针药并用治疗紧张性头痛的疗效观察及对患者脑血流量、心理状态的影响

Efficacy Observation of Acupuncture Medication Combined in Treating Tension Headache and Its Effect on Cerebral Blood Flow and Psychological State

目的观察针药并用治疗紧张性头痛的临床疗效及对脑血流量、心理状态的影响。方法将153例紧张性头痛老年患者随机分为联合组51例、针刺组50例及中药组52例。中药组给予芎芷全蝎汤加味治疗,针刺组给予针刺治疗,联合组予以针刺联合芎芷全蝎汤加味治疗。观察3组治疗前后视觉模拟量表(VAS)评分、中医证候积分、头痛发作频率及持续时间、脑血流动力学[大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)血流速度]、心理状态[简版老年抑郁量表(GDS-15)、沃里克—爱丁堡积极心理健康量表(WEMWBS)]、对周围刺激的相关反应的变化,并比较3组的临床疗效。结果联合组临床疗效明显高于针刺组及中药组(P<0.05);针刺组及中药组临床疗效比较,差异无统计学意义(P>0.05)。3组治疗后VAS评分、中医证候积分、头痛发作频率及持续时间均较治疗前降低(P<0.05);联合组低于针刺组及中药组(P<0.05),针刺组及中药组比较,差异无统计学意义(P>0.05)。3组治疗后ACA、MCA、PCA血流速度均较治疗前降低(P<0.05);联合组低于针刺组及中药组(P<0.05),针刺组及中药组比较差异无统计学意义(P>0.05)。3组治疗后GDS-15评分均较治疗前降低(P<0.05);联合组低于针刺组及中药组(P<0.05),针刺组及中药组比较差异无统计学意义(P>0.05)。3组治疗后WEMWBS评分则较治疗前升高(P<0.05),联合组高于针刺组及中药组(P<0.05),针刺组及中药组比较差异无统计学意义(P>0.05)。联合组治疗后对单独视觉刺激、单独听觉刺激及双重刺激反应的准确率均较治疗前升高(P<0.05),且高于针刺组及中药组(P<0.05)。结论针药并用治疗紧张性头痛效果显著,不仅能改善患者脑血流速度,还能提升心理健康水平,提高患者视听刺激反应能力。

Objective To observe the clinical efficacy of acupuncture medication combined for tension headache and its effect on cerebral blood flow and psychological state.Method One hundred and three elderly patients with tension headache were randomized to a combination group(51 cases),an acupuncture group(50 cases)and a Chinese herbal medicine group(52 cases).The Chinese herbal medicine group was treated with modified Xiongzhi Quanxie decoction;the acupuncture group,with acupuncture therapy;the combination group,with acupuncture plus modified Xiongzhi Quanxie decoction.The visual analog scale(VAS)score,the TCM syndrome score,headache attack frequency and duration,cerebral hemodynamics blood flow velocities of anterior cerebral artery(ACA),middle cerebral artery(MCA)and posterior cerebral artery(PCA),psychological state[15-item geriatric depression scale(GDS-15)and Warwick-Edinburgh mental well-being scale(WEMWBS)]and related responses to peripheral stimuli were observed in the three groups before and after treatment.The clinical therapeutic effects were compared between the three groups.Result The clinical therapeutic effect was better in the combination group than in the acupuncture and Chinese herbal medicine groups(P<0.05)and had no statistically significant difference between the acupuncture and Chinese herbal medicine groups(P>0.05).After treatment,the VAS score,the TCM syndrome score,and headache attack frequency and duration decreased in the three groups compared with before(P<0.05),were lower in the combination group than in the acupuncture and Chinese herbal medicine groups(P<0.05)and had no statistically significant difference between the acupuncture and Chinese herbal medicine groups(P>0.05).After treatment,ACA,MCA and PCA blood flow velocities decreased in the three groups compared with before(P<0.05),were lower in the combination group than in the acupuncture and Chinese herbal medicine groups(P<0.05)and had no statistically significant difference between the acupuncture and Chinese herbal medicine groups(P>0.05).After treatment,the GDS-15 score decreased in the three groups compared with before(P<0.05),was lower in the combination group than in the acupuncture and Chinese herbal medicine groups(P<0.05)and had no statistically significant difference between the acupuncture and Chinese herbal medicine groups(P>0.05).After treatment,the WEMWBS score increased in the three groups compared with before(P<0.05),was higher in the combination group than in the acupuncture and Chinese herbal medicine groups(P<0.05)and had no statistically significant difference between the acupuncture and Chinese herbal medicine groups(P>0.05).After treatment,the accuracy rates of responses to visual stimulus alone,auditory stimulus alone and dual stimuli increased in the combination group compared with before(P<0.05)and were higher than in the acupuncture and Chinese herbal medicine groups(P<0.05).Conclusion Acupuncture medication combined has a marked therapeutic effect on tension headache.It can improve not only cerebral blood flow velocity but also psychological health levels and the ability to respond to audio-visual stimuli in the patients.