湿针疗法联合家庭腹壁拉伸运动治疗原发性痛经的临床疗效研究

摘要

目的 探讨以肌筋膜疼痛触发点(MTrPs)为原理,应用湿针疗法联合家庭腹壁拉伸运动治疗原发性痛经(PD)的安全性、有效性.方法 选取2015-11-01至2015-12-31就诊于新疆医科大学第一附属医院的PD患者30例作为试验组,同期选取非痛经者30例作为正常对照组.正常对照组不做任何医疗干预,嘱日常及经期注意保暖,避免过度劳累、受凉及情绪波动,维持正常作息及饮食习惯.试验组采用湿针疗法于腹壁MTrPs处行灭活处理,并联合家庭腹壁拉伸运动的锻炼方法进行规律锻炼维持治疗效果.试验组在治疗期间应停止接受其他治疗,并在治疗后随访6个月.应用疼痛视觉模拟评分法(VAS)评分评价患者治疗前、治疗后经期来潮48 h内的腹痛程度;观察试验组治疗前当月、治疗后次月月经来潮48 h内血清前列腺素(PG)F2α、PGE2水平及正常对照组于试验组治疗后同月的月经来潮48 h内血清PGF2α、PGE2水平;观察并记录试验组治疗有效率及不良反应发生情况.结果 试验组治疗后次月月经来潮48 h内VAS评分低于治疗前(P＜0.01).试验组治疗后次月月经来潮48 h内血清PGF2α水平低于治疗前,血清PGE2水平高于治疗前(P＜0.01).试验组治疗后次月月经来潮48 h内血清PGE2水平与正常对照组比较,差异无统计学意义(P＞0.05);试验组治疗后次月月经来潮48 h内血清PGF2α水平低于正常对照组(P＜0.05).试验组治疗后1、3、6个月治疗有效率分别为80.0%(24/30)、83.3%(25/30)、76.7%(23/30).试验组穿刺处肌肉酸胀感25例,可通过家庭腹壁拉伸运动迅速得到缓解;非经期阵发性下腹坠痛、抽搐感4例,接受湿针治疗后行规律家庭腹壁拉伸运动次月可明显缓解.结论 湿针疗法联合家庭腹壁拉伸运动治疗PD的效果确切,可显著降低月经来潮48 h内血清PGF2α水平,升高月经来潮48 h内血清PGE2水平,从而改善经期腹痛等相关不适症状,不良反应少且症状轻,具备良好的安全性及有效性.%Objective To verify the safety and effectiveness of wet acupuncture therapy in the treatment of primary dysmenorrhea (PD) with home abdominal wall stretching exercise and to determine the possible mechanism of analgesia based on the principle of myofascial pain trigger points (MTrPs).Methods Thirty patients with PD who were treated in the Outpatient Department of the First Affiliated Hospital of Xinjiang Medical University from November 1,2015 to December 31,2015 were selected as the experimental group,and 30 non-PD controls were selected as the normal control group during the same period.Individuals in the normal control group did not receive any medical interventions and were advised to stay warm during menstrual periods,avoid overwork,cold temperatures and mood swings,and maintain normal daily routines as well as eating habits.The experimental group underwent wet acupuncture therapy to inactivate the MTrPs in the abdominal wall along with abdominal wall stretching exercises,and regular exercise to maintain the therapeutic effect.This group did not receive other therapies during the treatment period and were followed up for 6 months after treatment.The visual analog scale (VAS) was used to evaluate the degree of abdominal pain in patients within 48 h of menstruation before and after treatment.The levels of serum PGF2α and PGE2 were measured in the experimental group within 48 h of menstrual cramps in the month before treatment and in the month after treatment.In addition,the levels of serum PGF2α and PGE2 in the normal control group within 48 h of menstrual cramps in the month after treatment were also measured.Treatment efficacy and adverse reactions were observed and recorded in the experimental group.Results The VAS score within 48 h of menstrual cramps in the experimental group was lower after treatment than before treatment(P＜0.01).The level of serum PGF2α within 48 h of menstrual cramps the month after treatment was lower than that before treatment in the experimental group,and serum PGE2 levels were higher after treatment than before treatment (P＜0.01).Serum PGE2 levels within 48 h of menstrual cramps after treatment in the experimental group were not statistically different to those in the normal control group (P＞0.05).Serum PGF2α levels within 48 h of menstrual cramps after treatment in the experimental group were lower than those in the normal control group (P＜0.05).The efficacy rates at 1,3,and 6 months after treatment were 80.0% (24/30),83.3% (25/30),and 76.7% (23/30),respectively.In the experimental group,25 cases of musculoskeletal sensation at the puncture site were rapidly relieved by abdominal wall stretching exercise;4 cases of non-menstrual paroxysmal lower abdominal pain and twitching sensation were significantly reduced the month after receiving wet acupuncture therapy and abdominal wall stretching exercise.Conclusion Treatment with wet acupuncture therapy and home abdominal stretching exercise was effective in patients with PD,and significantly reduced serum PGF2α levels in the experimental group within 48 h of menstrual cramps,increased serum PGE2 levels within 48 h of menstrual cramps, thereby improving discomfort due to menstrual abdominal pain in the experimental group and was safe with few adverse reactions.