定痛温经汤联合温针灸对原发性痛经寒凝血瘀证的临床疗效

目的探讨定痛温经汤联合温针灸治疗原发性痛经寒凝血瘀证临床疗效及对子宫动脉血流动力学、血清内啡肽、疼痛介质的影响。方法选取2018年6月—2019年8月于大连市妇产医院门诊收治的原发性痛经寒凝血瘀证患者120例,随机分为治疗组及对照组,各60例;对照组给予温经汤治疗,治疗组给予温经汤联合温针灸治疗,两组患者均治疗3个月经周;比较两组患者临床疗效及治疗前后痛经积分、子宫动脉搏动指数(API)、阻力指数(RI)、收缩期峰值/舒张期峰值(S/D)、血清α-内啡肽(α-EP)、β-内啡肽(β-EP)及疼痛相关介质P物质(SP)、多巴胺(DA)、五羟色胺(5-HT)含量。结果两组患者治疗后痛经症状积分明显降低,与治疗前比较,差异有统计学意义(P<0.05);且治疗组降低程度更为明显,差异有统计学意义(P<0.05)。治疗后治疗组总有效率93.33%,对照组总有效率88.33%,治疗组疗效优于对照组,差异有统计学意义(P<0.05)。治疗后两组患者子宫API、RI及S/D值较治疗前均降低,差异有统计学意义(P<0.05),且治疗组低于对照组(P<0.05)。治疗后两组血浆SP、DA及5-HT含量均较治疗前降低(P<0.05),且治疗组降低幅度优于对照组(P<0.05)。治疗后两组血清0x09α-EP及β-EP含量升高与治疗前比较,差异有统计学意义(P<0.05),且治疗组升高幅度优于对照组(P<0.05)。结论定痛温经汤联合温针灸对原发性痛经寒凝血瘀证临床疗效显著,其机制可能与改善子宫血流动力学、降低患者外周血疼痛相关介质,升高内源性阿片肽含量有关。

Clinical effect of Dingtong Wenjing Decoction with warming needle moxibustion on primary dysmenorrhea in cold coagulation blood stasis syndrome and its effect on uterine arterial blood flow mechanics,serum endorphins and pain mediators

Objective To investigate the clinical effect of Dingtong Wenjing Decoction combined with warming needle moxibustion in treating primary dysmenorrhea differentiated by cold coagulation blood stasis syndrome and its effect on uterine arterial blood flow mechanics,serum endorphins and pain mediators.Methods A total of 120 patients with primary dysmenorrhea differentiated by cold coagulation blood stasis syndrome were randomly divided into the combination group and the drug group,with 60 cases in each group.The drug group was treated with Dingtong Wenjing Decoction,while the combination group was treated with Dingtong Wenjing Decoction and warming needle moxibustion.Patients in both groups were treated for 3 menstrual weeks.The clinical efficacy,dysmenorrhea score,uterine artery pulsation index(API),resistance index(RI),systolic peak/diastolic peak(S/D),serumα-endorphin(α-EP),β-endorphin(β-EP),substance P(SP),dopamine(DA)and serotonin(5-HT)content were compared between the two groups before and after treatment.Results After treatment,dysmenorrhea score in both groups decreased compared with that before treatment,with statistical significance(P<0.05),and the combination group had a greater improvement,with statistical significance(P<0.05).The total effective rate was 93.33%in the combination group,which was significantly higher than that(88.33%)in the drug group,with statistical significance(P<0.05).After treatment,API,RI and S/D levels in both groups decreased,with statistical significance(P<0.05),and the combination group was lower than the drug group(P<0.05).After treatment,serum SP,DA and 5-HT levels decreased compared with those before treatment(P<0.05),and the combination group was lower than the drug group(P<0.05).After treatment,serumα-EP andβ-EP levels increased compared with those before treatment,with statistical significance(P<0.05),and the combination group was higher than the drug group(P<0.05).Conclusion Dingtong Wenjing Decoction combined with warming needle moxibustion has a significant effect in treating primary dysmenorrhea cold congeal and blood stasis syndrome.The mechanism may be related to improving uterine hemodynamics,reducing peripheral blood pain-related mediators in patients,and increasing endogenous opioid peptide content.