四维疗法对颈源性高血压临床疗效评价
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摘要
目的:观察并记录经四维疗法对颈源性高血压患者的临床疗效(临床症状、血压、疼痛)、血液流变学指标[全血黏度(低、中、高切)]、血浆黏度、红细胞刚性指数、红细胞聚集指数、纤维蛋白原浓度、动脉[左椎动脉(LVA)、右椎动脉(RVA)、基底动脉(BA)]血流动力学参数[阻力指数(RI)、搏动指数(PI)、平均血流速度(Vm)]。方法:收集120例颈源性高血压患者,按照入组时间顺序分为对照组和观察组,对照组给予口服苯磺酸氨氯地平片口服降压+常规治疗(针刺、手法按摩等),观察组给予口服苯磺酸氨氯地平片口服降压+四维治疗法(手法按摩+针刺+止疼与改善循环药物+功能康复训练),两组均连续治疗3个月。治疗后用视觉模拟评分法(VAS)测定患者的疼痛程度,并采用《颈性眩晕症状与功能评估量表》(ESCV)评估患者的症状缓解程度,并用水银血压计测量血压(收缩压、舒张压)以评估降压效果。比较治疗前后两组血流变学指标的变化情况与经颅多普勒超声观察患者动脉(BA、LVA、RVA)的血流动力学(Vm、RI、PI)指标。结果:两组治疗前VAS评分比较,差异无统计学意义(P>0.05);治疗后两组VAS评分均低于治疗前,且观察组低于对照组,差异均有统计学意义(P<0.05);治疗后观察组症状缓解有效率高于对照组,差异均有统计学意义(P<0.05);治疗后观察组降压效果高于对照组,差异有统计学意义(P<0.05)。治疗前两组血流变学指标比较,差异无统计学意义(P>0.05);治疗后两组血流变学指标均降低,且观察组低于对照组,差异均有统计学意义(P<0.05)。治疗前两组动脉(BA、LVA、RVA)血流动力学(Vm、RI、PI)比较,差异无统计学意义(P>0.05);治疗后两组动脉(BA、LVA、RVA)的Vm高于治疗前,且观察组动脉(BA、LVA、RVA)的Vm高于对照组,差异均有统计学意义(P<0.05);治疗后两组动脉(BA、LVA、RVA)的RI、PI低于治疗前,且观察组动脉(BA、LVA、RVA)的RI、PI低于对照组,差异均有统计学意义(P<0.05)。结论:四维疗法能通过改善动脉血流动力学与血液流变学指标而颈源性高血压患者的血压、疼痛、眩晕等临床症状。
Objective: To research the effect of four-dimensional therapy on the clinical effect(symptoms, blood pressure, and pain degree), the changes of blood rheology and arterial(left vertebral artery(LVA), right vertebral artery(RVA), and basal artery(BA)) hemodynamics(average cerebral blood flow(Vm), resistance index(RI), pulsatility index(PI)) on patients with cervical hypertension. Methods: A tota of 120 patients(Department of Orthopaedics, from the second Affiliated Hospital to Liao ning University of Chinese Medicine, 2012.6-2018.10) with cervical hypertension were slected, and then they were divided into observation group(n=60) and control group(n=60). The control group were given enalapril meleate(amlodipine besylate)+conventional therapy(acupuncture treatment and massage), the observation group were given four-dimensional therapy on the basic of control group, they were treated 3 weeks. The primary endpoints were the changes from baseline to week 3 in the symptoms and function were scored using the Evaluation Scale for Cervical Vertigo, the secondary endpoints were changes from baseline to month 3 in the artery hemodynamics(Vm, RI, and PI) in the BA, LVA, blood rheology, and RVA. At last, assessing the pain degree through visual analog scale(VAS), measuring the blood pressure, and accessing the clinical effect. Results: The score of vertigo in the two groups had no statistical significance(P>0.05) before treatment, the score of vertigo in the two groups were higher than pretherapy, and had statistical significance(P<0.05), and the score in the observation group were higher than control group, and had statistical significance(P<0.05). The hemodynamics(Vm, RI, and PI) in the artery(BA, LVA, and RVA) had no statistical significance(P>0.05) in the two groups before treatment, and the hemodynamics(Vm) in the artery(BA, LVA, and RVA) were higher than pretherapy, and had statistical significance(P<0.05), the the hemodynamics(Vm) in the artery(BA, LVA, and RVA) of observation group were higher than control group, and had statistical significance(P<0.05). The hemodynamics(RI and PI) in the artery(BA, LVA, and RVA) were lower than pretherapy, and had statistical significance(P<0.05), the the hemodynamics(Vm) in the artery(BA, LVA, and RVA) of observation group were lower than control group, and had statistical significance(P<0.05). The blood rheology had no statistical significance(P>0.05) in the two groups before treatment, the blood rheology were lower than pretherapy, and had statistical significance(P<0.05), the blood rheology of observation group were lower than control group, and had statistical significance(P<0.05). The degree of VAS had no statistical significance(P>0.05) in the two groups before treatment, the degree of VAS were lower than pretherapy, and had statistical significance(P<0.05), the degree of VAS of observation group were lower than control group, and had statistical significance(P<0.05). The blood pressure(systolic pressure and diastolic pressure) had no statistical significance(P>0.05) in the two groups before treatment, the blood pressure(systolic pressure and diastolic pressure) were lower than pretherapy, and had statistical significance(P<0.05), the blood pressure(systolic pressure and diastolic pressure) of observation group were lower than control group, and had statistical significance(P<0.05), the clinical effect in the observation group were higher than control group, and had statistical significance(P<0.05). Conclusions: Giving four-dimensional therapy can improve the blood pressure and relieve the pain through improving blood rheology and hemodynamics in the artery in the patients with cervical hypertension.
