针刺结合百会压灸治疗椎动脉型颈椎病的疗效观察

发布时间：2018-03-14 09:43

本文选题：椎动脉型颈椎病　切入点：针刺　出处：《广州中医药大学》2017年博士论文　论文类型：学位论文

【摘要】：目的:本临床实验根据随机对照的科研设计原则将90名受试者分为针刺结合压灸组、单纯针刺组、压灸组进行比较研究。应用颈性眩晕症状与功能评估量表、经颅多普勒(TCD)检查、颈椎X线检查、WHO生存质量测定量表(WHOQOL-BREF)分别在治疗前后对受试者进行评分,对数据进行统计分析,探讨针刺结合压灸法、单纯针刺、药物治疗椎动脉型颈椎病的效果对比,阐明针刺结合百会压灸治疗椎动脉型颈椎病的临床意义。方法:本研究的96名椎动脉型颈椎病患者病例来源为台湾中医诊所。按完全随机1:1:1的比例分为三组:针刺结合压灸组、单纯针刺组、药物组,每组32例。西医诊断标准参照《第三届全国颈椎病专题座谈会纪要》关于椎动脉型颈椎病的西医诊断标准,中医辨证分型标准参照中国中医药管理局《中医病证诊断疗效标准》制定的椎动脉型颈椎病的中医证候诊断标准,将椎动脉型颈椎病分为以下五个证型:肝阳上扰型、瘀血内阻型、痰浊阻窍型、肝肾阴虚型、气血亏虚型。针刺结合压灸组的针刺主穴为病变椎体夹脊穴、风池(双),百会穴行压灸法,留针30分钟,间断性行针2-3次。疗效观察具体项目包括:《颈性眩晕症状与功能评估量表》、WHO生存质量测定量表(WHOQOL-BREF)、颅内椎—基底动脉的收缩期峰值血流速度(Vp)及舒张末期峰值血流速度(Vd)。关于椎动脉型颈椎病的疗效评定标准参照2002年颁发《中药新药临床研究指导原则》中有关颈椎病疗效评定标准进行修改制定。结果:治疗前,针刺结合百会压灸组、单纯针刺组、药物组在性别、年龄、病程、中医辨证分型、颈性眩晕症状与功能评估量表、WHO生存质量测定量表、椎—基底动脉的收缩期峰值血流速度(Vp)及舒张末期峰值血流速度(Vd)差异经分析均无统计学意义,说明三组的一般基线资料具有可比性。1.颈性眩晕症状与功能评估量表①眩晕指标得分比较经过三周的治疗后,针刺结合百会压灸组、单纯针刺组、药物组的眩晕症状均有不同程度的好转,且针刺结合百会压灸疗法的临床疗效比单纯针刺、药物治疗明显。远期疗效方面,针刺结合百会压灸、单纯针刺更有优势,且针刺结合百会压灸组的远期疗效要优于药物组。②颈肩痛指标得分比较治疗三周后,针刺结合百会压灸组、单纯针刺组的颈肩疼痛评分与药物组进行两两比较,差异有统计学意义(P0.05)。随访调查时,三组的颈肩疼痛评分组间差异不明显(P0.05)。三周治疗结束后,针刺结合百会压灸、单纯针刺可缓解椎动脉型颈椎病患者的颈肩疼痛症状,而药物治疗对于改善患者的颈肩疼痛症状无疗效。随访数据表明,三种不同疗法对于改善椎动脉型颈椎病患者的颈肩疼痛症状,在时效性方面均未能获得良好的远期效果。③头痛指标得分比较三周的治疗后,单纯针刺组、药物治疗组的头痛评分进行组间比较无统计学意义(P0.05)。治疗三周后,针刺结合百会压灸、单纯针刺组、药物治疗均可改善椎动脉型颈椎病的头痛症状,但三种疗法的临床疗效差异不明显。在疗效时间维持方面,针刺结合百会压灸对于缓解椎动脉型颈椎病的头痛症状,与单纯针刺、药物治疗相比较,可获得较好的远期疗效。④日常生活及工作得分比较治疗三周后,针刺结合百会压灸组、单纯针刺组的日常生活及工作评分与药物组比较具有统计学意义(P0.05)。随访时,针刺结合百会压灸组的日常生活及工作评分与药物治疗相比较,差异有统计学意义(P0.05)。治疗三周后,针刺结合百会压灸、单纯针刺组、药物治疗对于椎动脉型颈椎病患者的日常生活及工作均有良好的促进作用,但三种疗法的疗效差异不明显。对于改善椎动脉型颈椎病患者的日常生活及工作方面,针刺结合百会压灸的疗效要优于药物治疗。⑤心理及社会适应得分比较组内比较:无论是治疗后,还是随访时,三组椎动脉型颈椎病患者的心理及社会适应评分,与治疗前相比较均有不同程度的改善,差异有统计学意义(P0.05)。组间比较:治疗三周后,针刺结合百会压灸组的心理及社会适应评分与单纯针刺组、药物组比较均具有统计学意义(P0.05)。随访时,三组的组间差异无统计学意义(P0.05)。2.WHO生存质量测定量表比较经过三周的治疗后,针刺结合百会压灸组的WHO生存质量测定量表评分与单纯针刺组、药物组比较均有统计学意义(P0.05)。随访时,针刺结合百会压灸组的WHO生存质量测定量表评分与药物组比较有统计学意义(P0.05)。治疗三周后,三种不同疗法均可改善椎动脉型颈椎病患者的WHO生存质量测定量表评分,且针刺结合百会压灸要优于单纯针刺、药物治疗。在远期疗效方面,药物组与针刺结合百会压灸组、单纯针刺组相比不甚理想。3.椎—基底动脉的收缩期峰值血流速度(Vp)及舒张末期峰值血流速度(Vd)比较三周治疗后,针刺结合百会压灸、单纯针刺、药物治疗均能升高椎动脉型颈椎病患者异常降低的椎—基底动脉收缩期峰值血流速度(Vp),与治疗前比较均有统计学意义(P0.05)。随访时:三组的椎—基底动脉收缩期峰值血流速度(Vp)与治疗前相比较差异不明显(P0.05)。组间比较:无论是三周的治疗结束后,还是随访调查时,三组椎—基底动脉收缩期峰值血流速度(Vp)进行组间两两比较均无统计学意义(P0.05)。治疗后,针刺结合百会压灸组、单纯针刺组、药物治疗组椎动脉型颈椎病患者的椎—基底动脉舒张末期峰值血流速度(Vd)与治疗前比较均无统计学差异(P0.05)。随访时:三组的椎—基底动脉舒张末期峰值血流速度(Vd)与治疗前相比较差异不明显(P0.05)。无论是三周的治疗结束后,还是随访调查时,三组椎—基底动脉舒张末期峰值血流速度(Vd)组间差异不明显(P0.05)。4.总体疗效评价由统计结果可知,三组治疗后颈椎病总体疗效对比有统计学差异(P0.05),针刺结合百会压灸组的临床治愈率为12.9%;显效率为38.7%;有效率为35.5%;无效率为12.9%;总有效率为87.1%。单纯针刺组的临床治愈率为9.7%;显效率为29.0%;有效率为32.3%;无效率为29.0%;总有效率为71.0%。药物组的临床治愈率为6.7%;显效率为26.7%;有效率为33.3%;无效率为33.3%;总有效率为66.7%。以上数据表明,针刺结合百会压灸治疗椎动脉型颈椎病临床疗效显著,可较好地改善椎动脉型颈椎病患者头晕症状,促进颈部功能的恢复,其临床疗效要好于单纯针刺治疗和口服甲磺酸倍他司汀治疗。结论:由以上研究数据可得知如下结论:①对于改善颈性眩晕症状与功能评估量表方面,针刺结合百会压灸可较好地缓解椎动脉型颈椎病的眩晕、颈肩痛、头痛症状,针刺结合百会压灸疗法的临床疗效比单纯针刺、药物治疗明显。关于眩晕的远期疗效对比方面,针刺结合百会压灸、单纯针刺更有优势,且针刺结合百会压灸组的远期疗效要优于药物组。但随访数据表明,三种不同疗法对于改善椎动脉型颈椎病患者的颈肩疼痛症状,在时效性方面均未能获得良好的远期效果。此外,治疗三周后,针刺结合百会压灸、单纯针刺组、药物治疗对于椎动脉型颈椎病患者的日常生活及工作均有良好的促进作用,但三种疗法的疗效差异不明显。对于改善椎动脉型颈椎病患者的日常生活及工作方面,针刺结合百会压灸的疗效要优于药物治疗。②关于WHO生存质量测定量表方面,治疗三周后,三种不同疗法均可改善椎动脉型颈椎病患者的WHO生存质量测定量表评分,且针刺结合百会压灸要优于单纯针刺、药物治疗。在远期疗效方面,药物组与针刺结合百会压灸组、单纯针刺组相比不甚理想。③椎动脉型颈椎病TCD观察指标方面,三周治疗后,针刺结合百会压灸、单纯针刺、药物治疗均能升高椎动脉型颈椎病患者异常降低的椎—基底动脉收缩期峰值血流速度(Vp)。但远期疗效对比方面,三组的椎—基底动脉收缩期峰值血流速度(Vp)与治疗前相比较差异不明显。针刺结合百会压灸组、单纯针刺组、药物治疗组对于改善椎动脉型颈椎病患者的椎—基底动脉舒张末期峰值血流速度(Vd)无明显作用。
