温经汤加减外敷治疗慢性盆腔痛优化方案研究

Study on the optimization scheme of TCM external application with modified Wenjing Decoction on chronic pelvic pain

目的探讨不同温经汤加减外敷方法治疗慢性盆腔痛的疗效及成本-效果比,优化操作方案。方法将2017年9月—2020年9月在北京中医药大学东方医院门诊就诊的144例慢性盆腔痛寒凝血瘀型患者随机分为4组各36例,30 min 14 d组给予温经汤加减外敷30 min/次,每个月经周期连续治疗14 d;30 min 21 d组给予温经汤加减外敷30 min/次,每个月经周期连续治疗21 d;60 min 14 d组给予温经汤加减外敷60 min/次,每个月经周期连续治疗14 d;60 min 21 d组给予温经汤加减外敷60 min/次,每个月经周期连续治疗21 d。治疗3个月经周期后,观察4组患者简化McGill疼痛评分、中医症状评分、局部体征积分、生活质量积分变化,比较4组慢性盆腔痛疗效、抑郁状况改善情况、不良反应发生情况及成本-效果比。结果 30 min 14 d组29例、30 min 21 d组28例、60 min 14 d组30例、60 min 21 d组28例完成研究。治疗后4组简化McGill疼痛评分、中医症状评分、局部体征积分均明显降低,60 min 14 d组明显低于30 min 14 d组,60 min 21 d组明显低于30 min 21 d组,差异均有统计学意义(P均<0.05);30 min 14 d组与30 min 21 d组、60 min 14 d组与60 min 21 d组比较差异均无统计学意义(P均>0.05)。治疗后4组生活质量积分均明显增加(P均<0.05),但4组间比较差异均无统计学意义(P均>0.05)。60 min 14 d组慢性盆腔痛及抑郁治疗总有效率最高,但与其他组比较差异均无统计学意义(P均>0.05);4组均无明显不良反应发生;60 min 14 d组成本-效果比最低。结论温经汤加减外敷治疗寒凝血瘀型慢性盆腔痛疗效确切,其中每次敷药60 min、每个月经周期连续14 d为可优化操作方案。

Objective It is to explore the curative effect and cost-effectiveness ratio of different modified Wenjign Decoction for external application in the treatment of chronic pelvic pain,and to optimize the operation plan.Methods A total of 144 patients with chronic pelvic pain of type of cold coagulation and blood stasis treated in the outpatient clinic of Dongfang Hospital of Beijing University of Chinese Medicine from September 2017 to September 2020 were randomly divided into 4 groups with 36 cases in each group.The 30 min 14 d group was given Wenjing Decoction for external application,30 min/time,and continuously treated for 14 days in each menstrual cycle;the 30 min 21 d group was given Wenjing Decoction for external application,30 min/time,and continuously treated for 21 days in each menstrual cycle;the 60 min 14 d group was given Wenjing Decoction for external application,60 min/time,and continuously treated for 14 days in each menstrual cycle;the 60 min 21 d group was given Wenjing Decoction for external application,60 min/time,and continuously treated for 21 days in each menstrual cycle.After treatment for 3 menstrual cycles,the changes in the scores of simplified McGill pain,TCM symptoms,local physical signs,and quality of life of the patients in the 4 groups were observed,and the efficacy of chronic pelvic pain,the improvement of depression,the occurrence of adverse reactions and the cost-effectiveness of the 4 groups were compared.Results 29 cases in the 30 min 14 d group,28 cases in the 30min 21 d group,30 cases in the 60 min 14 d group,and 28 cases in the 60 min 21 d group completed the study.After treatment,the scores of simplified McGill pain,TCM symptoms,and local signs were significantly reduced in the 4 groups,the 60 min 14 d group was significantly lower than the 30 min 14 d group,and the 60 min 21 d group was significantly lower than the 30 min 21 d group,the differences were all statistically significant(all P<0.05);there was no significant difference between the 30 min 14 d group and 30 min 21 d group,60 min 14 d group and 60min 21 d group(all P>0.05).After treatment,the scores of quality of life of the 4 groups were increased significantly(all P<0.05),but there was no statistically significant difference among the 4 groups(all P>0.05).The 60 min 14 d group had the highest total effective rate of chronic pelvic pain and depression,but there was no significant difference compared with other groups(P>0.05);no obvious adverse reactions occurred in the 4 groups;the cost-effect ratio was the lowest in 60 min 14 d group.Conclusion Modified Wenjing Decoction for external application is effective in the treatment of chronic pelvic pain of type of cold-coagulation and blood stasis,and the operation plan that treating for 60 minutes each time and for 14 consecutive days in each menstrual cycle can be optimized.