Objective: To research the effect of four-dimensional therapy on the clinical effect(symptoms, blood pressure, and pain degree), the changes of blood rheology and arterial(left vertebral artery(LVA), right vertebral artery(RVA), and basal artery(BA)) hemodynamics(average cerebral blood flow(Vm), resistance index(RI), pulsatility index(PI)) on patients with cervical hypertension. Methods: A tota of 120 patients(Department of Orthopaedics, from the second Affiliated Hospital to Liao ning University of Chinese Medicine, 2012.6-2018.10) with cervical hypertension were slected, and then they were divided into observation group(n=60) and control group(n=60). The control group were given enalapril meleate(amlodipine besylate)+conventional therapy(acupuncture treatment and massage), the observation group were given four-dimensional therapy on the basic of control group, they were treated 3 weeks. The primary endpoints were the changes from baseline to week 3 in the symptoms and function were scored using the Evaluation Scale for Cervical Vertigo, the secondary endpoints were changes from baseline to month 3 in the artery hemodynamics(Vm, RI, and PI) in the BA, LVA, blood rheology, and RVA. At last, assessing the pain degree through visual analog scale(VAS), measuring the blood pressure, and accessing the clinical effect. Results: The score of vertigo in the two groups had no statistical significance(P>0.05) before treatment, the score of vertigo in the two groups were higher than pretherapy, and had statistical significance(P<0.05), and the score in the observation group were higher than control group, and had statistical significance(P<0.05). The hemodynamics(Vm, RI, and PI) in the artery(BA, LVA, and RVA) had no statistical significance(P>0.05) in the two groups before treatment, and the hemodynamics(Vm) in the artery(BA, LVA, and RVA) were higher than pretherapy, and had statistical significance(P<0.05), the the hemodynamics(Vm) in the artery(BA, LVA, and RVA) of observation group were higher than control group, and had statistical significance(P<0.05). The hemodynamics(RI and PI) in the artery(BA, LVA, and RVA) were lower than pretherapy, and had statistical significance(P<0.05), the the hemodynamics(Vm) in the artery(BA, LVA, and RVA) of observation group were lower than control group, and had statistical significance(P<0.05). The blood rheology had no statistical significance(P>0.05) in the two groups before treatment, the blood rheology were lower than pretherapy, and had statistical significance(P<0.05), the blood rheology of observation group were lower than control group, and had statistical significance(P<0.05). The degree of VAS had no statistical significance(P>0.05) in the two groups before treatment, the degree of VAS were lower than pretherapy, and had statistical significance(P<0.05), the degree of VAS of observation group were lower than control group, and had statistical significance(P<0.05). The blood pressure(systolic pressure and diastolic pressure) had no statistical significance(P>0.05) in the two groups before treatment, the blood pressure(systolic pressure and diastolic pressure) were lower than pretherapy, and had statistical significance(P<0.05), the blood pressure(systolic pressure and diastolic pressure) of observation group were lower than control group, and had statistical significance(P<0.05), the clinical effect in the observation group were higher than control group, and had statistical significance(P<0.05). Conclusions: Giving four-dimensional therapy can improve the blood pressure and relieve the pain through improving blood rheology and hemodynamics in the artery in the patients with cervical hypertension.
引文
1 黄科生,陈东风.颈源性高血压患者健康促进生活方式调查分析 [J].广东医学,2012,33 (7):188-189.
2 王明月,张兵,刘琨,等.丹参川芎嗪联合电针刺激等治疗颈源性高血压临床效果观察[J].临床误诊误治,2018,31(11):38-43.
3 潘春山,雷春升,蔡静敬.针灸联合推拿治疗神经根型颈椎病效果观察[J].中西医结合心血管病电子杂志,2019,7(8):158,162.
4 杨春明,吴春欢.针灸辅助治疗神经根型颈椎病的临床疗效及其对患者椎动脉血流动力学的影响[J].临床合理用药杂志,2019,12(6):22-25.
5 张国龙,胡新宇.四维疗法在脊柱软组织伤病中的应用探讨[J].中国疗养医学,2016,25(5):558-560.
