针刺肌筋膜激痛点联合药物治疗偏头痛病人疗效及血液ET、NO水平影响研究

Efficacy of acupuncturing MTrPs combined with drugs in the treatment of migraine patients and its influence on blood endothelin and nitrogen monoxid

目的:探讨偏头痛病人在进行针刺肌筋膜触发(激痛)点(myofascial trigger point,MTrPs)联合药物治疗后疼痛的疗效和对血液活性物质血浆内皮素(endothelin,ET)、血清一氧化氮(nitrogen monoxid,NO)水平的影响。方法:将西南大学医院2020年9月至2021年6月符合纳入标准的45名偏头痛病人按随机数字表法分为药物组、针刺组及联合组,每组15例。药物组口服尼莫地平片,每次30 mg,每日3次,连续服用2周;针刺组采用针刺头夹肌、斜角肌和胸锁乳突肌中的MTr Ps,每周3次,共治疗2周;联合组口服尼莫地平片,每次30 mg,每日3次,并针刺病人头夹肌、斜角肌和胸锁乳突肌中的MTr Ps,每周3次,共治疗2周。分别对三组病人治疗前后的疼痛和头痛影响评分、血液活性物质ET和NO水平进行比较。结果:治疗前三组病人基线期各项指标差异无统计学意义;联合组与针刺组在干预后的疼痛视觉模拟评分法(visual analogue scale,VAS)评分显著低于药物组且显著低于治疗前(P<0.05);三组病人在干预后的ET与NO数值较治疗前显著降低,且联合组在干预后的ET与NO数值显著低于针刺组与药物组(P<0.05)。结论:针刺MTr Ps联合药物能显著降低血液活性物质的水平,减轻偏头痛病人的疼痛程度且不良反应较少,较单一针刺或药物治疗更有效地减少疼痛症状、改善生活质量、降低血液中血管活性物质ET、NO的水平。

Objective:To explore the therapeutic effect of acupuncturing myofascial trigger point(MTrPs)combined with drugs on migraine and its effect on the levels of blood active substances endothelin(ET)and nitrogen monoxide(NO).Methods:The 45 migraine patients who met the inclusion criteria from September 2020 to June 2021 at Southwest University Hospital were divided into drug group,acupuncture group and combined group according to the random number table method,with 15 cases in each group.Drug group took nimodipine tablets orally at 30 mg three times daily for 2 weeks.In the acupuncture group,MTrPs in the cephalic clamp muscle,scalene muscle and sternocleidomastoid muscle were used 3 times a week for 2 weeks.The combined group took oral nimodipine tablets at 30 mg three times a day,and acupuncture was used to prick MTrPs in the cephalic clip muscle,scalene muscle and sternocleidomastoid muscle three times a week for 2 weeks.The pain and headache impact scores,hemoactive substance ET and NO levels before and after treatment were compared in the three groups.Results:Before treatment,there were no significant difference in the baseline indexes among the three groups,but the visual analogue scale(VAS)scores of pain after intervention in the combination group and acupuncture group were significantly lower than those in the drug group and before treatment(P<0.05).The values of blood ET and NO in these three groups after intervention were significantly lower than those before treatment,and the values of ET and NO in the combined group after intervention were significantly lower than those in the acupuncture group and drug group(P<0.05).Conclusion:MTrPs acupuncture combined with drugs can significantly reduce the level of blood active substances,reduce the degree of pain in patients with migraine and have fewer adverse reactions,which is more effective than single acupuncture or drug therapy in reducing pain symptoms,improving quality of life and reducing the level of vasoactive substances in blood.