补泻针法治疗中风后失眠的临床观察及神经递质机理研究

发布时间：2018-01-03 01:45

本文关键词：补泻针法治疗中风后失眠的临床观察及神经递质机理研究　出处：《广州中医药大学》2016年博士论文　论文类型：学位论文

【摘要】：目的：通过临床病例的收集及动物实验,分析补泻针法治疗缺血性脑卒中后失眠患者的疗效、动物模型血清中5-HT和5-HIAA神经递质的影响,探讨其分子机理。方法：本课题研究分为临床研究及动物实验研究两个方面：(1)临床研究纳入病例共70例,随机法,分为①针刺组,②对照组,每组35例。受试者中途退出而剔除的病例共10例,最终收集病例60例,其中①针灸组30例,②对照组30例。干预手段：1基础干预所有入患者均按中风内科常规处理。进行对症治疗及支持治疗,包括控制血压、血糖、血脂、体温,吸氧,维持水、电解质及酸碱平衡,予阿司匹林并使用改善脑部血液循环及脑细胞活化剂等。所有患者均做基本康复治疗(包括良肢位的摆放、床边坐位平衡、水平移动、平衡训练、站立床训练、主被动运动、作业疗法等)。2针刺组基础取穴(虚证实证共有)：印堂,神庭,百会,四神聪,血管舒缩区,操作手法：平补平泻,出现酸胀后留针30分钟；虚证配穴：神门,足三里,太溪；其中复式手法选穴：足三里,其他配穴操作手法同基础取穴操作手法。足三里复式手法具体操作：采用烧山火式补法,即分天人地三层,天层：约2-5mm,人层：约6-9mm,地层：10-12mm,操作者左手作切压手,右手施针,嘱病人自然鼻吸口呼,随其呼气将针浅刺入天层(一进)；操作者顺时针捻转针柄3次,同时配合紧按慢提的手法,之后再随患者呼气再刺入人层(二进),同样重复上述操作进入地层(三进),重复上述捻转提插手法,若未产生热感时,术者可用指甲由上向下轻刮针柄,以催气至。如果患者仍无热感,可将针提到天层(一退),复同前法进行操作,以上三进一退重复三次,待患者感觉热时,将针缓缓地退出皮肤,并要用干棉签快速压迫针孔。实证配穴：丘墟,太冲,大陵；其中复式手法选穴：丘墟,其他配穴操作手法同基础取穴操作手法。丘墟复式手法具体操作：采用透天凉式泻法,同样分天人地三层,天层：约2-5mm,人层：约6-9mm,地层：10-12mm,操作者左手作切压手,右手施针,与烧山火相反,嘱病人作口吸鼻呼,随其吸气将针深刺入地层(一进)；操作者逆时针捻转针柄6次,同时配合轻按重提的手法,随患者吸气再退入人层(一退),重复上述操作,再随患者吸气退入天层(二退),操作同前,完毕后随患者吸气将针轻压入地层,共重复此过程3次,以期待患者出现凉感；留针至该次治疗结束与其他穴位同时出针。针具选用直径0.25mm,长40mm汉医牌不锈钢毫针以上方法每日1次；治疗时间选在下午3-6点,共治疗10次,周一至五连续治疗5次,周六周日休息2天,治疗结束时观察疗效。3对照组口服舒乐安定。每次1mg,周一至五每晚睡前服1次,周六周日休息2天,共服10天,治疗结束时观察疗效。治疗前、停止治疗后第一天、第五天分别记录患者临床症状、匹兹堡睡眠质量指数表并用睡眠监测仪监测睡眠质量。(2)动物实验研究SPF级健康SD大鼠84只,造模成功后得到32只,分为4组①正常组(8只)②模型组(8只),③针刺组(8只),④西药组(8只)。造模方法：使用血管内拴线阻断法制造中风模型,中风模型再腹腔注射PCPA制造缺血性脑卒中后失眠。干预措施：①A.正常组,B.模型组失眠组空抓,不予任何处理。C.针刺组：印堂、神庭、百会,四神聪。针具选用华佗牌0.22x5mm皮内针,针刺手法：平补平泻,留针30min,针刺时间周一至五每日上午9：00-10：00,周六周日休息2天,共连续治疗10次。②D.西药组：实验第3天开始舒乐安定(艾司唑仑)生理盐水溶液灌胃治疗。按成人催眠剂量10mg/天,用人鼠给药剂量体表面积折算公式计算出大鼠给药剂量为0.92mg/kg。每日上午10：00～11：00给大鼠灌胃。结果：1.补泻针刺及口服舒乐安定能降低缺血性脑卒中后失眠患者中医证候积分2.补泻针刺及口服舒乐安定能降低缺血性脑卒中后失眠患者匹兹堡睡眠质量指数3.根据缺血性脑卒中后失眠患者副反应量表(TESS)评分,补泻针刺比口服舒乐安定更低,副作用更小,证明该治疗手段有效。4.参照参照国家药品监督管理局发布的《中药新药临床研究指导原则》疗效评定标准,舒乐安定治疗缺血性脑卒中后失眠疗效比补泻针刺好。5.血管内拴线阻断法加腹腔注射PCPA法能制造能制造缺血性脑卒中后失眠大鼠动物模型。6.针刺及舒乐安定溶液灌胃能提高动物模型血清中5-HT和5-HIAA含量,两者效果相当。结论：1.证实了复式补泻针刺能缓解缺血性脑卒中患者失眠状态。为下一步实验提供临床试验证明。下一步实验将是复式补泻针法对照不分证型平补平泻的针法,同样穴位、同样针具,目的是证实按辩证论治理论施行针灸治疗比不按辩证论治针灸治疗有效。2.补泻针刺治疗脑卒中后失眠副作用效果优于口服舒乐安定。3.血管内拴线阻断法加腹腔注射PCPA发可能是脑卒中后失眠模型的有效造模方法。4.针刺能提高动物模型血清中5-HT和5-HIAA含量。因为该模型是在缺血性脑卒中后失眠状态,根据针灸后中枢性神经递质改变的结果,证明了在脑缺血病理状态下针灸治疗能改变生物原胺类中枢性神经递质的含量,特别是与情绪焦躁或抑郁密切相关的5-HT和5-HIIA物质的含量,从而起到治疗失眠的动物实验证据。也为进一步动物实验以证明按辨证论治施行的补泻针法能否优于不按辨证论治施行的无补泻差异的针刺手法提供动物实验证据。
[Abstract]:Objective: through the collection of clinical cases and animal experiments, clinical analysis of patients with insomnia in the treatment of ischemic stroke after reinforcing acupuncture, effect of 5-HT and 5-HIAA in serum of neurotransmitters in animal models, and explore its molecular mechanism. Methods: This study consists of two clinical studies and animal experiments: (1) clinical research in 70 cases, were randomly divided into acupuncture group, the control group, 35 cases in each group. The subjects dropped out and removed in 10 cases, the final total of 60 cases were collected, including the acupuncture group of 30 cases, 30 cases of the control group. Intervention: 1 of all patients into intervention according to the conventional medical treatment for stroke. Symptomatic treatment and supportive treatment, including control of blood pressure, blood glucose, blood lipid, body temperature, oxygen, water, electrolyte and acid-base balance, aspirin use and improve blood circulation to the brain and brain cell activator were all. The patients had basic rehabilitation (including good limb position, the bed sitting balance, horizontal movement, balance training, standing