6 焦付达,邬波.中医四维疗法治疗早中期膝关节骨性关节炎临床观察[J].沈阳医学院学报,2017,19(4):316-318.
7 宋金华,高恕涛,胡新宇.功能锻炼在四维疗法治疗中的作用[J].中国疗养医学,2017,26(2):140-142.
8 中国康复医学会.颈椎病诊治与康复指南(2010版)[M].北京:中医药科技出版社,2010:5-9.
9 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
10 1999 Word Health Organization International Society of H ypertension Guide lines for the Man agement of Hyperte sion Guide lines Subcommittee [J].J Hypertense,1999,17 (2):151-183.
11 陈东风,黄科生,孙戎,等.电针刺激颈肌起止点治疗颈源性高血压的效果[J].广东医学,2014,35(20):3170-3172.
12 李业甫.中国推拿治疗学[M].上海:上海中医药大学出版社,1994:3-4.
13 谭周纯,洪文.龙氏治脊疗法结合针刺治疗椎动脉型颈椎病60例临床观察[J].中医临床研究,2016,8(13):45-47.
14 刘霖,徐燕,袁长蓉.姑息护理常用核心量表简述[J].护理学杂志,2008,23(6):75-77.
15 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
16 郝华明,刘芳,黎珍娟,等.心法按摩整脊治疗颈源性高血压56例[J].实用中医药杂志,2014,30(5):435-436.
17 李子丰,李心乐,张平.脉冲式机械加载通过调节骨髓干细胞分化和降低炎性反应治疗颈椎病[J].中国民康医学,2015,27(14):135.
18 王勤俭,董良杰,张睿昕,等.增力点压法治疗颈源性高血压40例[J].中医研究,2018,31(11):16-18.
19 姜东升,刘胜.脊柱调衡手法配合醒脑开窍针刺法治疗颈性高血压[J].辽宁中医杂志,2007,34(9):1310-1311.
20 张连军,莫鸣,徐冬梅.银杏叶提取物联合氯吡格雷治疗缺血性脑卒中的临床疗效与安全性[J].实用临床医药杂志,2018,22(7):35-37,41.
2 王明月,张兵,刘琨,等.丹参川芎嗪联合电针刺激等治疗颈源性高血压临床效果观察[J].临床误诊误治,2018,31(11):38-43.
3 潘春山,雷春升,蔡静敬.针灸联合推拿治疗神经根型颈椎病效果观察[J].中西医结合心血管病电子杂志,2019,7(8):158,162.
4 杨春明,吴春欢.针灸辅助治疗神经根型颈椎病的临床疗效及其对患者椎动脉血流动力学的影响[J].临床合理用药杂志,2019,12(6):22-25.
5 张国龙,胡新宇.四维疗法在脊柱软组织伤病中的应用探讨[J].中国疗养医学,2016,25(5):558-560.
6 焦付达,邬波.中医四维疗法治疗早中期膝关节骨性关节炎临床观察[J].沈阳医学院学报,2017,19(4):316-318.
7 宋金华,高恕涛,胡新宇.功能锻炼在四维疗法治疗中的作用[J].中国疗养医学,2017,26(2):140-142.
8 中国康复医学会.颈椎病诊治与康复指南(2010版)[M].北京:中医药科技出版社,2010:5-9.
9 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
10 1999 Word Health Organization International Society of H ypertension Guide lines for the Man agement of Hyperte sion Guide lines Subcommittee [J].J Hypertense,1999,17 (2):151-183.
11 陈东风,黄科生,孙戎,等.电针刺激颈肌起止点治疗颈源性高血压的效果[J].广东医学,2014,35(20):3170-3172.
12 李业甫.中国推拿治疗学[M].上海:上海中医药大学出版社,1994:3-4.
13 谭周纯,洪文.龙氏治脊疗法结合针刺治疗椎动脉型颈椎病60例临床观察[J].中医临床研究,2016,8(13):45-47.
14 刘霖,徐燕,袁长蓉.姑息护理常用核心量表简述[J].护理学杂志,2008,23(6):75-77.
15 国家中医药管理局.中医病证诊断疗效标准[M].南京:南京大学出版社,1994.
16 郝华明,刘芳,黎珍娟,等.心法按摩整脊治疗颈源性高血压56例[J].实用中医药杂志,2014,30(5):435-436.
17 李子丰,李心乐,张平.脉冲式机械加载通过调节骨髓干细胞分化和降低炎性反应治疗颈椎病[J].中国民康医学,2015,27(14):135.
18 王勤俭,董良杰,张睿昕,等.增力点压法治疗颈源性高血压40例[J].中医研究,2018,31(11):16-18.
19 姜东升,刘胜.脊柱调衡手法配合醒脑开窍针刺法治疗颈性高血压[J].辽宁中医杂志,2007,34(9):1310-1311.
20 张连军,莫鸣,徐冬梅.银杏叶提取物联合氯吡格雷治疗缺血性脑卒中的临床疗效与安全性[J].实用临床医药杂志,2018,22(7):35-37,41.