摘要
颈性眩晕(CerivealVertigo, CV),又称“颈源性眩晕”,是由于颈部椎间盘变形、骨质增生、髓核突出、神经刺激、慢性劳损、外伤和炎症等多种因素刺激和压迫周围的神经和血管,引起大脑供血不足而出现以头晕、恶心、呕吐及颈部不适为主症的一类病症。临床症状一般有头晕,恶心,呕吐,耳鸣,视物不清等,最突出的特点为体位性眩晕即当改变体位尤以扭转头部时眩晕加重,严重者可发生碎倒,但一般不伴有意识障碍。可见,该病症并不是一个特定的疾病名称,而是泛指由于颈椎病而引起椎-基底动脉供血不足而导致眩晕的一类中枢性眩晕名称。
随着社会现代化的进程,人们的生活习惯、工作发生了极大的变化,不少新生的“现代病“也日趋增多,颈椎病就是其中的一种。原本为老年性的颈椎病现已向中青年扩展,甚至一些中学生也常有头痛头晕,颈项酸痛不适的现象。如不及早地进行防治,将严重影响人们的正常工作、健康和生活。严重者可因脊髓压迫而瘫痪,也可因长期脑供血不足而导致脑细胞失养,记忆力衰退,引发老年性痴呆。
根据近几年研究报告显示,眩晕病在40～60岁的中老年人群中多发,而且总数的40%是由颈性眩晕引起。现代社会的逐步发展逐渐增加的工作效率和劳动强度,并且随着广泛使用电脑和生活节奏的加快,大大增加了年轻人的颈性眩晕的发病率,并且长期保持低头状态工作会与本病有密切关系。此病会对工作效率和生活质量造成一定影响。
颈性眩晕的病因及发病机制目前尚无统一的观点,诸多学者阐论不一。国内学者主要将颈性眩晕归入椎动脉型和交感型颈椎病的范畴。尽管国内外有理疗、药物治疗、手术等治疗方法。但是针灸疗法凭借着简洁、方便、经济、绿色的优势受到越来越多患者的欢迎。随着国内针灸治疗颈性眩晕的临床随机对照试验日益增多,有必要系统全面了解该领域的针灸临床的科研现状和文献计量情况。因此,本研究采用循证医学和文献计量学的方法,全面评价针灸治疗颈性眩晕的临床随机对照试验的研究现状,以期为同道提供参考。
另外,临床随机对照试验是验证干预措施疗效的标准设计方案,其研究和报告质量直接影响对干预措施疗效的判断。因此,本研究还采用国际公认的试验报告统一标准(CONSORT声明)和报告针刺临床试验中干预措施的国际标准(STRICTA)来评价针灸治疗颈性眩晕的临床随机对照试验的报告质量,以期为今后进行高质量研究提供改进依据。
目的：
依据既定检索策略,CNKI298篇、CBM107篇、WF45篇、VIP46篇。文献语言均为中文。经过浏览题目、文摘、全文后,确定180篇随机对照试验进行研究。通过筛选,排除不符合纳入标准的253篇文献,包括：重复检出的文献210篇；综述、评论、探讨类文献30篇；动物实验类文献12篇；重复发表的文献6篇；非随机对照临床试验文献21篇；个案经验文献6篇；其他不符合纳入文献51篇。详细的文献筛选流程见图1。所有文献发表的时间为1997-2011年。依据临床流行病学和循证医学原则和方法,本研究制定了《针灸治疗颈性眩晕试验质量评价信息采集表》(简称评价表)。内容涉及基本情况,诊断、纳入和排除标准,估算样本含量,基线资料可比性,随机方法,随机方案隐藏,观察指标和疗效标准,盲法使用,病例随访,不良反应,统计学处理以及结论推导等。
方法：
文献系统分析与评价是依据临床流行病学和循证医学原则和方法,本研究制定了《针灸治疗颈性眩晕试验质量评价信息采集表》(简称评价表)。内容涉及基本情况,诊断、纳入和排除标准,估算样本含量,基线资料可比性,随机方法,随机方案隐藏,观察指标和疗效标准,盲法使用,病例随访,不良反应,统计学处理以及结论推导等。而Meta分析是按照Cochrane Review Handbook5.0推荐使用的质量评价标准：偏倚风险评估工具,包括7个方面：①随机分配方法；②分配方案隐藏；③对研究对象、治疗方案实施者、结果测量者采用盲法；④结果数据的完整性；⑤选择性报告研究结果；⑥其它偏倚来源。针对每一项研究结果,对上述7条作出“是”(低度偏倚)、“否”(高度偏倚)和“不清楚”(缺乏相关信息或偏倚情况不确定)的判断。两位评价者交叉核对纳入试验的质量评价结果,对有分歧而难以确定则通过讨论或由第三位评价者协助解决。
结果：
