激痛点电针疗法与腹横肌平面阻滞治疗慢性腹壁疼痛的疗效对比

Comparison of the clinical efficacy on chronic abdominal wall pain between trigger-point electroacupuncture and transversus abdominis plane block

目的:比较激痛点(TrP)电针疗法与腹横肌平面(TAP)阻滞治疗慢性腹壁疼痛(CAWP)的临床疗效。方法:将62例CAWP患者随机分为TrP电针组(31例,脱落1例)和TAP阻滞组(31例,脱落1例)。TrP电针治疗组行TrP电针治疗,TAP阻滞组行超声引导下TAP阻滞治疗,均治疗2次(间隔1周)。观察治疗前和治疗后1周、1个月、3个月的数字评价量表(NRS)评分;观察治疗前和治疗后1周、3个月的焦虑自评量表(SAS)和抑郁自评量表(SDS)评分;观察治疗前和治疗后3个月的生活质量量表(SF-36)评分;记录随访期间补救镇痛药物使用率并评价临床疗效。结果:与本组治疗前比较,两组患者治疗后各时间点NRS评分降低(P<0.05),治疗后1周、3个月的SAS、SDS评分降低(P<0.05),SF-36各项评分升高(P<0.05)。与TAP阻滞组比较,TrP电针治疗组在治疗后1个月、3个月的NRS评分降低(P<0.05),治疗后3个月SAS、SDS评分降低(P<0.05),SF-36评分升高(P<0.05)。TAP阻滞组和TrP电针组补救镇痛药物的使用率分别为6.7%和13.3%,两组差异无统计学意义。TrP电针治疗组的临床有效率(96.7%)优于TAP阻滞组(83.3%,P<0.05)。结论:TrP电针疗法和TAP阻滞均能显著缓解CAWP患者疼痛,改善患者焦虑抑郁情绪并提高生活质量。TrP电针疗法在治疗后3个月临床疗效优于TAP阻滞治疗。

Objective To compare the clinical efficacy between trigger-point(TrP)electroacupuncture and transversus abdominis plane(TAP)block in treatment of chronic abdominal wall pain(CAWP).Methods A total of 62 CAWP patients were randomly divided into a TrP electroacupuncture group(31 cases,1 case dropped off)and a TAP block group(31 cases,1 case dropped off).Electroacupuncture at trigger points was delivered in the TrP electroacupuncture group,and TAP block was administered under ultrasonic guidance in the TAP block group.Separately,the score of the numerical pain rating scale(NRS)was observed before treatment and in 1 week,1 month and 3 months after treatment;the scores of the self-rating anxiety scale(SAS)and the self-rating depressive scale(SDS)observed before treatment and in 1 week and 3 months after treatment;and the score of the short form 36 questionnaire(SF-36)was observed before treatment and in 3 months after treatment.The utilization rate of remedial drugs was recorded during follow-up visit.The clinical efficacy was compared.Results At each time point after treatment,NRS score decreased in comparison with that before treatment(P<0.05),the scores of SAS and SDS 1 week and 3 months after treatment were reduced(P<0.05)and the each item score of SF-36 increased(P<0.05)3 months after treatment of each group.Compared with the outcomes in the TAP block group,NRS scores were reduced 1 month and 3 months after treatment respectively(P<0.05),the scores of SAS and SDS decreased(P<0.05)and SF-36 score was elevated(P<0.05)3 months after treatment in the TrP electroacupuncture group.There was no significant difference in the utilization rate of remedial drugs between the two groups.The clinical efficacy of the TrP electroacupuncture group(96.7%)was superior to that of the TAP block group(83.3%,P<0.05).Conclusion Both TrP electroacupuncture and TAP block can markedly relieve pain,attenuate the emotional symptoms of anxiety and depression and improve the quality of life in the patients with chronic abdominal wall pain.The clinical efficacy of TrP electroacupuncture is better than that of TAP block 3 months after treatment.