穴位按压治疗血管性痴呆患者躯体疼痛的临床疗效

目的:评价穴位按压治疗血管性痴呆患者躯体疼痛的临床疗效。方法:选取2011—2015年于北京中医医院针灸科治疗的血管性痴呆伴随躯体疼痛患者60例,随机分为穴位按压组和药物组,每组30例,穴位按压组中患者每日接受家庭护理人员按压局部阿是穴,30 min/次。药物组中患者每日按需口服布洛芬缓释胶囊,均接受12周治疗。主要评价指标是修订版面部表情疼痛量表(Faces Pain Scale-Revised,FPS-R)和中文版晚期老年痴呆症疼痛评估量表(Chinese Pain Assessment in Advanced Dementia Scale,C-PAINAD),次要评价指标是日常生活能力量表(Barthel Index)和不良反应。结果:2组FPS-R与C-PAINAD评分均在12周后显著降低。在第1、2周时,穴位按压组疼痛评分高于药物组(P0.05),在第4、6、8、10、12周时穴位按压组疼痛评分低于药物组(P0.05)。2组日常生活能力量表评分均在12周后升高。其中,第1、6、8、10、12周时穴位按压组评分高于药物组(P0.05)。药物组中2例患者存在轻度的胃肠道症状,穴位按压组中未发生不良事件。结论:布洛芬缓释胶囊在前2周治疗期间能够更快地减轻血管性痴呆患者的躯体疼痛,而穴位按压的止痛效果在接下来的10周更为有效,并且这种治法安全、更容易被护理人员接受。2组治疗均可以提高患者的生命质量。

Acupressure for Relieving Body Pain in Patients with Vascular Dementia

To assess the effectiveness of acupressure for treating body pain in patients suffering from vascular dementia. Methods:In this randomized controlled study, 60 patients with vascular dementia also suffered from musculoskeletal pain in any part of the body were recruited from the Department of Acupuncture and Moxibustion of Beijing Traditional Chinese Medicine Hospital from 2011 to 2015. Participants were randomly allocated to the acupressure alone or medication group to receive daily local AShi point acupressure for 30 minutes or to receive p.r.n Ibuprofen sustained release capsule, respectively. Either treatment was provided daily for 12 weeks. The primary outcome measures included the changes of the scores of Faces Pain Scale-Revised (FPS-R) and Chinese Pain Assessment in Advanced Dementia Scale (C-PAINAD). The secondary outcome measures were Barthel Index and adverse effects. Results:The two groups were comparable at baseline in their demographic data as well as their severity of pain and dementia. Compared with pre-treatment, the scores of FPS-R and C-PAINAD in two groups were significantly decreased after the treatment. The two groups differed in their pain reduction with pain scores in the acupressure group being significantly higher than those in the medication group in the 1st and 2nd treatment week (P<0.01), then significantly lower than those in the medication group in the 4th, 6th, 8th, 10th and 12th treatment week (P<0.01). Similarity, the Barthel Index increased in both groups over time with the scores in the acupressure group being statistically significantly higher than that in the medication group in the 1st, 6th, 8th, 10th and 12th treatment week (P<0.01). Two patients with gastrointestinal symptoms were observed in the medication group. No adverse event was reported in the acupressure group. Conclusion:Ibuprofen sustained release capsule relieved pain more quickly in the first two weeks. The analgesia of acupressure is more effective within the following 10 weeks, and acupressure is safe and can be easily accepted by family carers. Quality of life in those patients improves in both groups as pain reduced.