脑功能治疗仪联合心理干预治疗老年人药物过度使用性头痛的临床研究
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摘要
目的研究和探讨脑功能治疗仪联合心理干预对老年人药物过度使用性头痛(MOH)的临床疗效。方法选择2014年7月—2015年7月在福建医科大学福总临床医学院干部科、神经内科门诊序贯就诊的50～80岁确诊为MOH的患者共120例,按随机数表法分为观察组与对照组,每组各60例。对照组采用撤药及尼莫地平(30 mg,3次/d)预防性治疗;观察组在对照组的基础上采用YS7004脑功能治疗仪治疗及心理干预综合治疗,治疗4周后,对比2组患者治疗前后的VAS评分、头痛发作频率、血清碱性成纤维细胞生长因子(bFGF)浓度以评价患者头痛程度,对比焦虑自评量表(SAS)和抑郁自评量表(SDS)以评价患者心理状态,对比健康调查量表(SF-36)评价患者生活质量。结果①治疗后2组患者VAS评分、头痛发作频率、血清碱性成纤维细胞生长因子(bFGF)浓度均较治疗前降低,且观察组降低幅度优于对照组,差异有统计学意义(P<0.01);②治疗后对照组患者SAS评分与SDS评分与治疗前差异无统计学意义(P>0.05),观察组治疗后SAS评分与SDS评分显著低于治疗前(P<0.01);③治疗后2组患者SF-36评分均较治疗前提高,且观察组提高更为显著,差异具有统计学意义(P<0.01)。结论在常规治疗的基础上联合脑功能治疗仪及心理干预治疗方法,对老年人药物过度使用性头痛具有更加显著的疗效,可以缓解头痛,改善焦虑、抑郁的心理,提高患者的生活质量。
Objective To study and explore the clinical efficacy of brain function therapy combined with psychological intervention in elderly patients with medication overuse headache(MOH). Methods From July 2014 to July 2015, 120 patients were diagnosed as MOH patients in the department of cadre's ward and department of neurology. The patients were divided into observation group and control group according to the random number table method, with 60 cases in each group. The control group was treated with nifedipine and nimodipine nimodipine(30 mg tid) prophylactic treatment, based on which the observation group used YS7004 brain function treatment and psychological intervention comprehensive treatment. After four weeks treatment, VAS score, headache attack frequency and serum basic fibroblast growth factor(bFGF) concentration in the two groups before and after treatment were evaluated to compare the level of headache, the SAS and the SDS to assess the patient's mental state, compared to the health survey scale(SF-36) to assess the quality of life of patients. Results ①The VAS score, the frequency of headache and the level of serum basic fibroblast growth factor(bFGF) in the two groups were lower than those before treatment, and the decrease rate of the observation group was better than that of the control group, with statistical significance(P<0.01). ②The scores of SAS score and SDS before and after treatment were significantly different from those before treatment(P>0.05). The SAS score and SDS score of the observation group were significantly lower than those before treatment(P<0.01). ③After treatment, SF-36 scores were significantly higher than those before treatment, and the observation group was more significant, showing statistical significance(P<0.01). Conclusion On the basis of routine treatment, combined with brain function therapy instrument and psychological intervention therapy, it has a more significant effect on elderly patients with medication overuse headache, which can relieve headache, improve anxiety and depression, and improve the quality of life of patients.
Objective To study and explore the clinical efficacy of brain function therapy combined with psychological intervention in elderly patients with medication overuse headache(MOH). Methods From July 2014 to July 2015, 120 patients were diagnosed as MOH patients in the department of cadre's ward and department of neurology. The patients were divided into observation group and control group according to the random number table method, with 60 cases in each group. The control group was treated with nifedipine and nimodipine nimodipine(30 mg tid) prophylactic treatment, based on which the observation group used YS7004 brain function treatment and psychological intervention comprehensive treatment. After four weeks treatment, VAS score, headache attack frequency and serum basic fibroblast growth factor(bFGF) concentration in the two groups before and after treatment were evaluated to compare the level of headache, the SAS and the SDS to assess the patient's mental state, compared to the health survey scale(SF-36) to assess the quality of life of patients. Results ①The VAS score, the frequency of headache and the level of serum basic fibroblast growth factor(bFGF) in the two groups were lower than those before treatment, and the decrease rate of the observation group was better than that of the control group, with statistical significance(P<0.01). ②The scores of SAS score and SDS before and after treatment were significantly different from those before treatment(P>0.05). The SAS score and SDS score of the observation group were significantly lower than those before treatment(P<0.01). ③After treatment, SF-36 scores were significantly higher than those before treatment, and the observation group was more significant, showing statistical significance(P<0.01). Conclusion On the basis of routine treatment, combined with brain function therapy instrument and psychological intervention therapy, it has a more significant effect on elderly patients with medication overuse headache, which can relieve headache, improve anxiety and depression, and improve the quality of life of patients.
引文
[1] CHEUNG V,AMOOZEGAR F,DILLI E.Medication overuse headache[J].Curr Neurol Neurosci Rep,2015,15(1):509.
[2] 陈芳,韩蕴丽,刘振玲,等.《头痛分类和诊断标准》与儿童偏头痛临床特征关系探讨[J].中国实用神经疾病杂志,2015,18(13):45-47.
[3] MANZONI G C,TORELLI P.Chronic headaches:a clinician’s experience of ICHD-3 beta[J].Neurol Sci,2015,36 Suppl 1:51-55.