按检索策略和资料收集方法,在第一部分检索180篇文献中继续筛选合格文献,最终纳入11篇随机对照试验。均为单个随机平行对照试验。除4没有交代纳入病例来源,其余研究对象均为门诊和／或住院病例。颈性眩晕有2项试验采用1994年国家中医药管理局颁布的《中医病症诊断疗效标准》、7项研究采用同第二届全国颈椎病专题座谈会制定的标准,有1项试验采用中药新药临床研究指导原则的标准。仅有3项研究交代纳入标准,6项研究叙述排除标准。在疗效标准方面,7项研究采用国家中医药管理局颁布的《中医病症诊断疗效标准》,另有两项研究采用眩晕症状与功能评估量表,其余均为自拟标准。所有研究均采用临床有效率,有3项研究观测椎基底动脉血流的情况,2项研究采用颈性眩晕症状与功能评估量表。截止2011年底,针灸治疗颈性眩晕的随机对照试验逐年增加,研究机构的层次不断提高,特别是几年来注重随机序列方法的使用,但是仍然存在如下方面的不足：①随机序列的产生未能交代。随机序列是临床试验减少偏倚,提高试验结果真实性的首要措施。如果随机序列没有交代,那么证据的使用者无法判断该文献是否是真正的随机对照试验。②缺乏盲法的使用。③组间资料缺乏足够论述。真正意义上双盲也许很难实施,但是评价者盲法和分配隐藏是可以实施的。以上几点是今后我们在设计针灸治疗颈性眩晕的干预试验时应该注意的。
针灸之所以能长期存在并经久不衰,关键在于其防治病症的广泛性和有效性。而随机对照试验是评价针灸临床防治效果的最有力的工具之一。开展针灸随机对照试验研究可对病症认识,针灸防治病症的有效性、安全性和社会-经济效益等方面做出较为客观的评估,为针灸相关决策提供可靠的最高级别证据,也为进一步开展高质量的针灸临床研究在方法学上提出建设性意见。国内针灸或相关领域的研究人员在接受了循证医学和临床流行病学的基本训练后,从事此类型研究的逐年增多。1997就有针灸治疗颈性眩晕的随机对照试验出现,继而大量试验研究不断涌现,说明针灸关注颈性眩晕的临床研究起步还是比较早的,传播也日益广泛。本研究评价了从1997-2011年12月间国内期刊发表的180篇有关针灸的治疗颈性眩晕的随机对照试验。总体来看,这些文献比以往的临床观察有了很大的进步,体现在提出的临床问题比较具体,多角度评价针灸的临床疗效,逐步向国际标准靠拢,研究结论较为客观,但是仍存在一些不足。
Cervical vertigo (CerivealVertigo CV), also known as "cervical vertigo", is due to neck disc deformation, bone hyperplasia, and herniated nucleus, nerve stimulation, chronic fatigue, trauma and inflammation and other factors that stimulate and oppression around the nerves and blood vessels, causing insufficient blood supply to the brain and main symptoms of dizziness, nausea, vomiting, and neck discomfort of a class of diseases. Clinical symptoms are dizziness, nausea, vomiting, ringing in the ears, as the material is unclear, the most prominent features of positional vertigo that is, when a change of position especially when you turn the head, dizziness increased, severe cases can be broken down, but generally do not accompanied by disturbance of consciousness. Visible, the disease is not a specific disease name, but refers to cervical spondylosis of vertebral-basilar artery insufficiency caused by the vertigo of a class of central vertigo name.
