本文選題：腸易激綜合征 + 彌散傷害抑制性控制　； 參考：《廣州中醫(yī)藥大學(xué)》2016年碩士論文

【摘要】：目的：大量的研究表明腸易激綜合征(IBS)患者存在彌散性傷害性抑制性控制(DNIC)鎮(zhèn)痛效應(yīng)缺失,本研究旨在通過(guò)電針治療以腹痛為主癥的IBS,觀察遠(yuǎn)端或局部取穴對(duì)IBS的鎮(zhèn)痛效應(yīng),探討在DNIC機(jī)制缺失導(dǎo)致全身內(nèi)源性鎮(zhèn)痛效應(yīng)受損情況下,針刺鎮(zhèn)痛的臨床選穴規(guī)律。方法：該研究己獲得廣東省中醫(yī)院倫理委員會(huì)的批準(zhǔn)(倫理批件號(hào)：B2015-055-02),并在中國(guó)臨床試驗(yàn)注冊(cè)中心注冊(cè)登記(登記號(hào)：ChiCTR-IPR-15006879)。招募對(duì)象為廣東省中醫(yī)院門診以腹痛為主癥的IBS患者,所有的志愿者均已簽定知情同意書(shū)。本研究采用完全隨機(jī)對(duì)照方法,將23名受試者隨機(jī)分成四組：①局部穴位強(qiáng)刺激組(雙側(cè)天樞、外陵傷害性刺激)、②局部穴位弱刺激組(雙側(cè)天樞、外陵非傷害性刺激)、③遠(yuǎn)端穴位強(qiáng)刺激組(雙側(cè)足三里、上巨虛傷害性刺激)、④遠(yuǎn)端穴位弱刺激組(雙側(cè)足三里、上巨虛非傷害性刺激)。強(qiáng)刺激(傷害性刺激)：100%≤痛閾≤130%；弱刺激(非傷害性刺激)：50%≤痛閾≤80%。針刺深度為1-1.5寸,以得氣為宜,采取疏密波(2／100Hz),留針30min,療程為2-3次/周,每隔2-3天1次,7次為一個(gè)療程,共兩個(gè)療程。療效評(píng)價(jià)指標(biāo)：壓力痛閾(每次治療前后均采用痛閾測(cè)定儀Vonfrey測(cè)定3次,取平均值),腹痛和IBS-SSS評(píng)分(均在治療前、第一、二次療程結(jié)束后、治療后3個(gè)月測(cè)定)。結(jié)果：本試驗(yàn)預(yù)計(jì)招收40人,實(shí)際納入23人,年齡在21-50歲之間,病程約在2-11年之間。患者基線特征的可比性分析中,兩組年齡、病程、痛閾、腹痛分?jǐn)?shù)、IBS-SSS評(píng)分等經(jīng)分析均無(wú)統(tǒng)計(jì)學(xué)意義(p＞0.05),說(shuō)明兩組間的基線資料具有可比性。1)痛閾：組內(nèi)比較：局部穴位強(qiáng)刺激組和局部穴位弱刺激組在第一、二個(gè)療程結(jié)束后痛閾較治療前明顯升高(P0.05)；組間比較：局部選穴對(duì)痛閾的影響與遠(yuǎn)端選穴對(duì)比有明顯差異(P0.01)；2)腹痛評(píng)分：組內(nèi)比較：在第一、二個(gè)療程結(jié)束后,局部穴位強(qiáng)刺激組、局部穴位弱刺激組的腹痛評(píng)分較前明顯下降(P0.01)；治療結(jié)束后3個(gè)月,局部穴位強(qiáng)刺激組(P0.05)、局部穴位弱刺激組(P0.01)的腹痛評(píng)分較第二個(gè)療程結(jié)束后均明顯升高；組間比較：局部選穴對(duì)腹痛的影響與遠(yuǎn)端選穴對(duì)比有明顯差異(P0.01)；3) IBS-SSS評(píng)分：組內(nèi)比較：在第一、二個(gè)療程結(jié)束后,四組的IBS-SSS評(píng)分均較前明顯下降(p0.05)。結(jié)論：局部取穴無(wú)論是傷害性或非傷害性刺激對(duì)治療IBS腹痛均有良好的鎮(zhèn)痛效果,而遠(yuǎn)端取穴對(duì)IBS無(wú)明顯鎮(zhèn)痛效果,提示在DNIC缺失導(dǎo)致內(nèi)源性鎮(zhèn)痛系統(tǒng)受損情況下,針刺鎮(zhèn)痛宜以局部選穴為主。
[Abstract]:Objective: to investigate the analgesic effect of diffuse nociceptive inhibitory control (DNIC) in patients with irritable bowel syndrome (IBS) by electroacupuncture, and to observe the analgesic effect of distal or local acupoints on IBS. To explore the clinical selection rule of acupuncture analgesia under the condition that the absence of DNIC mechanism leads to the damage of systemic endogenous analgesia. Methods: the study has been approved by the Ethics Committee of Guangdong Provincial traditional Chinese Medicine Hospital (Ethics lot No.: B2015-055-02U) and registered with China Clinical trial Registration Center (10 ChiCTR-IPR-15006879). The subjects were IBS patients with abdominal pain in outpatient clinic of Guangdong traditional Chinese Medicine Hospital. All the volunteers had signed informed consent form. In this study, 23 subjects were randomly divided into four groups (bilateral Tianshu, Wuling nociceptive stimulation and weak stimulation group). Wuling non-nociceptive stimulation group (bilateral Zusanli group, Shangjuxu nociceptive stimulation group) (bilateral Zusanli group, Shangjuxu non-nociceptive stimulation group). Strong stimulation (nociceptive stimulus 100% 鈮，

本文編號(hào)：1986749