[Abstract]:Objective: This clinical experiment research according to the design principles of randomized 90 subjects were divided into acupuncture combined with compressive moxibustion group, acupuncture group, moxibustion group pressure were compared. The application of cervical vertigo symptoms and functional assessment scale, transcranial Doppler (TCD) examination, X-ray examination of cervical spine, scale to determine the quality of life of WHO (WHOQOL-BREF) was assessed on the subjects before and after treatment, statistical analysis of data, to explore the effects of acupuncture and moxibustion pressure, acupuncture, contrast agents for the treatment of vertebral artery type of cervical spondylosis, elucidate the clinical significance of acupuncture Baihui pressure moxibustion treatment of vertebral artery type of cervical spondylosis. Methods: the study of 96 cases artery type of cervical spondylosis patients from Taiwan Chinese medicine clinic. The ratio of 1:1:1 were randomly divided into three groups: acupuncture combined with compressive moxibustion group, acupuncture group, drug group, 32 cases in each group. The diagnostic standard of Western medicine according to < Third National neck Vertebral disease symposium summary > diagnostic criteria of Western Medicine on vertebral artery type of cervical spondylosis, TCM syndrome differentiation standard reference Chinese administration of traditional Chinese medicine "of TCM syndrome diagnosis and treatment standard > the cervical spondylosis of vertebral artery type of TCM syndrome diagnosis standard, the vertebral artery type of cervical spondylosis is divided into the following five types liver Yang on the disturbance type, blood stasis, phlegm, yin deficiency of liver and kidney, deficiency of Qi and blood type. Acupuncture combined with acupuncture moxibustion group as the main point of pressure vertebral body Jiaji, Baihui, Fengchi (double) line pressing moxibustion, intermittent needle needle for 30 minutes, 2-3 times. To observe the curative effect of specific projects include:" cervical vertigo symptoms and functional assessment scale >, scale to determine the quality of life of WHO (WHOQOL-BREF), peak systolic velocity of intracranial vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd). The criteria for evaluation of curative effect on vertebral artery type of cervical spondylosis with reference to 200 2 years by the "Chinese medicine clinical research guiding principles > about cervical spondylosis therapeutic effect evaluation standard of modified formulation. Results: before treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug group in gender, age, course of disease, TCM syndrome, cervical vertigo symptoms and function assessment scale. Determination of the quality of life of WHO, the peak systolic velocity of vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd) by analyzing the differences were not statistically significant, indicating the general baseline data of three groups have comparable evaluation of cervical vertigo symptoms and.1. function scale of index scores after the three treatment of vertigo the week after acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug