从肝论治椎动脉型颈椎病的临床观察

发布时间：2018-07-12 19:04

本文选题：从肝论治 + 椎动脉型颈椎病　；参考：《湖北中医药大学》2017年硕士论文

【摘要】：目的:观察从肝论治椎动脉型颈椎病的治疗效果,为治疗椎动脉型颈椎病的中医治疗提供新的思路。方法:选取自2013年4月至2015年12月在湖北省中医院花园山院区就诊的椎动脉型颈椎病患者,将所选患者从中医肝的角度出发进行辨证,并分为肝阳上亢证、肝肾阴虚证、肝郁气滞证及风痰上扰证4个证型,并在以上每个证型中设观察组及对照组各25例患者,各组病例在性别、年龄、病程上无统计学差异(P0.05),可以进行比较。其中观察组患者根据辨证后的分型,肝阳上亢证组服用天麻钩藤饮、肝肾阴虚证组服用一贯煎合六味地黄丸、肝郁气滞证组予以柴胡疏肝散、风痰上扰证组则予以半夏白术天麻汤。并在所有患者的药物中加入葛根30g及川芎9g,在方中当作引经药,假如原方中有葛根及川芎两味药物便不重复加入。观察组患者单纯予以以上中药方口服进行治疗,药物统一由湖北省中医院花园山院区提供并统一煎制,每日早晚各服一次。对照组患者则仅予以盐酸氟桂利嗪胶囊口服治疗,每日晚临睡前口服1粒。以上所有观察组及对照组患者均以2个星期为治疗周期,并在后期对所有患者进行为期3个月的随访监测,嘱所有患者避免长期低头、过度旋转等有害颈椎的动作,指导患者行相同的颈椎保健操。比较各证型的治疗效果、不良反应及复发率三个方面。统计学分析使用SPSS18.0,计量资料以(x?±s)表示,计数资料采用X2检验,组间比较选择t检验,以P0.05作为差异具有统计学意义。结果:本次观察经过为期2周的治疗周期以及后续3个月随访,所有患者共计200人有197例获得完整随访。肝阳上亢证组中观察组与对照组的总有效率分别为92.0%、68.0%,肝肾阴虚证组中观察组与对照组的总有效率分别为87.0%、76.0%,肝郁气滞证组中观察组与对照组的总有效率分别为91.0%、68.0%,风痰上扰证组中观察组与对照组的总有效率分别为84.0%、80.0%。中药组的总不良反应率为2.0%,西药组总不良反应率为9.0%,P0.05,差别具有统计学意义。中药组的复发率为1.0%,西药组复发率为7.0%,P0.05,差别具有统计学意义。结论:由从肝论治的理论出发,对椎动脉型颈椎病进行辨证分型,并针对个各证型分别予以相应的中药方剂,可使大部分患者的临床症状明显减轻,起到了优于西药的临床效果。可以说从肝论治椎动脉型颈椎病辨证合理,疗效确切。并且相对于服用盐酸氟桂利嗪胶囊而言,通过中药治疗还具有不良反应发生率低及复发率低的优点。本理论及治疗方法值得在临床上进一步深入研究及推广。
[Abstract]:Objective: to observe the therapeutic effect of treating cervical spondylosis of vertebral artery type from liver theory, and to provide a new idea for the treatment of cervical spondylosis of vertebral artery type. Methods: from April 2013 to December 2015, patients with cervical spondylopathy of vertebral artery type were selected from Huayuan Mountain Hospital, Hubei traditional Chinese Medicine Hospital. The selected patients were divided into liver yang hyperactivity syndrome, liver kidney yin deficiency syndrome and liver yang hyperactivity syndrome. There were 4 syndromes of stagnation of liver qi and disturbance of wind and phlegm, and 25 patients in observation group and control group in each syndrome type above. There was no statistical difference in sex, age and course of disease in each group (P0.05). According to the type of syndrome differentiation, the observation group took Tianma Gouteng decoction, the liver and kidney yin deficiency group took the consistent decoction combined with Liuwei Dihuang pills, the liver stagnation syndrome group was treated with Chaihu Shugan San, Wind and phlegm disturbance syndrome group was given Pinellia macrocephala Gastrodia decoction. 30 g and 9 g of kudzu root and 9 g of Chuanxiong were added to all patients' drugs. If the original prescription had Radix Puerariae root and Chuanxiong drugs, they would not be added repeatedly. The patients in the observation group were treated by oral administration of the above traditional Chinese medicine prescriptions. The drugs were provided by the Huayuan Mountain Hospital of Hubei Provincial Hospital of traditional Chinese Medicine and the decoction was made once a day and once a day in the morning and evening. The patients in the control group were treated with flunarizine hydrochloride capsule orally and 1 tablet before bedtime every day. All the patients in the observation group and the control group were treated for 2 weeks, and all the patients were followed up for 3 months at the later stage, and all the patients were told to avoid the harmful cervical movement, such as long-term bow, excessive rotation and so on. Instruct the patient to do the same exercises as the cervical vertebrae. The therapeutic effect, adverse reaction and recurrence rate of each syndrome type were compared. SPSS 18.0 was used for statistical analysis, and (x? 卤s) for metrological data, X2 test was used for counting data, t test was chosen for comparison between groups, and P0.05 was used as statistical significance. Results: 197 out of 200 patients were followed up for 2 weeks and followed up for 3 months. The total effective rates of observation group and control group were 92.00.The total effective rates of observation group and control group were 87.0 and 76.0, respectively. The total effective rates of observation group and control group were 91.0 and 68.0, respectively. The total effective rates of observation group and control group were 84.0 and 80.0 respectively. The total adverse reaction rate of the traditional Chinese medicine group was 2.0 and that of the western medicine group was 9. 0 and P 0. 05. The difference was statistically significant. The recurrence rate was 1.0 in Chinese medicine group and 7.0 in western medicine group, the difference was statistically significant. Conclusion: based on the theory of liver treatment, the syndrome differentiation and classification of cervical spondylosis of vertebral artery type and the corresponding traditional Chinese medicine prescriptions for each syndrome type can obviously alleviate the clinical symptoms of most patients. It has better clinical effect than western medicine. It can be said that treating cervical spondylosis of vertebral artery type from liver is reasonable and effective. Compared with flunarizine hydrochloride capsule, traditional Chinese medicine treatment also has the advantages of low incidence of adverse reactions and low recurrence rate. This theory and therapy are worthy of further study and popularization in clinic.
【学位授予单位】：湖北中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R274.9

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