刃针对颈源性眩晕患者椎基底动脉血流的影响
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摘要
目的:观察刃针对颈源性眩晕患者椎基底动脉血流的影响。方法:将60例颈源性眩晕患者随机等分为刃针组和药物组。刃针组采用刃针疗法,3d治疗1次,共治疗15d。药物组采用口服盐酸氟桂利嗪胶囊,每次10mg,每晚1次,共治疗15d。在两组治疗前后,分别采用颅多普勒超声(TCD)测定左侧椎动脉(LVA)、右侧椎动脉(RVA)、基底动脉(BA)的平均血流速度的变化情况,对颈源性眩晕症状与功能评估量表评分进行评测,并观察两组的临床疗效。结果:治疗后,刃针组总有效率为90.0%(27/30),药物组总有效率为70.0%(21/30),刃针组优于药物组(P<0.05)。和治疗前比较,治疗后刃针组和药物组患者的颈源性眩晕症状及功能评分均显著升高(P<0.05),刃针组治疗后的眩晕、颈肩痛、日常生活及工作、心理和社会状况、总分评分均高于药物组(P<0.05)。两组患者治疗后LVA、RVA、BA的平均血流速度与治疗前比较,均明显加快(P<0.05),且刃针组快于药物组(P<0.05)。结论:刃针治疗能明显减轻颈源性眩晕患者的症状,增加脑组织血流灌注,具有较好的临床疗效。
Objective To investigate the therapeutic effect of blade needle therapy for cervicogenic dizziness(CD)and changes of blood flow of vertebral artery in patients with CD.Methods A total of 60 patients with CD were equally randomized into medication(16 women and 14 men,38.9±10.9 years in age)group and blade needle group(17 women and 13 men,40.1±12.4 years in age).Patients of the blade needle group were treated by performing blade needle stimulation(longitudinal cutting along the musculoaponeurotic layer)to the tender points(attachment points)of the bilateral superior and inferior oblique muscles of the head,major and minor posterior cephalic rectus,about 2/3 of suboccipital nuchal line,and near the cervical processes of C1—C2 segments.The treatment was conducted once every 3 days for 15 days.Patients of the medication group were ordered to take Flunarizine Hydrochloride capsules(10 mg)once every night for 15 days.Transcranial Doppler was used to measure changes of mean blood flow velocities of the left vertebral artery(LVA),right vertebral artery(RVA),and basilar artery(BA)before and after the treatment.The therapeutic effect was assessed according to the Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes or Illnesses of Traditional Chinese Medicine(1994)and the Assessment Scale for Symptoms and Function of Cervicogenic Dizziness(2017).Results Following the treatment,of the two 30 cases in the medication and blade needle groups,5(16.7%)and 7(23.3%)were cured,16(53.3%)and 20(66.7%)were improved in their symptoms,9(30.0%)and 3(10.0%)failed,with the effective rate being 70.0%and 90.0%,respectively.The effective rate of the blade needle was significantly superior to that of the medication(P<0.05).The scores of vertigo,neck-should pain,daily living and work,psychology,social adaptation,and total score of the assessment scale,as well as the average blood flow velocities of LVA,RVA and BA were considerably increased in both groups in comparison with their own pre-treatment(P<0.05),and obviously higher in the blade needle group than in the medication group(P<0.05).Conclusion Blade needle treatment has a good clinical effect in the treatment of CD patients,which is probably associated with its function in increasing blood perfusion of the brain tissue,and thus being worthy of clinical application.