bed training, passive movement, occupational therapy and so on).2 based acupuncture acupuncture group (total deficiency of empirical): Yintang, shenting, Baihui, Sishencong, vasomotor area. Operation manual: reinforcing reducing, the needle for 30 minutes after the emergence of acid bilges; deficiency of acupoints of Shenmen, Zusanli, Taixi; the complex technique of acupoints: Zusanli acupoints, manipulation and other basic operating practices. Zusanli acupoints complex technique of concrete operation: fill mining method Shaoshanhuo, namely and three layer, layer about 2-5mm, one day: layer: about 6-9mm, 10-12mm, operator formation: left hand cut pressure hand, right hand needle, the symptoms of natural nasal suction call, with the breath will be shallow needle into the sky (a) layer; the operator clockwise twisting the needle handle 3 times. At the same time with the pressing and slow lifting technique Then, with the patient breath to penetrate into the layer (Er Jin), who also repeat the above operation into the ground (San Jin), repeat the twirling lifting and thrusting manipulation, if not to generate heating, patients can nail down from the upper scraping needle handle, to rush to gas. If the patient is still no heat, the needle that day (back), double layer with method of operation, more than a retreat San Jin repeated three times for patients with thermal sensation, the needle slowly out of the skin, and use dry cotton swab quickly. The empirical distribution point: compression pinhole Qiuxu, Taichong, Daling; the complex technique of acupoint selection: Qiuxu. Other acupoints with acupuncture manipulation based manipulation. Qiuxu complex technique of concrete operation: the story is cool reducing method, also divided to three layers of heaven, the day: about 2-5mm, one layer: about 6-9mm, 10-12mm, operator formation: left hand cut pressure hand, right hand needle, contrary to burn, will patients with nasal suction call. The suction needle piercing the deep stratum (a); the operator counterclockwise twisting the needle handle 6 times, at the same time with the light by repeated practices, with the patient inhale again back into the one layer (back), repeat the above operation, then with the patient inhale back into the day (Er Tui), with the operation layer,. After the patients inhale the needle light into the formation, is this process is repeated 3 times, in the hope of patients with cool feeling to the end; the needle treatment with other acupoints and needle. The needle with diameter 0.25mm, length 40mm - brand stainless steel needle above 1 times a day; the treatment time in the afternoon 3-6 for 10 times, Monday, to five for 5 consecutive times, Saturday Sunday 2 days off at the end of the treatment efficacy of.3 control group estazolam. Every Monday to five 1mg, 1 times every night before bedtime, Saturday Sunday rest for 2 days, a total of 10 days, to observe the curative effect after treatment. Before treatment. The first day after cessation of treatment And fifth days were recorded in patients with clinical symptoms, Pittsburgh sleep quality index and quality monitor of sleep sleep. (2) animal experimental study on SPF 84 healthy SD rats, after the success of the model are 32, divided into 4 groups: normal group (8 rats), model group (8 rats). The acupuncture group (8 rats), the western medicine group (8). Modeling methods: the use of endovascular occlusion sukwan manufacturing model of stroke, stroke model by intraperitoneal injection