With the process of social modernization, people's living habits, work has undergone great changes, many nascent "modern disease" is also increasing, cervical spondylosis is one of them. Originally for age-related cervical disease is now to expand middle-aged, and even some middle school students often have headaches and dizziness, neck pain discomfort phenomenon. If we do not control, will seriously affect people's normal work, health and life. Severe cases may be due to spinal cord compression and paralysis, can also be due to the insufficiency of long-term brain and cause brain cell dystrophy, memory loss caused by Alzheimer's disease.
According to the research report shows that in recent years, vertigo in40to60years in the elderly population in the hair, and40%of the total number of cervical vertigo. The gradual development of modern society, gradually increase the work efficiency and labor intensity, and with the acceleration of widespread use of computers and the pace of life, greatly increased the incidence of cervical vertigo of young people, and long bow to state with the disease close relationship. Work efficiency and quality of life of the disease will have some impact.
The etiology and pathogenesis of cervical vertigo is no unified point of view, many scholars explain on the different Domestic scholars cervical vertigo in the vertebral artery type and scope of the sympathetic cervical spondylosis. Although the domestic and foreign physical therapy, medication, surgery and other treatments. Acupuncture by virtue of simplicity, convenience, economy, green advantage more and more welcomed by patients. With the increasing number of domestic acupuncture treatment of cervical vertigo clinical randomized controlled trials, the necessary systematic and comprehensive understanding in the field of acupuncture clinical research status and bibliometric situation. In this study, evidence-based medicine and bibliometrics, a comprehensive evaluation of randomized controlled trials of acupuncture treatment of cervical vertigo Clinical Research, in order to provide a reference for fellow.
In addition, randomized controlled trials to verify the efficacy of interventions to standard design, studies and reports a direct impact on the quality of the judgment of the efficacy of interventions. Therefore, this study also uses an internationally recognized test Consolidated Standards of Reporting (CONSORT statement) and international standards (The STRICTA) report on acupuncture clinical trials of interventions to evaluate the clinical acupuncture treatment of cervical vertigo to the quality of reporting randomized controlled trials of future high-quality research to provide improved basis.
Objective:Based on the established search strategy, CNKI298CBM107articles, WF45, VIP46. Literature languages are Chinese. Browse topics, abstracts and full text to determine the180randomized controlled trials to study. Exclude through the screening,253articles met the inclusion criteria, including: duplicate detection literature210; Review, review, investigate the class of30; of animal experiments12;6repeat the published literature; non-randomized controlled21; of the clinical trials of six cases in the empirical literature; other does not meet the51included studies. Detailed literature screening process shown in Figure1. All literature published from1997to2011. In accordance with the principles and methods of clinical epidemiology and evidence-based medicine, this study developed the acupuncture treatment of cervical vertigo test quality evaluation information collection form (referred to as the evaluation form). Covering basic, diagnostic, inclusion and exclusion criteria, to estimate the sample size, comparability of baseline data, the random method, random program, hide, observe the indicators and efficacy standards, blinding, use the follow-up of cases, adverse reactions, statistical analysis, and conclusions deduced and so on.
Results:The search strategy and data collection methods, retrieved in the first part180in the literature continue screening qualified literature, and ultimately included in the11randomized controlled trials. Are the single randomized controlled trials. In addition to four, no mention into the source of cases, the rest of the study are outpatient and/or hospitalized patients. Cervical vertigo two trials using the "Chinese disease diagnosis and efficacy standards promulgated by the State Administration of Traditional Chinese Medicine in1994, seven studies using the standards set by the Second National symposium of cervical spondylosis, a test of new herbal drugs clinical research standards of the guiding principles. Only three studies account for the inclusion criteria and six studies described in the exclusion criteria. Promulgated by the State Administration of Traditional Chinese medicine disease diagnosis and efficacy standards in terms of efficacy standards, seven studies, two other studies with vertigo symptoms and functional assessment scale, the rest are self. All studies using clinical efficiency, there are three observations of vertebral basilar artery blood flow, two cervical vertigo symptoms and functional assessment scales. By the end of2011, the randomized controlled trials of acupuncture treatment of cervical vertigo increased year by year, and continuously improve the level of research institutions, especially a few years to focus on the use of random sequence method, but there are still the following deficiencies:①The random sequence generation failed to be accountable. Random sequence of clinical trials to reduce bias, the primary measures to improve the authenticity of the test results. If the random sequence is not accountable, then the users of the evidence can not determine whether it is truly randomized controlled trials of the literature.②Group baseline information on the lack of adequate description. Although most trials are accountable to the baseline data were comparable, but the detailed data and statistical value is not well represented. Such clinical trials Qi comparability will be greatly reduced.(3) blinded use missing. Blinded use and random adaptation, the main purpose is to make the observation execution and subjects are not subject to the subjective will have impact in order to reduce test bias. Although the true sense of the double-blind may be difficult to implement, but the evaluator blinding and allocation concealment can be implemented. The above points are the future, we should pay attention to the design of acupuncture treatment of cervical vertigo Intervention Trial.