group the vertigo symptoms were improved in varying degrees, and the clinical curative effect of combined acupuncture and moxibustion Baihui pressure than simple acupuncture treatment, the long-term effect is obvious. Acupuncture combined with moxibustion, acupuncture Baihui pressure, more advantages, and the long-term curative effect of acupuncture combined with moxibustion Baihui pressure group than the drug group. The neck pain index scores were compared after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure group, neck and shoulder pain scores and the drug group compared 22 acupuncture group, the difference was statistically significant (P0.05). The follow-up survey, neck and shoulder pain scores between the three groups no significant difference (P0.05). After three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture can relieve the patients with vertebral artery type of cervical spondylosis neck and shoulder pain, and drug treatment has no effect for improving patients with neck and shoulder pain symptoms. Follow up data show that the three kinds of therapy for patients with vertebral artery type of cervical spondylosis neck and shoulder pain, on the other hand have failed to obtain a good long-term effect. The treatment of headache index scores were compared after three weeks of pure needle Acupuncture group, headache drug treatment group scores were compared between the groups was not statistically significant (P0.05). After three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture group, drug therapy can improve the vertebral artery type of cervical spondylosis headache symptoms, but the clinical curative effect of three treatments was not obvious in time. Maintain curative effect acupuncture combined with Moxibustion on Baihui, alleviate the pressure of vertebral artery type of cervical spondylosis headache symptoms, and acupuncture and drug treatment compared, can obtain better long-term effect. The daily life and work scores were compared after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group work and daily life score and drug group compared with statistical significance (P0.05). During follow-up, acupuncture combined with daily life and work pressure score and drug treatment compared to Baihui moxibustion group, the difference was statistically significant (P0.05). After three weeks of treatment, acupuncture Baihui pressure Moxibustion, acupuncture group, drug treatment to promote the role of daily life and work of patients with vertebral artery type of cervical spondylosis is good, but the effect is not obvious difference between the three kinds of therapy. To improve the daily life and work of patients with vertebral artery type of cervical spondylosis, drug treatment is superior to the curative effect of acupuncture combined with moxibustion Baihui pressure. 