Objective To investigate the therapeutic effect of blade needle therapy for cervicogenic dizziness(CD)and changes of blood flow of vertebral artery in patients with CD.Methods A total of 60 patients with CD were equally randomized into medication(16 women and 14 men,38.9±10.9 years in age)group and blade needle group(17 women and 13 men,40.1±12.4 years in age).Patients of the blade needle group were treated by performing blade needle stimulation(longitudinal cutting along the musculoaponeurotic layer)to the tender points(attachment points)of the bilateral superior and inferior oblique muscles of the head,major and minor posterior cephalic rectus,about 2/3 of suboccipital nuchal line,and near the cervical processes of C1—C2 segments.The treatment was conducted once every 3 days for 15 days.Patients of the medication group were ordered to take Flunarizine Hydrochloride capsules(10 mg)once every night for 15 days.Transcranial Doppler was used to measure changes of mean blood flow velocities of the left vertebral artery(LVA),right vertebral artery(RVA),and basilar artery(BA)before and after the treatment.The therapeutic effect was assessed according to the Criteria for Diagnosis and Therapeutic Effect Evaluation of Syndromes or Illnesses of Traditional Chinese Medicine(1994)and the Assessment Scale for Symptoms and Function of Cervicogenic Dizziness(2017).Results Following the treatment,of the two 30 cases in the medication and blade needle groups,5(16.7%)and 7(23.3%)were cured,16(53.3%)and 20(66.7%)were improved in their symptoms,9(30.0%)and 3(10.0%)failed,with the effective rate being 70.0%and 90.0%,respectively.The effective rate of the blade needle was significantly superior to that of the medication(P<0.05).The scores of vertigo,neck-should pain,daily living and work,psychology,social adaptation,and total score of the assessment scale,as well as the average blood flow velocities of LVA,RVA and BA were considerably increased in both groups in comparison with their own pre-treatment(P<0.05),and obviously higher in the blade needle group than in the medication group(P<0.05).Conclusion Blade needle treatment has a good clinical effect in the treatment of CD patients,which is probably associated with its function in increasing blood perfusion of the brain tissue,and thus being worthy of clinical application.
引文
[1]李晓峰.颈源性眩晕与颈椎不稳定相关性及其中医分型论治临床研究[J].中医临床研究,2014,6(24):61-62.
[2]BRANDT T,BRONSTEIN A M.Cervical vertigo[J].J Neurol Neurosurg Psychiatry,2001,71(1):8-12.
[3]柯尊华,王静怡.颈椎病流行病学及发病机理研究进展[J].颈腰痛杂志,2014,35(1):62-64.
[4]曾建勇,范洪武,张云涛,等.颈性眩晕的病理机制、诊断和治疗[J].临床与病理杂志,2015,35(8):1564-1569.
[5]魏见伟,王德春.颈源性眩晕的发病机制与诊治的研究进展[J].中国矫形外科杂志,2006,14(17):1317-1319.
[6]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[7]薛黎清.程氏“通脱法”针刺治疗颈源性眩晕的临床研究[D].南京:南京中医药大学,2017.
[8]吕晓兰,杨光福,武变英.颈源性眩晕的研究概况[J].中国实用医药,2013,8(9):237-238.
[9]LI Y,PENG B.Pathogenesis,diagnosis,and treatment of cervical vertigo[J].Pain Physician,2015,18(4):E583-E595.
[10]张雄伟,张以善,张智杰,等.大脑中动脉主干闭塞患者的经颅多普勒超声检测[J].中国临床医学,2006,13(5):719-721.
[11]庄礼兴,童娟,李月梅.压灸百会穴为主治疗颈性眩晕的临床研究[J].针刺研究,2000,35(2):124-126.
[12]韩文刚.眩晕病的TCD检查与临床[J].世界最新医学信息文摘,2015,15(7):102.
[13]谭晓丽,马江华,张晓莉,等.经颅多普勒超声(TCD)对头晕或眩晕患者的诊断价值研究[J].世界最新医学信息文摘,2015,15(71):143.
[14]桂星花,马朝阳,唐雷,等.人迎穴改良针刺法对椎动脉型颈椎病患者颈部血流速度的影响及疗效观察[J].针刺研究,2017,42(2):163-167.
[15]安凌飞,郁金岗,郑雷刚,等.大数据助力斜刃针治疗颈性眩晕[J].中医临床研究,2017,9(17):34-36.
