热敏灸预处理对原发性痛经患者临床疗效及子宫动脉血流的影响——一项随机对照盲法试验

The Clinical Effect of Pretreatment with Heat-sensitive Moxibustion on Primary Dysmenorrhea and Its Influence on Uterine Artery Blood Flow:A Randomized,Blinded Controlled Trial

目的比较热敏灸在经期前介入与月经当天介入治疗原发性痛经的临床疗效差异,以优化临床治疗方案。方法将纳入的60例原发性痛经患者随机分为预处理组和常规处理组,每组30例。所有患者仰卧位时选取双侧子宫穴与归来穴合围的区域,俯卧位时选择双侧肾俞穴与次髎穴合围的区域,分别施回旋灸2 min,雀啄灸1 min,再循经往返灸激发灸感,找出所有热敏穴,最终选择2个灸感最好的热敏穴进行治疗。预处理组于月经来临前3~7天开始施灸,常规处理组于月经当天施灸,两组均每日1次,每个月经周期治疗7天,连续进行3个月经周期。治疗前后进行COX痛经症状评价量表(CMSS)评分、疼痛视觉模拟量表(VAS)评分,检测子宫动脉血流动力学指标[包括血液搏动指数(PI)和阻力指数(RI)],治疗后比较两组患者的中医临床疗效。结果两组治疗后CMSS评分、VAS评分、PI、RI均低于本组治疗前,且治疗后预处理组VAS评分、CMSS评分、PI、RI低于常规处理组(P<0.05或P<0.01)。预处理组治疗后中医临床疗效总有效率为93.3%(28/30),优于常规处理组的73.3%(22/30,P<0.05)。结论热敏灸在经期前介入治疗原发性痛经的临床疗效优于月经当天介入治疗,能更好地改善患者痛经症状和子宫局部血液循环。

Objective To compare the clinical effect of heat-sensitive moxibustion before menstruation and since the first day of menstruation on primary dysmenorrhoea(PD),thereby optimizing the clinical treatment plan.Methods Sixty patients with PD were randomly divided into pretreatment group(treated before menstruation)and conventional treatment group(treated since the first day of menstruation)of 30 cases each.For all patients,the area surrounded by bilateral Zigong(EX-CA1)and bilateral Guilai(ST 29)in the supine position,and that formed by bilateral Shenshu(BL 23)and Ciliao(BL 32)in the prone position were selected for circling moxibustion(2 min),sparrow-pecking moxibustion(1 min),and then moxibustion along the channels to stimulate the moxibustion sensation and obtain two heat-sensitive points with the best sensation for treatment.In the pretreatment group,moxibustion was applied 3-7 days before the onset of menstruation,and in the conventional treatment group,moxibustion was applied on the day of menstruation.Both groups were treated once daily for 7 days per menstrual cycle for 3 consecutive cycles.The clinical outcomes of the two groups were measured before and after treatment in terms of the COX menstrual pain symptom scale(CMSS)scores,visual analogue scale for pain(VAS)scores,and uterine artery hemodynamic indicators including blood pulsation index(PI)and resistance index(RI),and the clinical effect was compared.Results After treatment,the CMSS scores,VAS scores,PI and RI in the two groups decreased,and lower scores were found in the pretreatment group(P<0.05 or P<0.01).The total effective rate after treatment was 93.3%(28/30)in the pretreatment group,which was better than 73.3%(22/30)in the conventional treatment group(P<0.05).Conclusion The clinical effect of heat-sensitive moxibustion before the menstruation for PD was better than that implemented since the first day of menstruation,by significantly improving the patients'dysmenorrhoea symptoms and uterine artery blood flow index.