活血和络法治疗血管神经性头痛的临床研究
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摘要
目的：血管神经性头痛是头颅部血管神经调节障碍所引起的一种反复发作性的头痛,有周期性、发作性、剧烈性的特点,病程缠绵,多久治不愈。不同研究显示,此病一般人口的终身流行率从30%～78%不等。其中以偏头痛最为常见,发病率约占所有头痛的1/4,且女性发病率大于男性。目前,血管神经性头痛的发病机制尚未完全阐明,主要认为是头颅血管收缩舒张功能障碍、神经机能紊乱以及某些体液物质一时性改变所致。西医治疗主要选用血管收缩剂、钙通道阻滞剂、5-羟色胺受体拮抗剂、止痛剂、镇静剂、抗焦虑及抑郁等药物,虽然能够减轻疼痛,缓解症状,但不能祛除病灶,且常易复发,故效果不理想。随着社会高速发展,人类生活节奏的加快及工作压力的增大,近年来血管神经性头痛的发病率呈明显上升趋势,其发病过程长且年轻化,为临床中常见的多发病。近年来中医在治疗本病方面积累了丰富的经验,治疗采用辨证施治的方法,标本同治,近期和远期疗效皆显著,而且复发率低,疗效优于单纯西医治疗。研究及推广中医对血管性头痛的治疗,对当今人类的健康有重大的意义。本课题通过治疗组中医辨证论治和对照组服用都梁滴丸治疗比较,观察血管神经性头痛患者的中医药治疗效果。
方法：采取随机对照的方法,将符合诊断标准的60例血管神经性头痛患者分为治疗组和对照组。在同等治疗常规的基础上,治疗组根据肝阳上亢、痰湿重浊、气血两虚及阴虚的不同辨证分型,以活血和络汤为基础方加减治疗,以7天为一个疗程,连用4个疗程。对照组用都梁滴丸(北京九龙制药厂生产),180mg,qid,治疗一个月。主要使用“视觉模拟疼痛评分”(Visual Analogue Scale,VAS)法,评价头痛程度和治疗后的缓解程度,计算出疗效指数,对两组的治疗效果予以评价。并且观察本病患者中主要常见兼症及体征,如失眠、倦惫、头痛频率及头痛持续时间,分别观察两组患者这些症状体征的改善情况。
结果：治疗组治愈9例,显效15例,有效4例,无效2例,总有效率93.33%；对照组治愈5例,显效6例,有效14例,无效5例,总有效率83.33%。经统计分析,治疗组在疗效指数方面优于对照组(P=0.006<0.05)。主要常见兼症体征,如失眠、倦惫、头痛频率及头痛持续时间的改善情况,治疗组也优于对照组。
Objective:Angioneurotic headache was a recurrent headache caused by skull, blood vessels and nerves adjustment disorders, has periodic, episodic, intense sexual characteristics, duration of lingering, and more permanently. Different studies have shown that the lifetime prevalence of the disease in the general population ranging from30%to78%. The most common is migraine headache, the incidence accounts for about1/4in all the headaches, and the incidence of women is bigger than men. At present, pathogenesis of angioneurotic headache is not yet fully elucidated, the main ideas have head vasoconstriction diastolic dysfunction, nerve function disorders, as well as changes in some humoral substance of the moment. Western treatment are about selecting vasoconstrictor, calcium channel blockers and5-hydroxytryptamine receptor antagonists, analgesics, tranquilizers, anti-anxiety and depression drugs. Though they can reduce pain, relieve symptoms, but can not get rid of the lesions, and often easy to relapse, it was not good idea. With the rapid development of the quickening pace of human life and the working pressure increases, a clear upward trend in recent years, angioneurotic headache incidence of the disease process long and younger, is a common multiple in the clinical In recent years, traditional Chinese medicine in treatment of this disease has accumulated rich experience in the treatment of syndrome differentiation specimens wen, short-term and long-term efficacy are significant, and low recurrence rate, the effective is good than western medicine. Researching and promotion of traditional Chinese medicine treatment of vascular headache is of great significance to human health today. This subject compares of traditional Chinese medicine diagnosis and treatment by treatment group and control group was given the all beam Dripping Pill, observed the effect of Chinese medicine treatment of patients with angioneurotic headache.