Acupuncture has been able to exist for a long and enduring, the extensiveness and effectiveness of the key to its prevention and control disease. Randomized controlled trial is one of the most powerful tool in the evaluation of prevention and treatment of acupuncture effect. To carry out acupuncture randomized controlled Experimental Study on understanding of the disease, the effectiveness of acupuncture control the disease, security and social economic benefits to make a more objective assessment, to provide the highest level of evidence for acupuncture-related decision-making, but also for further quality acupuncture clinical research on the methodology put forward constructive ideas. Domestic acupuncture or related fields, researchers in evidence-based medicine and clinical epidemiology training, engaged in this type of research is increasing year by year. There are randomized controlled trials of acupuncture treatment of cervical vertigo1997, then a lot of tests continue to emerge, indicating that the clinical research of acupuncture concern of cervical vertigo started earlier, the spread of increasingly widespread. This study evaluated the randomized controlled trial of180domestic journals published from1997to December2011, the acupuncture treatment of cervical vertigo. Overall, the literature than the previous clinical observation have made great progress, reflecting the specific clinical issues in the proposed multi-angle to evaluate the clinical efficacy of acupuncture, and gradually move closer to international standards, a more objective conclusions, but there are still some inadequate.
引文
[1]范德辉,刘悦.针刺结合正骨推拿治疗颈性眩晕疗效观察江西中医药,2006,(02)
[2]金圣博,李明珠,韩明舫.扳法结合针刺对颈性眩晕患者疗效及椎-基底动脉血流的影响[]].辽宁中医药大学学报,2011,(04)
[3]李斌.龙氏正骨手法结合针灸治疗颈性眩晕的临床研究[D].广州中医药大学,2009,.
[4]林家驹,朱维明,陈利芳.针灸加正骨治疗颈性眩晕58例临床观察[J].江中医杂志,2008,(03)
[5]石普斌.推拿手法合针刺治疗颈性眩晕52例[J].浙江中医杂志,2010,(11)
[6]王君.针刺配合手法治疗颈性眩晕100例[J].中国中医药现代远程教,2009,(09)
[7]王文春,张安仁,卢家春.改良《颈性眩晕症状与功能评估量表》在椎动脉型颈椎病中医临床中的应用及评价[J].西南军医,2007,(04)
[8]张小峰.针刺联合推拿治疗颈性眩晕188例[J].针灸临床杂志,2007,(10)：8-9
[9]张玉和,张立平,张冬云.三针刺配合直旋扳法治疗颈性眩晕症[j].针灸临床杂志,2003,(04)
[10]张泽胜；陈千里.针刺配合颈椎短杠杆微调手法治疗颈性眩晕[J]按摩与导引,2008,(03)
[11]赵大贵；穆敬平；彭新民.颈夹脊电针加三维正骨治疗颈性眩晕临床观察[J].中国中医急症,2007,(08)
[12]曹鸿寿,张杰.针刺涌泉穴治疗颈性眩晕100例临床观察.中国针灸,2000(11)：653
[13]崔海,王东岩,任占敏.针刺颈夹脊穴治疗颈性眩晕30例临床观察.山西中医,2004；20(5)：31
[14]戴朝富.项丛刺配合TDP照射治疗颈性眩晕临床观察.中国针灸,1999；(5)：279
[15]杨安府.大椎穴配落枕穴治疗颈性眩晕症.陕西中医函授,1999；(6)：30
[16]张超云,陈惠贞.风池穴透刺治疗颈性眩晕32例.上海针灸杂志,2006；25(3)：29
[17]赵学田.灵龟八法针法为主治疗颈性眩晕49例.福建中医药,2006；37(5)：37
[18]陈小凯,吴虹.针晕听区治疗颈性眩晕80例疗效观察.针灸临床杂志,2003；19(2)： 12
[19]李燕,陈晓波.风池穴位注射治疗颈性眩晕74例疗效观察.河北中医,2006；28(8)：604
[20]范卫星.穴位注射治疗颈性眩晕36例.针灸临床杂志,1998；14(10)：12-13
[21]周长斗.风池穴温针灸治疗颈性眩晕疗效观察.中国针灸,2000；(5)：277
[22]徐运瑜.温针灸治疗颈性眩晕疗效观察,2006：18(6)：542
[23]曾小香.隔姜灸治疗颈性眩晕40例疗效观察.新中医,2004；36(8)：52
[24]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.针刺研究,2000：25(2)：124
[25]诸灵军.推拿结合针刺治疗颈性眩晕78例.陕西中医,2002；23(6)：545
[26]邹敏.推拿配合针灸治疗颈性眩晕65例.实用中医药杂志,2002；28(7)：35
[27]李丽英.针刺配合推拿治疗颈性眩晕120例.辽宁中医学院学报,2004；6(5)：407
[28]郭友华.丹参注射液治疗颈性眩晕47例[J].医药导报,2001,20(9)：579.