5. Psychological and social adaptation score comparison group comparison: both after treatment or follow-up, psychological and social three groups of patients with cervical spondylosis of vertebral artery type adaptation score, compared with before treatment were improved, the difference was statistically significant (P0.05). Comparison between groups: after three weeks of treatment with acupuncture psychological and social pressure to score Baihui moxibustion group and acupuncture group, drug group were statistically significant (P0.05). During follow-up, there was no significant difference among the three subgroups (P0.05) scale was used to measure the quality of life of.2.WHO Compared with after three weeks of treatment, the determination of scale and the acupuncture group with acupuncture Baihui WHO quality of life pressure moxibustion group, drug group were statistically significant (P0.05). During follow-up, determination of scale and the medication group was statistically significant compared with acupuncture Baihui WHO pressure moxibustion group's quality of life (P0.05). After three weeks of treatment, the determination of scores of three different therapies can improve patients with vertebral artery type of cervical spondylosis WHO quality of life, and the acupuncture combined with compressive moxibustion on Baihui is superior to acupuncture and drug treatment. In the long-term effect, drug group and acupuncture combined with moxibustion Baihui pressure group compared with the acupuncture group is not ideal the peak systolic velocity.3. of vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd) three weeks after treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture, drug treatment significantly increased the vertebral artery type of cervical spondylosis patients with different Often lower basilar artery peak systolic velocity (Vp), compared with before treatment were statistically significant (P0.05). Follow up: three groups of vertebrobasilar artery peak systolic velocity (Vp) compared with before treatment, no significant difference (P0.05). Comparison between groups: whether it is the end of treatment three after a week, or the follow-up survey, three groups of vertebrobasilar artery peak systolic velocity (Vp) were compared between the 22 groups had no statistical significance (P0.05). After the treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug treatment of patients with vertebral artery type of cervical spondylosis group of vertebrobasilar artery diastolic at the end of peak flow velocity (Vd) before and after treatment were no statistically significant difference (P0.05). Follow up: three groups of vertebrobasilar artery diastolic peak flow velocity (Vd) compared with before treatment, no significant difference (P0.05). It is the end of three weeks of treatment, but also Is the follow-up survey, three groups of vertebrobasilar artery diastolic peak flow velocity (Vd) there was no significant difference between groups (P0.05.4.) to evaluate the overall curative effect from the statistical results, the three groups after treatment compared with the overall curative effect of cervical spondylosis had statistically significant difference (P0.05), the clinical cure rate was 12.9% with acupuncture and moxibustion Baihui pressure; the effective rate was 38.7%; the effective rate was 35.5%; no efficiency was 12.9%; the total efficiency of clinical 87.1%. acupuncture group the cure rate was 9.7%; the effective rate was 29%; the effective rate was 32.3%; no efficiency 29%; total clinical efficiency of 71.0%. medicine group the cure rate was 6.7%; significant efficiency 26.7%; efficiency was 33.3%; no efficiency