基于自主神经功能的不同选穴原则对无先兆性偏头痛患者针刺干预的随机对照研究

目的:基于自主神经功能探讨不同选穴原则干预无先兆性偏头痛患者的治疗效果。方法:2016年11月至2018年6月收集浙江中医药大学附属第三医院针灸科符合纳入标准的偏头痛患者84例,随机分为自主神经组41例(脱失1例)和常规治疗组40例(脱失2例),治疗频率为3次/周,均治疗2周,8周后回访。缓解期检测心率变异性特征,包括频域指标和时域指标,于发作期、首次治疗后及疗程结束3个时点同时进行心率变异性特征检测和简式McGill疼痛评分,治疗8周后回访时再次进行简式McGill疼痛评分,且全程对安全性指标进行检测。结果:两组患者缓解期时心率变异特征、治疗后各时间段频域指标无显著差异。时域指标中,与本组发作时比较,首次治疗后两组患者的24h全部正常N~N间期标准差(SDNN)均有显著差异(P<0.05),自主神经组首次治疗后与发作时比较,24h全部正常N~N间期每5min平均值的标准差(SDANN)也有显著差异(P<0.05)。治疗8周后回访时,自主神经组McGill量表中感觉项、VAS项评分均显著低于常规治疗组(P<0.01,P<0.05),两组8周随访时的总有效率分别是85.4%和80.0%,且均未发生严重不良事件。结论:针刺对偏头痛患者有即时和远期的疗效,常规取穴和自主神经取穴均可使交感神经活性增强,针对自主神经功能取穴具有一定的优势,对临床针刺治疗无先兆性偏头痛如何选穴具有一定的参考价值。

Randomized controlled study of different acupoints selection principles based on autonomic nerve function in patients with migraine without aura

Objective:To explore the therapeutic effects of different acupoints selection principles in patients with migraine without aura and to elucidate the role of autonomic dysfunction in migraine.Methods:Patients with migraine without aura who met the inclusion criteria from Acupuncture and Moxibustion Department,The Third Affiliated Hospital of Zhejiang Chinese Medical University in November 2016 to June 2018 were randomly assigned to the autonomic(40 cases with 2 cases dropout)and conventional acupoint groups(41 cases with 1 case dropout)after informed consent.The frequency of treatment was 3 times/week,both were treated for 2 weeks,and follow-up at 8 weeks after treatment.The heart rate variability characteristics were detected during the remission period,including the frequency domain index and the time domain index.The heart rate variability characteristic test and the simple McGill pain score were simultaneously performed at the three points of the attack period,the first treatment,and the end of the treatment period.The simplified McGill pain score was performed again in the follow-up visit and the safety indicators were tested throughout.Results:There was no significant difference in heart rate variability between the two groups during remission.And there was also no significant difference in frequency domain indicators after treatment.While in the domain index time,compared with the onset,the normal N-N interval standard deviation(SDNN)of the two groups was statistically different at 24 h(P<0.05).After the first treatment in the autonomic nerve group,compared with the onset,there was also a statistical difference in the standard deviation(SDANN)of the mean value per 5 min of the N-phase(P<0.05).In the McGill scale scores of the two groups,the autonomic nerve group had multiple scores significantly lower than the conventional acupoint group(P<0.01,P<0.05).In addition,the total effective rate at 8 weeks was 85.4%and 80.0%,respectively,and no serious adverse events occurred.Conclusion:Acupuncture has immediate and long-term effects on migraine patients.Both conventional acupoints and autonomic acupoints enhance sympathetic activity.Acupoints for autonomic nerve function have certain advantages,and it has certain reference value how to choose the acupoints between the clinical treatment of migraine.