[29]陈永忠,任义钟,CHEN Yong-zhong, REN Yi-zhong电针配合牵引治疗颈性眩晕临床观察[J].上海针灸杂志,2007,26(5).
[30]林创坚,陈怀,陈国华.调整肌松复合手法治疗颈性眩晕60例临床对照研究[J].按摩与导引,2006,22(7).
[31]膝淑霞,杨爱东.孔霞.定眩汤治疗颈性眩晕47例临床观察[J].中国中医急症,2004,13(10)：652-653.
[32]刘黎明.葛根天麻饮治疗颈性眩晕40例[J].四川中医,2005,23(Ⅰ)：69.
[33]熊永铮,熊康寿.理脊推拿配合益气通脉饮治疗颈源性眩晕36例疗效观察[J].湖南中医药导报,2003,9(11).
[34]马顺利.养血清脑颗粒治疗颈性眩晕30例[J].光明中医,2008,23(5)：625.
[35]孙迎东,住风芹,孙云廷.中药定晕1号方治疗颈性眩晕96例临床观察[J].中国中医急症,2008.17(9)：1198.1200.
[36]张秀瑛.中西医结合治疗颈性眩晕50例疗效观察[J].实用中医内科杂志,2007,21(3).
[37]陈述列.中药配合针刺治疗颈性眩晕[J].时珍国医国药,2005,16(1).
[38]赵冀伟.养血清脑颗粒治疗颈性眩晕30例[J].上海中医药杂志,2003,37(11).
[39]周勤.针药并用治疗颈性眩晕临床观察[J].上海针灸杂志,2004.23(3)：10-11.
[40]胡永文,吴云刚,吴春雷,等.自拟止晕方治疗椎动脉型颈椎病疗效观察[J].福建中医药。2005,36(2)：16.17.
[41]王瑜兰.长春西汀治疗椎基底动脉供血不足性眩晕疗效观察.江西医药,207,42(5)：428-429
[42]陈小华,叶兴荣,陈正东.舒血宁与尼莫地平联用治疗椎基底动脉供血不足性眩晕.华北国防医药,207,19(4)：47-48.
[43]刘慧玲,于肪,李晓娜.盐酸氟桂利嗪治疗椎基底动脉供血不足性眩晕临床观察.现代中西医结合杂志,2007,16(23)：3317.
[44]于兰芳,袁波,黄晓春等.杏丁联合胞二磷胆碱治疗中老年椎-基底动脉供血不足性眩晕的研究.现代中西医结合杂志,206,15(20)：2758-2760.
[45]徐辉.麦肯基治疗技术治疗颈椎病.中国临床康复,2003：2.
[46]毛玉容,黄东峰Mckenzie诊疗法在颈椎病中的应用.中华医学康
[47]章岩,高恒强Mckenzie综合治疗法对青年期颈椎病的近期和远期疗效.中国临床康复,206,21：5.
[48]陆延廷.骨科康复学.第2版.北京：人民卫生出版社,2007：869-871.
