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背景:紧张性头痛指双侧枕颈部或全头部的紧缩性或压迫性头痛,其发病机制尚未完全明了,可与多种因素有关,常规治疗是药物对症疗法,但疗效不一,特别是慢性患者,长期服药引起副作用。目的:探讨口腔负压对紧张性头痛患者的治疗效果及其微循环障碍改善机制。设计:病例-对照观察。单位:河北北方学院病理生理教研室。对象:于2001-12/2002-06河北北方学院附属第一医院神经内科收治紧张性头痛患者20例,男8例,女12例;年龄18～28岁,平均23.4岁;病程1～6年。随机分为治疗组和对照组,各10例。方法:应用口腔负压仪,将负压施加器放入口腔的最适位置,调节负压维持在(0.05±0.01)MPa。治疗时间10min/次(首次应用治疗5min),1次/d,时间固定,5d为1个疗程,共3个疗程。对照组同样口含负压施加器10min/次,但不给负压。①疗效判断标准:采用目测类比评分法进行疼痛量化评估,显效:视觉模拟评分下降>70%,有效:下降30%～70%,无效:下降<30%。②甲襞微循环观察与评价:应用XTL-Ⅱ型微循环显微电视系统进行甲襞微循环观察,放大260倍,常规检查左手无名指甲襞第一排管袢,记录微血管形态、微血流状态和袢周状态,按田牛等加权积分法对微循环障碍程度进行定量分析。主要观察指标:治疗3个疗程后的治疗效果,甲襞微循环观察结果。结果:纳入患者20例,均进入结果分析。①治疗效果:目测类比评分下降>70%治疗组7例(70%),对照组0例;目测类比评分下降30%～70%治疗组2例(20%),对照组1例(10%);目测类比评分下降<30%治疗组1例(10%),对照组9例(90%)。②治疗前后甲襞微循环观察表明,负压使微循环障碍明显改善,由治疗前的中度异常恢复到大致正常,总积分值由4.18±0.68降低至1.97±0.41(P<0.01)。结论:口腔负压对紧张性头痛患者具有明显的治疗效果,其机制可能与改善微循环及调整神经功能紊乱有关。
Background: Tension headache refers to the neck or head of both sides of the occipital or head compression or pressure headache, the pathogenesis has not yet fully understood, with a variety of factors, conventional treatment is drug symptomatic therapy, but with different effects, especially Chronic patients, long-term medication side effects. Objective: To investigate the therapeutic effect of oral negative pressure on patients with tension-induced headache and the improvement mechanism of microcirculation disturbance. Design: Case-control observation. Unit: Hebei North University Department of Pathophysiology. PARTICIPANTS: Twenty patients with tension-induced headache were admitted to the First Affiliated Hospital of Hebei North University from December 2001 to June 2002. There were 8 males and 12 females, aged from 18 to 28 years, with an average of 23.4 years. The course of disease ranged from 1 to 6 years . Randomly divided into treatment group and control group, 10 cases each. Methods: Using oral negative pressure meter, the negative pressure applicator was placed in the optimum position of oral cavity, and the negative pressure was maintained at (0.05 ± 0.01) MPa. Treatment time 10min / times (the first application of treatment 5min), 1 time / d, time fixed, 5d for a course of treatment, a total of 3 courses. The same control mouth oral negative pressure applicator 10min / time, but not to negative pressure. ① Criteria for judging therapeutic effect: Quantitative assessment of pain using visual analogue scale was effective. Visual analogue scale decreased by> 70%, effective: decreased by 30% -70%, invalid: decreased by <30%. The observation and evaluation of nailfold microcirculation: Using XTL-Ⅱmicro-microcirculation microsurgical system to observe the microcirculation of nailfolds, magnifying 260 times, routinely examining the first row of tubes of the left hand fingernails, recording the morphology of microvessels, State and Zhou Zhou state, according to the cattle and other weighted integral method for quantitative analysis of the degree of microcirculation. MAIN OUTCOME MEASURES: Therapeutic effect after 3 courses of treatment, observation results of nailfold microcirculation. Results: Twenty patients were included in the analysis of the results. ① Therapeutic effect: visual analogue scale decreased by 70% in 7 cases (70%) in treatment group and 0 case in control group; visual analogue scale decreased by 30% -70% in treatment group (2%) and control group (10% ); The visual analogue scale decreased <30% in the treatment group, 1 case (10%), and in the control group, 9 cases (90%). (2) The observation of nailfold microcirculation before and after treatment showed that negative pressure improved the microcirculation barrier significantly, and returned to the normal range from the moderate before treatment, the total score decreased from 4.18 ± 0.68 to 1.97 ± 0.41 (P <0.01). Conclusion: Oral negative pressure has obvious therapeutic effect on patients with tension-induced headache. The mechanism may be related to improving microcirculation and regulating neurological disorders.