Analgesic Effect and Hemodynamics of Uterine Artery in Patients with Dysmenorrhea of the Type of Blood Stasis Due to Cold

目的探讨针刺联合雷火灸对寒凝血瘀型痛经患者疗效、镇痛效应及子宫动脉血流动力学的影响。方法筛选2017年12月—2019年12月收治患者,依据纳、排标准,最终入组寒凝血瘀型痛经患者84例,随机分为两组。对照组42例,予西药布洛芬缓释胶囊口服治疗,治疗组应用针刺联合雷火灸治疗,疗程为3个月。观察两组即时(治疗后30 min)、近期(治疗3个月后)和远期(随访6个月)的镇痛效应,观察两组患者疗程前后寒凝血瘀中医证候积分和子宫动脉血流动力学指标改善情况,并比较两组临床疗效。结果两组患者即时、近期和远期时的痛经VAS评分均较治疗前有所降低,但在同一时刻点组间比较,两组即时痛经VAS评分比较差异无统计学意义(P>0.05),近期和远期痛经VAS评分均低于对照组(P<0.05);对照组中医证候积分与治疗前比较差异无统计学意义(P>0.05),治疗组中医证候积分较治疗前降低(P<0.05),治疗组明显低于对照组(P<0.05);两组治疗后的子宫动脉搏动指数(PI)、阻力指数(RI)和收缩期峰值/舒张期峰值(A/B值)较治疗前均有所降低(P<0.05),但在同一时刻点组间比较,治疗组明显低于对照组(P<0.05);两组近期临床有效率比较差异无统计学意义(P>0.05),但治疗组远期临床有效率明显优于对照组(97.62%、78.57%)(P<0.05)。结论针刺联合雷火灸具有温经散寒、化瘀止痛、调畅气血之功效,与常规西药一样,具有良好的即时镇痛效应,但近期和远期镇痛效应优于布洛芬缓释胶囊,且针刺联合雷火灸可消除或减轻痛经患者的中医临床症状,改善子宫血液循环,从根本上消除痛经患者寒凝血瘀的致病因素,显著提升远期疗效,故值得推广应用。

Objective This paper explored the effect of acupuncture combined with thunder-fire moxibustion on curative effect,analgesic effect and hemodynamics of uterine artery in patients with dysmenorrhea of the type of blood stasis due to cold.Methods According to the inclusion and exclusion criteria,collected the information of patients with dysmenorrhea of the type of blood stasis due to cold who were diagnosed and treated in our hospital from December 2017 to December 2019.84 patients were randomly divided into two groups[the control group(group A)vs.the treatment group(group B)].42 patients in the group A were treated with ibuprofen sustained-release capsule orally.42 patients in the group B were treated with acupuncture combined with thunder-fire moxibustion.The course of treatment was 3 months.The analgesic effects of immediate(30 min after treatment),short-term(3 months after treatment)and long-term(6 months follow-up),the improvement of TCM syndrome integral and uterine artery hemodynamics index before and after treatment,and the clinical efficacy after treatment of the two groups were compared.Results After treatment,the results of the group A compared with the group B were as follows:The VAS scores of dysmenorrhea in immediate,short-term and long-term of patients in both groups were lower than those before treatment.However,when comparing between groups at the same time point,it was found that there was no significant difference in VAS scores of dysmenorrhea in immediate between the two groups(P>0.05).The VAS scores of dysmenorrhea in short-term and long-term of group B were lower than that of group A(P<0.05).There was no significant difference in TCM syndrome scores before and after treatment in group A(P>0.05).The TCM syndrome scores of patients in group B after treatment were lower than those before treatment(P<0.05),which were significantly lower than those in group A(P<0.05).The plusatility index(PI),resistance index(RI)and systolic/diastolic ratio(A/B)of uterine artery in two groups after treatment were lower than those before treatment(P<0.05).However,when comparing between groups at the same time point,it was found that the above indexes in the group B were significantly lower than those in the group A(P<0.05).There was no significant difference in clinical effective rate in short-term between the two groups(P>0.05).The long-term clinical effective rate of the group B was obviously better than that of the group A(97.62%,78.57%,P<0.05).Conclusion Acupuncture combined with thunder-fire moxibustion has the effects of warming channel and expelling cold,removing blood stasis and relieving pain,and regulating Qi and blood.Like conventional Western medicine,it has a good immediate analgesic effect,but its short-term and long-term analgesic effects are better than ibuprofen sustained-release capsules.Acupuncture combined with thunder-fire moxibustion can eliminate or alleviate the clinical symptoms of dysmenorrhea patients,improve uterine blood circulation,fundamentally eliminate the pathogenic factors,and significantly improve the long-term curative effect,so it is worthy of popularization and application.