[49]诸灵军.推拿结合针刺治疗颈性眩晕78例.陕西中医,2002；23(6)：545
[50]胡斌清.推拿整复手法治疗颈性眩晕126例.上海中医药杂志,2008：9(42)23
[51]王和生,李忠仁.针刺配合灯盏细辛注射液治疗颈性眩晕40例.江苏中医药,2007；39(4)： 41
[52]任亚锋.加味温胆汤配合针刺治疗颈性眩晕65例.河南中医,2005；25(6)：62-63
[53].李应时.针灸加穴位注射治疗颈性眩晕75例.上海针灸杂志,1998；17(4)：9
[54]刘素芬.综合疗法治疗颈性眩晕112例.河南中医,2005；25(12)：67
[55]吴笛,吴艳华,谢永红.项针配合药物治疗颈性眩晕临床观察.上海针灸杂志,2008：9(27)23
[56]Rascol O,Hain TC,Brefel C,er sl.Anutivertigo medications and drug-induced vertigo.Drugs,1995,50(5):77
[57]Anonemous.InvestigationofAntivertigoDrugs Treatment美国医学会杂志(中文版),1999,5：108.
[58]HolmesB,BrogdenRN,HelRC,etal.Flunarizine,Areviewofitsp harmaeodynamicandtherapenticuse.Drusg,1984,27:6.
[59]Staesen AJ.Teratment of circulatory disturbances with flunarizine and cinnarline.VASAZ Gefaesskrankheiten,1997,6:59.
[60]Wang-J,Dutia MB. Efects of histsanmine and berashistine onrat-medial vestibular nucleus neurones:possible mechanism of action of anti-histaminergic drugs in veaigo and motion sickness.EXP Brain Res,1995,105(1):18.
[61]曹振玲,屈秋民,张辉等.倍他司汀治疗眩晕40例分析.西北药学杂志,1999,14(6)：267
[62]王涌,王小平,曹捷.沙塞普肽(胎脑)注射液治疗老年性眩晕症21例分析.现代中西医结合杂志.2000,9(21)：2158.
[63]王惠青,张莹,魏其达.尼麦角林治疗椎-基底动脉缺血性眩晕.中国新药与临床杂志,2001,20(3)：203.
[64]王瑜兰.长春西汀治疗椎基底动脉供血不足性眩晕疗效观察.江西医药,207,42(5)：428-429
[65]夏旭东,吴健春.甲磺酸倍他司汀治疗椎基底动脉供血不足性眩晕临床疗效观察.齐齐哈尔医学院学报,2007,28(15)：1807.
[66]陈小华,叶兴荣,陈正东.舒血宁与尼莫地平联用治疗椎基底动脉供血不足性眩晕.华北国防医药,207,19(4)：47-48.
[67]刘慧玲,于肪,李晓娜.盐酸氟桂利嗪治疗椎基底动脉供血不足性眩晕临床观察.现代中西医结合杂志,2007,16(23)：3317.
[68]于兰芳,袁波,黄晓春等.杏丁联合胞二磷胆碱治疗中老年椎-基底动脉供血不足性眩晕的研究.现代中西医结合杂志,206,15(20)：2758-2760.
[69]徐辉.麦肯基治疗技术治疗颈椎病.中国临床康复,2003：2.
[70]毛玉容,黄东峰Mckenzie诊疗法在颈椎病中的应用.中华医学康复,2003,18：3.
[71]章岩,高恒强Mckenzie综合治疗法对青年期颈椎病的近期和远期疗效.中国临床康复,206,21：5.
[72]陆延廷.骨科康复学.第2版.北京：人民卫生出版社,2007：869-871.
[73]国家中医管理局.《中医病证诊断疗效标准》.中级医刊,1995；30(9)：总571
[74]邵青,李建华.中医药治疗颈性眩晕90例疗效观察[J].云南中医中药杂志.2003,24(5)：6-7.
[75]刘玉启,周荣生,贾广义.中药离子导人配合颈椎牵引治疗颈性眩晕临床观察[J].中国中医急症.2004.13(8)：497-498.
[76]万于军,胨欣童,梁云花等.中药汽化热疗并辨证论治治疗颈性眩晕疗效观察[J].中国中医急症,2007.16(8)：930-931.
[77]熊卫荣.针灸加中药内服外熨治疗颈性眩晕54饲总结[J].湖南中医杂志,2005,21(5)：20-21.