[16]李霞,房连强,李里,等.以肩胛提肌起止点为刃针作用靶点治疗颈性眩晕的临床观察[J].针灸临床杂志,2013,29(11):27-29.
[17]郑雷刚,郁金岗,李永新,等.斜圆刃针对颈性眩晕患者血浆ET-1、CGRP水平的影响[J].中华中医药杂志,2017,32(10):4743-4745.
[18]郭长青,刘福水,马惠芳,等.针刀干预对颈椎病兔颈肌细胞凋亡的影响[J].针刺研究,2014,39(1):68-72.
[19]倪刚,毛世洲,陈庆亮,等.刃针结合推拿手法治疗椎动脉型颈椎病临床研究[J].新中医,2018,50(5):169-173.
[20]MAGNUSSON M,MALMSTRM E M.The conundrum of cervicogenic dizziness[J].Handb Clin Neurol,2016,137:365-369.
[2]BRANDT T,BRONSTEIN A M.Cervical vertigo[J].J Neurol Neurosurg Psychiatry,2001,71(1):8-12.
[3]柯尊华,王静怡.颈椎病流行病学及发病机理研究进展[J].颈腰痛杂志,2014,35(1):62-64.
[4]曾建勇,范洪武,张云涛,等.颈性眩晕的病理机制、诊断和治疗[J].临床与病理杂志,2015,35(8):1564-1569.
[5]魏见伟,王德春.颈源性眩晕的发病机制与诊治的研究进展[J].中国矫形外科杂志,2006,14(17):1317-1319.
[6]国家中医药管理局.中医病证诊断疗效标准[S].南京:南京大学出版社,1994.
[7]薛黎清.程氏“通脱法”针刺治疗颈源性眩晕的临床研究[D].南京:南京中医药大学,2017.
[8]吕晓兰,杨光福,武变英.颈源性眩晕的研究概况[J].中国实用医药,2013,8(9):237-238.
[9]LI Y,PENG B.Pathogenesis,diagnosis,and treatment of cervical vertigo[J].Pain Physician,2015,18(4):E583-E595.
[10]张雄伟,张以善,张智杰,等.大脑中动脉主干闭塞患者的经颅多普勒超声检测[J].中国临床医学,2006,13(5):719-721.
[11]庄礼兴,童娟,李月梅.压灸百会穴为主治疗颈性眩晕的临床研究[J].针刺研究,2000,35(2):124-126.
[12]韩文刚.眩晕病的TCD检查与临床[J].世界最新医学信息文摘,2015,15(7):102.
[13]谭晓丽,马江华,张晓莉,等.经颅多普勒超声(TCD)对头晕或眩晕患者的诊断价值研究[J].世界最新医学信息文摘,2015,15(71):143.
[14]桂星花,马朝阳,唐雷,等.人迎穴改良针刺法对椎动脉型颈椎病患者颈部血流速度的影响及疗效观察[J].针刺研究,2017,42(2):163-167.
[15]安凌飞,郁金岗,郑雷刚,等.大数据助力斜刃针治疗颈性眩晕[J].中医临床研究,2017,9(17):34-36.
[16]李霞,房连强,李里,等.以肩胛提肌起止点为刃针作用靶点治疗颈性眩晕的临床观察[J].针灸临床杂志,2013,29(11):27-29.
[17]郑雷刚,郁金岗,李永新,等.斜圆刃针对颈性眩晕患者血浆ET-1、CGRP水平的影响[J].中华中医药杂志,2017,32(10):4743-4745.
[18]郭长青,刘福水,马惠芳,等.针刀干预对颈椎病兔颈肌细胞凋亡的影响[J].针刺研究,2014,39(1):68-72.
[19]倪刚,毛世洲,陈庆亮,等.刃针结合推拿手法治疗椎动脉型颈椎病临床研究[J].新中医,2018,50(5):169-173.
[20]MAGNUSSON M,MALMSTRM E M.The conundrum of cervicogenic dizziness[J].Handb Clin Neurol,2016,137:365-369.