was 33.3%; the total effective rate was 66.7%. the above data shows that the curative effect of combined acupuncture Baihui pressure moxibustion in the treatment of vertebral artery type of cervical spondylosis, can effectively improve the symptoms of dizziness in patients with vertebral artery type of cervical spondylosis, promote functional recovery of the neck. The clinical curative effect is better than simple acupuncture and oral betahistine mesylate treatment. Conclusion: according to the above research data can be informed of the following conclusions: firstly, to improve the cervical vertigo symptoms and functional assessment scale, acupuncture and moxibustion can effectively relieve the pressure on vertebral artery type of cervical vertigo, neck pain, headache symptoms the clinical curative effect of combined acupuncture Baihui, moxibustion pressing than simple acupuncture and drug treatment significantly. The long-term curative effect comparison of vertigo, acupuncture combined with moxibustion Baihui pressure, acupuncture has more advantages, and the long-term curative effect of acupuncture combined with moxibustion Baihui pressure group than the drug group. But the follow-up data showed that three kinds of therapy for patients vertebral artery type of cervical spondylosis neck and shoulder pain, on the other hand have failed to obtain a good long-term effect. In addition, after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, simple acupuncture group, drug therapy To promote the role of daily life and work of patients with vertebral artery type of cervical spondylosis is good, but the effect is not obvious difference between the three kinds of therapy. To improve the daily life and work of patients with vertebral artery type of cervical spondylosis, drug treatment is superior to the curative effect of acupuncture combined with moxibustion on Baihui pressure. The measuring scale of life quality of WHO and after three weeks of treatment, the determination of scores of three different therapies can improve patients with vertebral artery type of cervical spondylosis WHO quality of life, and the acupuncture combined with compressive moxibustion on Baihui is superior to acupuncture and drug treatment. In the long-term effect, drug group and acupuncture combined with moxibustion Baihui pressure group compared with the acupuncture group is not ideal. The vertebral artery type of cervical spondylosis TCD observation indicators, after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture and drug treatment were increased in patients with vertebral artery type of cervical spondylosis of the abnormal decrease of vertebral basilar arteries received Systolic peak flow velocity (Vp). But the long-term curative effect comparison, three groups of vertebrobasilar artery peak systolic velocity (Vp) compared with before treatment, the difference is not obvious. Acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug treatment group to improve the vertebrobasilar artery vertebral artery type of cervical spondylosis patients the diastolic peak flow velocity (Vd) had no obvious effect.

【学位授予单位】：广州中医药大学
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R246.9

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