[78]尚正兰,曹静,续雅芳等.电针剜配合中药离子导人治疗颈性眩晕90例疗效观察[J].湖南中医药导报,2003,9(Ⅱ)：40-41.
[79]王子梅.任连堂.颈牵配合中药熏蒸治疗颈性眩晕疗效观察[J].中国医药论坛,2005。3(12)：78.
[80]罗伦,伍明全.颈性眩晕外治法加中药内服的疗效评估[J].华西医,2007.22(1)：64-65.
[81]陈秋顺.芍药木瓜汤配合手法治疗颈性眩晕的疗效观察与机制分析[J].中国中医骨伤科杂志,2006,14(11)：45-9.
[82]潘佳蕾,汤聘珊.中西医结合治疗颈性眩晕症42例疗效观察[J].浙江中西医结合杂志.2005,15(4)：213—214.
[83]张秀瑛.中西医结合治疗颈性眩晕50例疗效观察[J].实用中医内科杂志,2007.21(3)：49.
[84]李福.杨明珊.针刺治疗老年性颈性眩晕[J].河北医学。2006。12(5)：440—441.
[85]曹友德,王敏.针刺配合按摩治疗椎动脉型颈椎病的临床观察Clinical Observation of Acupuncture and Moxibustion for Vertebroarterial Cervical Spondylopathy《针灸临床杂志》2001年第17卷第10期
[86]陈卓伟.针灸与推拿结合治疗椎动脉型颈椎病56例《广东医学》2007年第28卷第05期
[86]赵亮.陕西中医SHAANXI JOURNAL OF TRADITIONAL CHINESE MEDICINE2006年第09期
[87]彭支莲,黄剑.针刺配合推拿治疗椎动脉型颈椎病疗效观察Observations on the Efficacy of Acupuncture plus Massotherapy in Treating Vertebroarterial Cervical Spondylopathy<《上海针灸杂志》2009年第28卷第01期
[88]莫元森.手法配合针刺治疗椎动脉型颈椎病30例疗效观察《第十次全国中西医结合创伤骨科学术大会》2002年第10卷
[89]杜保东,王建国.针刺推拿治疗椎动脉型颈椎病84例《现代中医药》2008年第28卷第02期
[90]赵春峰,刘金杰,张宇.针刺加牵引治疗椎动脉型颈椎病70例临床观察《中国现代医生》2008年第46卷第20期
[91]苏小霖,彭明霞,张日霖.针刺结合推拿治疗椎动脉型颈椎病临床疗效观察《医学理论与实践》2008年第21卷第04期
[92]滕春光.针刺加推拿治疗椎动脉型颈椎病疗效观察Clinical Observation on Cervical Spondylopathy of Vertebral Arteria Type Treated with Acupuncture and Massotherapy<《广西中医学院学报》2000年第17卷第01期
[93]参照1992年青岛全国第二届颈椎病专题座谈会拟定的诊断标准(孙宇,陈琪.第二届全国颈椎病专题座谈会纪要[J].中华外科杂志,1993,31(8)：472)
[94]国家中医管理局.《中医病证诊断疗效标准》.中级医刊,1995；30(9)：总571
[95]王楚怀,卓大宏.颈性眩晕患者症状与功能评估的初步研究.中国康复医学杂志,1998：13(6)：245-247
[96]耿稚江译,佳帆校.治疗卒中的进展[J].国外医学情报,1999.20(6)：18
[97]王忠诚.神经外科学[M].人民卫生出版社,1998.667
[98]周祖华.刺五加注射液与复方丹参注射液治疗颈性眩晕的比较[J].中国新药与临床杂志。2000,19(Ⅰ)：68.
[99]金卓祥。晕乃停治疗颈性弦譬的临床研究[J].实用医学杂志,1998,14(3)：216--217.
[100]魏征,李维礼,龙层花,等.脊柱病因治疗学.香港：商务出版社,1995,9.