Methods:Randomized controlled would be consistent with the diagnostic criteria,60cases of angioneurotic headache patients were divided into treatment and control groups. Treatment group in the same treatment on a regular basis with control groups, according to the yang, phlegm muddy, blood deficiency and yin deficiency syndrome type-based side to promoting blood circulation soup Treated for7days a course of treatment, once every four courses. The same treatment on a regular basis, using both beam Dropping Pill (Beijing Kowloon Pharmaceutical Factory production),180mg, qid,a month of treatment. Mainly using the visual analog pain score (the Visual analogue Scale, VAS) in France, evaluates the headache extent and degree of remission after treatment, calculated the efficacy index, the therapeutic effect of the two groups to be evaluated. And observed the patients in the main common of his symptoms and signs such as insomnia, tired exhausted, headache frequency and headache duration, observed the improve situation in two groups of patients with these symptoms and signs
Results:In treatment group,9cases were cured,15cases have markedly effective, four cases are in effective,2cases do not have effective, the total efficiency of treatment group is93.33%; In control group,5cases were cured,6cases have markedly effective,14cases are in effective,5cases do not have effective, the total efficiency of control group is83.33%. After statistical analysis, the treatment group is better than the control group (P=0.006<0.05) in terms of efficacy index. Main common of these symptoms and signs, such as insomnia, tired, exhausted, headache frequency and headache duration of improvement in the treatment group are better than the control group.
方法：采取随机对照的方法,将符合诊断标准的60例血管神经性头痛患者分为治疗组和对照组。在同等治疗常规的基础上,治疗组根据肝阳上亢、痰湿重浊、气血两虚及阴虚的不同辨证分型,以活血和络汤为基础方加减治疗,以7天为一个疗程,连用4个疗程。对照组用都梁滴丸(北京九龙制药厂生产),180mg,qid,治疗一个月。主要使用“视觉模拟疼痛评分”(Visual Analogue Scale,VAS)法,评价头痛程度和治疗后的缓解程度,计算出疗效指数,对两组的治疗效果予以评价。并且观察本病患者中主要常见兼症及体征,如失眠、倦惫、头痛频率及头痛持续时间,分别观察两组患者这些症状体征的改善情况。
结果：治疗组治愈9例,显效15例,有效4例,无效2例,总有效率93.33%；对照组治愈5例,显效6例,有效14例,无效5例,总有效率83.33%。经统计分析,治疗组在疗效指数方面优于对照组(P=0.006<0.05)。主要常见兼症体征,如失眠、倦惫、头痛频率及头痛持续时间的改善情况,治疗组也优于对照组。
Objective:Angioneurotic headache was a recurrent headache caused by skull, blood vessels and nerves adjustment disorders, has periodic, episodic, intense sexual characteristics, duration of lingering, and more permanently. Different studies have shown that the lifetime prevalence of the disease in the general population ranging from30%to78%. The most common is migraine headache, the incidence accounts for about1/4in all the headaches, and the incidence of women is bigger than men. At present, pathogenesis of angioneurotic headache is not yet fully elucidated, the main ideas have head vasoconstriction diastolic dysfunction, nerve function disorders, as well as changes in some humoral substance of the moment. Western treatment are about selecting vasoconstrictor, calcium channel blockers and5-hydroxytryptamine receptor antagonists, analgesics, tranquilizers, anti-anxiety and depression drugs. Though they can reduce pain, relieve symptoms, but can not get rid of the lesions, and often easy to relapse, it was not good idea. With the rapid development of the quickening pace of human life and the working pressure increases, a clear upward trend in recent years, angioneurotic headache incidence of the disease process long and younger, is a common multiple in the clinical In recent years, traditional Chinese medicine in treatment of this disease has accumulated rich experience in the treatment of syndrome differentiation specimens wen, short-term and long-term efficacy are significant, and low recurrence rate, the effective is good than western medicine. Researching and promotion of traditional Chinese medicine treatment of vascular headache is of great significance to human health today. This subject compares of traditional Chinese medicine diagnosis and treatment by treatment group and control group was given the all beam Dripping Pill, observed the effect of Chinese medicine treatment of patients with angioneurotic headache.
