不同治疗顺序的电针联合重复经颅磁刺激治疗偏头痛的临床疗效研究OACSTPCD
Clinical efficacy of electroacupuncture combined with repeated transcranial magnetic stimulation in the treatment of threatened migraine with different treatment sequences
目的:比较不同治疗顺序的电针联合重复经颅磁刺激(rTMS)治疗偏头痛的疗效.方法:选取2022年8月～2023年9月于宜宾市第二人民医院康复医学科就诊的偏头痛患者96例为研究对象,采用随机数字表法分为先电后磁组、先磁后电组、电磁同步组3组,每组各32例.3组分别脱落2例、3例、1例,最终分别为30例、29例、31例.3组均接受常规治疗(药物治疗及卫生宣教),在此基础上,先电后磁组先进行电针治疗,间隔10min后进行rTMS治疗;先磁后电组先进行rTMS治疗,间隔10min后进行电针治疗;电磁同步组同步进行rTMS和电针治疗.电针和rTMS均为20min/次,1次/日,5次/周,3组均治疗4周.在治疗前、治疗1周、2周、4周后采用视觉模拟评分法(VAS)评估3组患者的疼痛程度.在治疗前和治疗4周后采用偏头痛特异性生活质量表(MSQ)评估生活质量,同时检测血中P物质(SP)、5-羟色胺(5-HT)水平;并采用经颅多普勒超声检测仪检测3组患者双侧大脑前动脉、大脑后动脉、大脑中动脉的平均血流速度.结果:治疗方法与时间对VAS评分存在交互作用(P＜0.05),且电磁同步组在治疗2周、4周后的VAS评分均低于其余2组(均P＜0.05);在治疗4周后,电磁同步组SP均低于其余2组(均P＜0.05),5-HT均高于其余2组(均P＜0.05),MSQ评分低于先磁后电组(P＜0.05),与先电后磁组比较差异无统计学意义;治疗4周后,电磁同步组大脑前动脉、大脑后动脉、大脑中动脉的血流速度低于其余2组(均P＜0.05).结论:不同治疗顺序的电针联合rTMS治疗偏头痛疗效具有差异,同步治疗的效果可能优于先电后磁方案和先磁后电方案.
Objective:To compare the therapeutic effects of electroacupuncture combined with repeated transcranial magnetic stimulation in the treatment of migraine with aura in different treatment sequences.Methods:A total of 96 migraine patients who visited the Department of Rehabilitation Medicine of our hospital from August 2022 to Sep-tember 2023 were selected as the research subjects.They were randomly divided into 3 groups using a random num-ber table method:the electric magnetic group,the magnetic electric group,and the synchronous group.All 3 groups received routine treatment,with the electroacupuncture group receiving electroacupuncture treatment first and the magnetic group receiving rTMS treatment after a 10 min interval;The group treated with rTMS first,fol-lowed by electroacupuncture after a 10 min interval;The synchronous group received rTMS and electroacupuncture treatment simultaneously,and all 3 groups were treated for 4 weeks.The patients in all groups were evaluated for pain severity using visual analog scale(VAS)before treatment,1 week,2 weeks,and 4 weeks after treatment.The migraine specific quality of life questionnaire(MSQ)was evaluated before and after 4 weeks of treatment.The sub-stance P(SP)and serotonin(5-HT)levels were detected.The transcranial Doppler ultrasound was used to detect the average blood flow velocity of the bilateral anterior cerebral artery,posterior cerebral artery,and middle cerebral artery in 3 groups.Results:There was an interaction between treatment method and time in VAS(P＜0.05),and the VAS scores in the synchronous group were significantly lower than those in the rest two groups at 2nd and 4th week of treatment(P＜0.05).After 4 weeks of treat-ment,the synchronous group had lower SP and higher 5-HT level than the rest;lower MSQ than the magnetic electric group(P＜0.05),and no significant difference from the electric magnetic group.After 4 weeks of treatment,the flow velocity of the anterior cerebral ar-tery,posterior cerebral artery,and middle cerebral ar-tery in the synchronous group was significantly lower than the rest two groups(P＜0.05).Conclusion:In clinical studies of electroacupuncture combined with repeated transcranial magnetic stimulation in the treatment of migraine with aura in different treatment sequences,synchronous treatment has the best effect,followed by the electric mag-netic scheme,and finally the magnetic electric scheme.
闻自强;熊荣飞;王寿强;熊德启;李敏
宜宾市第二人民医院康复医学科,四川宜宾 644000
临床医学
重复经颅磁刺激电针偏头痛
repetitive transcranial magnetic stimulationelectroacupuncturemigraine
《中国康复》 2024 (007)
406-410 / 5
康复医学四川省重点实验室开放课题(KFFYXSZDSYS-05);宜宾市科技局课题(2021SF012);宜宾市第二人民医院院级课题(2021FY11)
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