[101]曹健.手法治疗颈椎病50例《陕西中医》2000年第21卷第07期
[102]夏娣文,王玉龙,畲江健,李小萍.针灸和手法治疗椎动脉型颈椎病的临床研究Clinical Study on Cervical Spondy lopathy of Vertebral Artery Type Treated with Acupuncture, Moxibustion and Manipulation<《中国中医药科技》2003年第10卷第04期
[103]陈向阳,于丰彦,郭珊.按摩、针灸、理疗等物理疗法治疗椎动脉型颈椎病的临床观察《新中医》2007年第39卷第12期
[104]周祖华.刺五加注射液与复方丹参注射液治疗颈性眩晕的比较.中国新药与临床杂志。2000,19(Ⅰ)
[105]金卓祥。晕乃停疗颈性弦的临床研究.实用医学杂志,1998,14(3)：216--217.
[106]邵青。李建华.中医药治疗颈性眩晕90例疗效观察.云南中医中药杂志.2003,24(5)：6.-7.
[107]徐玉华.杞菊地黄汤合天麻钩藤饮加减治疗颈性眩晕跖例.陕西中医,2008,29(4)：34。134.
[108]吴芝兴,董黎强.推拿手法结合中药治疗颈性眩晕的临床观察.中国现代中西医杂志。2004,2(3)：204—206.
[109]范培武,王骏飞,王佐.等.手法复位牵引配合中药治疗颈性眩晕63例.中国基层医药,2002,9(12)：1086-1087.
[120]刘玉启,周荣生,贾广义.中药离子导人配合颈椎牵引治疗颈性眩晕临床观察.中国中医急症.2004.13(8)：497-498.
[121]万于军。胨欣童。梁云花,等.中药汽化热疗并辨证论治治疗颈性眩晕疗效观察[J].中国中医急症,2007.16(8)：930-931.
[122]熊卫荣.针灸加中药内服外熨治疗颈性眩晕54饲总结田.湖南中医杂志,2005,21(5)：20-21.
[123]尚正兰,曹静,续雅芳。等.电针剜配合中药离子导人治疗颈眩晕90例.陕西中医.2008,29(2)：214--215.
[124]王子梅.任连堂.颈牵配合中药熏蒸治疗颈性眩晕疗效观察田.中国医药论坛,2005。3(12)：78.
[125]罗伦,伍明全.颈性眩晕外治法加中药内服的疗效评估田.华西医学,2007.22(0：64-65.
[126]陈秋顺.芍药木瓜汤配合手法治疗颈性眩晕的疗效观察与机制分析[J1.中国中医骨伤科杂志,2006,14(11)：45—9.
[127]潘佳蕾,汤聘珊.中西医结合治疗颈性眩晕症42例疗效观察叨.浙江中西医结合杂志.2005,15(4)：213—214.
[128]张秀瑛.中西医结合治疗颈性眩晕50例疗效观察田.实用中医内科杂志,2007.21(3)：49.
[129]郑重,张泉,邓晓筑,等.电针改善前庭功能障碍所致颈源性眩晕的实验研究忉.中国临床康复.2004,8(Ⅰ)：102—105.
[130]王强,曾庆云,高昂.推拿治疗颈性眩晕34例观察[J1,山东医药。2002,42(36)：45.
[131]秦荚华.张扬,彭磊。等.针刀为主治疗颈性眩晕症200例临床观察L玎.光明中医,2008,23(2)：271,371.
[132]Moncadas, palmer MJ, Higgs EA, et al.Nitric oxide:physiology path physiology and pharmacology[J].Pharmacol Rev,1991,43:109-142
[133]Taddei S, Virdis A, giadoni L, et al. Effects of antihypertensive drugs on endothelial dysfunction:clinical implis SODions[J]. Drugs,2002,62(2):265-284
[134]Panza JA, Casino PR, Kilcoyne CM,et al. Role of endotheli— tim—. derived nitric oxide in theabnormal endothelium—de— pendment vasorelaxation of patients with esssential hypertension [J]. Circulation,1993,87:1468-1474
[135]陈辉,王文.氧自基与高血压关系的研究进展[J].高血压 杂志,2002,10(5)：414—417
[136]OGA M, YUGEL, TERADA K, et al. Tortuosity of the vertebral artery in patients with cervical spondylotic myelopathy[J]. Spine, 1996,21:1085-1089.
[137]沈志祥,李宜谋.实用中西医结合骨伤科手册[M].北京：中国中医药出版社,1991.484.
[138]第二届颈椎病专题座谈会纪颈椎病专题座谈会拟定诊断标准及分型标准中华外科杂志