of PCPA after ischemic stroke insomnia. Interventions: A. normal group, B. model group, the insomnia group caught, without any treatment.C. acupuncture group: Yintang, shenting, Baihui, Sishencong. Needle selection of Hua Tuo brand 0.22x5mm intradermal needle, acupuncture, reinforcing reducing, needle 30min, acupuncture time on Monday to five 9:00-10:00 every morning, Saturday Sunday rest 2 days, total for 10 consecutive times. The western medicine group D.: experiment third days start SURAZEPAM (Ai Si Midazolam) normal saline gavage treatment. According to the adult hypnotic dose of 10mg/ day, with people in the dose conversion formula to calculate the surface area of rats with a dose of 0.92mg/kg. daily morning from 10:00 to 11:00 to rats by intragastric administration. Results: 1. reinforcing acupuncture and oral estazolam can reduce ischemic stroke the TCM Syndromes of 2. patients with insomnia reinforcing and reducing acupuncture and oral estazolam can reduce ischemic stroke patients with insomnia sleep quality index according to the Pittsburgh 3. after cerebral ischemic stroke patients with insomnia side effects scale (TESS) score, reinforcing acupuncture than estazolam lower, less side effects, the effective treatment for reference in.4. the State Drug Administration issued the "Chinese medicine clinical research guiding principles > curative effect evaluation standard, estazolam in the treatment of ischemic stroke insomnia curative effect than acupuncture reinforcing and reducing.5. in blood vessel Sukwan occlusion and intraperitoneal injection of PCPA can make manufacturing after cerebral ischemic stroke insomnia rats animal model.6. acupuncture and diazepam solution orally can increase 5-HT and 5-HIAA content in serum of the animal model, the two effects is confirmed by 1.. Conclusion: Compound reinforcing acupuncture can relieve the ischemic stroke patients with insomnia. Clinical trials that is the next step of the experiment. The next step will be double reinforcing and reducing acupuncture control syndrome type reinforcing reducing needle, the same point, the same needle is confirmed according to the dialectical theory of treatment of acupuncture treatment is not according to the dialectical treatment of acupuncture treatment of.2. reinforcing acupuncture treatment for stroke after insomnia side effect is better than the.3. estazolam sukwan endovascular occlusion and intraperitoneal injection of PCPA may be effective after stroke insomnia model modeling method of acupuncture can improve the animal model of serum.4. 5-HT and 5-HIAA content. Because the model is in the state of insomnia after cerebral ischemic stroke, according to the change of central neurotransmitter after acupuncture results proved that acupuncture treatment can change the content of the original biological amine neurotransmitter in the central state of cerebral ischemia pathological conditions, especially the content is closely related with the mood of anxiety or depression 5-HT and 5-HIIA material, so that the animal experimental evidence for the treatment of insomnia. For further animal experiments to prove that according to syndrome differentiation and treatment effect of acupuncture reinforcing reducing syndrome differentiation does not according to whether it is superior to the implementation of the treatment of diarrhea between acupuncture provided animal experimental evidence.

【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】：2016
【分类号】：R246.6

【相似文献】