[4] SARCHIELLI P,CORBELLI I,MESSINA P,et al.Psychopathological comorbidities in medication-overuse headache:a multicentre clinical study[J].Eur J Neurol,2016,23(1):85-91.
[5] Headache Classification Committee of the International Headache Society(IHS).The International Classification of Headache Disorders,3rd edition(beta version)[J].Cephalalgia,2013,33(9):629-808.
[6] 罗轮杰,罗本燕.药物过度使用性头痛[J].国际神经病学神经外科学杂志,2013,40(4):345-349.
[7] WANASUNTRONWONG A,JANSRI U,SRIKIATKHACHORN A.Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache[J].BMC Neurosci,2017,18(1):1.
[8] 孙华.药物过度使用性头痛的临床特点及诱发因素分析[J].北方药学,2017,14(4):183-184.
[9] JONSSON P,JAKOBSSON A,HENSING G,et al.Holding on to the indispensable medication-a grounded theory on medication use from the perspective of persons with medication overuse headache[J].J Headache Pain,2013,14(1):43.
[10] 陈小华,叶兴荣,庄志清,等.艾司西酞普兰联合乙哌立松治疗慢性紧张性头痛的疗效观察[J].实用临床医药杂志,2013,17(24):115,119.
[11] 王涛,王枫.小剂量左乙拉西坦单药与氟桂利嗪联合预防难治性偏头痛的疗效研究[J].实用临床医药杂志,2017,21(21):153-154,161.
[12] TASSORELLI C,JENSEN R,ALLENA M,et al.A consensus protocol for the management of medication-overuse headache:Evaluation in a multicentric,multinational study[J].Cephalalgia,2014,34(9):645-655.
[13] CHIANG C C,SCHWEDT T J,WANG S J,et al.Treatment of medication-overuse headache:A systematic review[J].Cephalalgia,2016,36(4):371-386.
[14] 周于然,李瑛.脊髓小胶质细胞在神经病理性疼痛发生发展过程中的作用机制研究进展[J].山东医药,2017,57(11):105-107.
[15] ISTOMINA O I,FILATOVA E G,LATYSHEVA N V.Behavioral dependence on analgesics in medication overuse headache[J].Zh Nevrol Psikhiatr Im S S Korsakova,2013,113(1):5-10.
[16] KRISTOFFERSEN E S,LUNDQVIST C.Medication-overuse headache:a review[J].J Pain Res,2014,7(6):367-378.
[2] 陈芳,韩蕴丽,刘振玲,等.《头痛分类和诊断标准》与儿童偏头痛临床特征关系探讨[J].中国实用神经疾病杂志,2015,18(13):45-47.
[3] MANZONI G C,TORELLI P.Chronic headaches:a clinician’s experience of ICHD-3 beta[J].Neurol Sci,2015,36 Suppl 1:51-55.
[4] SARCHIELLI P,CORBELLI I,MESSINA P,et al.Psychopathological comorbidities in medication-overuse headache:a multicentre clinical study[J].Eur J Neurol,2016,23(1):85-91.
[5] Headache Classification Committee of the International Headache Society(IHS).The International Classification of Headache Disorders,3rd edition(beta version)[J].Cephalalgia,2013,33(9):629-808.
[6] 罗轮杰,罗本燕.药物过度使用性头痛[J].国际神经病学神经外科学杂志,2013,40(4):345-349.
[7] WANASUNTRONWONG A,JANSRI U,SRIKIATKHACHORN A.Neural hyperactivity in the amygdala induced by chronic treatment of rats with analgesics may elucidate the mechanisms underlying psychiatric comorbidities associated with medication-overuse headache[J].BMC Neurosci,2017,18(1):1.
[8] 孙华.药物过度使用性头痛的临床特点及诱发因素分析[J].北方药学,2017,14(4):183-184.
[9] JONSSON P,JAKOBSSON A,HENSING G,et al.Holding on to the indispensable medication-a grounded theory on medication use from the perspective of persons with medication overuse headache[J].J Headache Pain,2013,14(1):43.
[10] 陈小华,叶兴荣,庄志清,等.艾司西酞普兰联合乙哌立松治疗慢性紧张性头痛的疗效观察[J].实用临床医药杂志,2013,17(24):115,119.
[11] 王涛,王枫.小剂量左乙拉西坦单药与氟桂利嗪联合预防难治性偏头痛的疗效研究[J].实用临床医药杂志,2017,21(21):153-154,161.
[12] TASSORELLI C,JENSEN R,ALLENA M,et al.A consensus protocol for the management of medication-overuse headache:Evaluation in a multicentric,multinational study[J].Cephalalgia,2014,34(9):645-655.
[13] CHIANG C C,SCHWEDT T J,WANG S J,et al.Treatment of medication-overuse headache:A systematic review[J].Cephalalgia,2016,36(4):371-386.
[14] 周于然,李瑛.脊髓小胶质细胞在神经病理性疼痛发生发展过程中的作用机制研究进展[J].山东医药,2017,57(11):105-107.
[15] ISTOMINA O I,FILATOVA E G,LATYSHEVA N V.Behavioral dependence on analgesics in medication overuse headache[J].Zh Nevrol Psikhiatr Im S S Korsakova,2013,113(1):5-10.
[16] KRISTOFFERSEN E S,LUNDQVIST C.Medication-overuse headache:a review[J].J Pain Res,2014,7(6):367-378.