Methods:Randomized controlled would be consistent with the diagnostic criteria,60cases of angioneurotic headache patients were divided into treatment and control groups. Treatment group in the same treatment on a regular basis with control groups, according to the yang, phlegm muddy, blood deficiency and yin deficiency syndrome type-based side to promoting blood circulation soup Treated for7days a course of treatment, once every four courses. The same treatment on a regular basis, using both beam Dropping Pill (Beijing Kowloon Pharmaceutical Factory production),180mg, qid,a month of treatment. Mainly using the visual analog pain score (the Visual analogue Scale, VAS) in France, evaluates the headache extent and degree of remission after treatment, calculated the efficacy index, the therapeutic effect of the two groups to be evaluated. And observed the patients in the main common of his symptoms and signs such as insomnia, tired exhausted, headache frequency and headache duration, observed the improve situation in two groups of patients with these symptoms and signs
Results:In treatment group,9cases were cured,15cases have markedly effective, four cases are in effective,2cases do not have effective, the total efficiency of treatment group is93.33%; In control group,5cases were cured,6cases have markedly effective,14cases are in effective,5cases do not have effective, the total efficiency of control group is83.33%. After statistical analysis, the treatment group is better than the control group (P=0.006<0.05) in terms of efficacy index. Main common of these symptoms and signs, such as insomnia, tired, exhausted, headache frequency and headache duration of improvement in the treatment group are better than the control group.
引文
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[1]张学昌.通窍活血汤加味治疗血管神经性头痛54例[J].实用中西医结合临床,2010.10(6)：49.
[2]郑诚东,蒋建章,刘梅仕.临床神经病学[M].哈尔滨：黑龙江科学技术出版社,2002.58：601.
[3]李金博,田琳,宋飞飞,孙涛,杨世忠.血管神经性头痛从肝论治[J].长春中医药大学学报,2008.24(1)：49.
[4]马蓉.芎芷头痛方治疗血管神经性头痛46例[J].实用中医药杂志,2010.26(10)：690.
[5]Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for Headache disorders,cranial neuralgias,and facial Pain[J].Second Edition.CePhalalnia,2004, 24(Suppll);1.
[6]于国华,赫素双.依那普利与血管神经性头痛[J].实用医技杂志,2006.13(1)：155.
[7]何建成,浦斌红.浅析血管神经性头痛的发病机理及滴鼻治疗[J].甘肃中医,2001.14(1)：9.
[8]高宙,胡疏,陈清,贾少微.血管神经性头痛患者脑血流灌注影像特点及临床研究[J].罕少疾病杂志,2010.17(6)：4.
[9]李知垠.血管神经性头痛的中医药治法研究进展[J].中医药信息,2006.23(5)：11.
[10]代伟、林忠嗣、单翠英.中医药治疗血管神经性头痛34例观察[J].实用中医内科杂志,2007.21(2)：79.
[11]牟艳杰,董少龙,吴鹏,邢俊娥.血管神经性头痛的中医治疗进展[J].广西中医药,2009.32(1)：1.
[12]樊小平.通络定痛汤治疗血管神经性头痛48例[J].江西中医药,2006.37(284)：25.
[13]张明,徐红.针刺夹脊穴治疗血管神经性头痛50例[J].中医外治杂志,2000.9(3)：19.
[14]范小明,胡兆春.枕大神经阻滞治疗慢性紧张型头痛的疗效观察[J].新医学,2007.38(4)：252-279.
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[17]高宙,胡疏,陈清,贾少微.血管神经性头痛患者脑血流灌注影像特点及临床研究[J].罕少疾病杂志,2010.17(6)：4.
[18]吴红丽,刘杰,姜英美,夏光辉.头痛宁汤治疗血管神经性头痛64例[J].中医杂志,2010.51(2)：175-176.
[2]郑诚东,蒋建章,刘梅仕.临床神经病学[M].哈尔滨：黑龙江科学技术出版社,2002.58：601.
[3]李金博,田琳,宋飞飞,孙涛,杨世忠.血管神经性头痛从肝论治[J].长春中医药大学学报,2008.24(1)：49.
[4]张明,徐红.针刺夹脊穴治疗血管神经性头痛50例[J].中医外治杂志,2000.9(3)：19.
[5]Headache Classification Committee of the International Headache Society. Classification and diagnostic criteria for Headachedisorders,cranial neuralgias,and facial Pain[J].Second Edition.CePhalalnia,2004,24(Suppll);1.
[6]李知垠.血管神经性头痛的中医药治法研究进展[J].中医药信息,2006.23(5)：11.
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