基于FLAIR序列血管高信号观察通督调神针刺对TIA患者的干预研究

发布时间：2018-02-08 19:45

  本文关键词： TIA 通督调神 针刺 FLAIR FVH　出处：《安徽中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：目的:本研究选取70例符合纳入标准的短暂性脑缺血发作(TIA)的患者为对象,经过观察比较通督调神针刺组和药物对照组对FLAIR序列血管高信号(FVH)的影响,讨论通督调神针刺疗法治疗TIA患者的临床疗效,以此说明该种方法治疗TIA患者的有效性。为其在脑卒中方面的预防提供依据。方法:共筛选出70例符合纳入标准的短暂性脑缺血发作(TIA)的患者,全部来自安徽中医药大学第二附属针灸医院门诊及住院的病人,采取随机原则将70例病人分为针刺治疗组与药物对照组各35例。针刺治疗组主穴选取大椎、百会、哑门、风府、命门、颈夹脊。患者每天一次,针刺得气后留针,分别在进针后第10分钟、第20分钟、第30分钟各行针1次,共留针30分钟。药物对照组患者服用尼莫地平片(尼莫同,国药准字H20003010,德国拜尔公司生产)30mg,一日3次。两组患者都以3周作为一个疗程,一共治疗2个疗程。两组患者在治疗前、治疗第1、6、12个月后分别行FLAIR序列检查,并在治疗前后参照《中风病先兆证诊断与疗效评定标准》进行中医症状评分,分别记录治疗后第1、6和12个月内两组患者脑梗死的发生率。进而比较两组方法的临床疗效。数据分析采用SPSS17.0统计软件。结果:(1)中风先兆的中医症状评分治疗两个疗程后,针刺治疗组较治疗前评分显著下降,差异有统计学意义(P0.01)。西药对照组较治疗之前比较评分显著下降,差异有统计学意义(P0.01)。针刺组与药物组比较,评分下降更明显,差异有统计学意义(P0.05)。说明针刺组与药物组都能改善患者症状,并且治疗组优于对照组,在改善患者的症状上更明显。(2)FVH的改变治疗前两组患者均发现有FVH,具有可比性。治疗1个月后检测两组患者FVH,治疗组为2例,对照组为1例,经统计学分析,卡方值=0.348,P=0.5550.05,无统计学意义。6个月后检测两组患者fvh,治疗组为3例,对照组为5例,经统计学分析,卡方值=0.565,p=0.4520.05,无统计学意义。12个月后检测两组患者fvh,治疗组为5例,对照组为15例,经统计学分析,卡方值=7.00,p=0.0080.05,有统计学意义。(3)脑梗死的发生率治疗后,一个月内两组均未出现脑梗死;6个月内,治疗组和对照组出现脑梗死病例分别为2例、4例,经统计学分析,卡方值=0.729,p=0.3930.05,无统计学意义。12个月内,治疗组和对照组出现脑梗死病例分别为3例、10例,经统计学分析,卡方值=4.629,p=0.0310.05,有统计学意义。(4)安全性评估70例tia患者在治疗前后,均未见针刺及药物不良反应,以及各项实验室指标在治疗前和治疗后也未见明显异常。所以本次研究采用的两种治疗方法都是安全可靠的。结论:(1)针刺组和药物组两种方法都能有效治疗tia,改善患者的临床症状,减少出现fvh,从而降低脑卒中的发生。且通督调神针刺组在治疗tia患者,改善临床症状方面优于药物对照组。(2)由结果2和3可知,两种治疗方法均能减少出现fvh的患者,从而降低脑梗死的发生率,针刺组无论是在治疗期间还是治疗之后出现fvh的患者少,发生脑梗死的概率低,而药物组在治疗期间1个月后只发现了1例fvh,也没有出现脑梗死,而在治疗结束后6个月、12个月内随着出现fvh的增多,脑梗死的发生率也在上升,说明针刺组在治疗tia,有效预防脑卒中方面优于药物组,远期疗效好。(3)虽然针刺组较药物组远期疗效显著,但在停止针刺治疗后也出现了少数fvh,发生了脑梗死,所以我们应该要间歇性进行针刺治疗tia患者,这样才能更加有效的预防脑卒中的发生。而药物组在患者服药期间有效的控制了fvh的出现以及脑梗死的发生,但是患者停止服药之后就出现了fvh患者,发生了脑梗死,到12个月发生脑梗死的概率更高,没有预防脑卒中的远期疗效,所以服用西药的患者应该持续的服用药物,从而有效的预防脑卒中的发生。(4)按国际标准化的针灸取穴简便、治疗规范、无不良反应和毒副作用,是治疗TIA安全有效的方法,值得我们临床推广。
[Abstract]:Objective: This study selected 70 patients met the inclusion criteria of transient ischemic attack (TIA) patients as the research object, through observation and comparison of Tongdu Tiaoshen acupuncture group and drug control group of FLAIR series high signal (FVH) vascular effects, clinical curative effect discussion Tongdu Tiaoshen acupuncture therapy in the treatment of TIA patients. In order to show the effectiveness of the TIA patients were treated with this method. Provide the basis for the stroke prevention. Methods: the selected 70 patients met the inclusion criteria of transient ischemic attack (TIA) patients, all from Anhui University of traditional Chinese medicine acupuncture is the second hospital outpatient and inpatient patients, taken randomly the principle of the 70 patients were divided into acupuncture group and drug control group with 35 cases in each group. The acupuncture group selected Baihui, Dazhui main points, yamen, Fengfu, Mingmen, Cervical Jiaji acupuncture patients. Once a day, was left after the gas, respectively in tenth minutes after the needle, second 0 minutes, thirtieth minutes each time a total of 1 needle, the needle for 30 minutes. The drug control group were treated by Nimodipine Tablets (nimedipine, Zhunzi H20003010, Germany Bayer) 30mg, 3 times a day. The two groups were 3 weeks as a course of treatment, a total of 2 courses of treatment in two groups. Before treatment, treatment after 1,6,12 months were examined by FLAIR sequence, and the symptoms of Chinese medicine according to "apoplexy omen syndrome diagnosis and curative effect evaluation standard. Before and after treatment, treatment after 1,6 and 12 months of the two groups of patients the incidence of cerebral infarction were recorded. Clinical efficacy and comparison of two group method. Data were analyzed by SPSS17.0 statistical software. Results: (1) the score of TCM symptoms of apoplexy after two courses of treatment, the acupuncture treatment group than before treatment were significantly decreased, the difference was statistically significant (P0.01). The western medicine group compared with before treatment were significantly more 涓嬮檷,宸�寮傛湁缁熻�″�︽剰涔�(P0.01).閽堝埡缁勪笌鑽�鐗╃粍姣旇荆�

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