天麻素辅助针灸治疗颈性眩晕疗效及对血浆ET-1和CGRP水平的影响

目的:探讨针灸联合天麻素治疗颈源性眩晕的疗效及对患者血清血浆内皮素-1(endothelin-1,ET-1)及人降钙素基因相关肽(calcitonin gene-related peptide,CGRP)水平的影响,为临床治疗提供相关依据。方法:140例符合纳入标准的颈源性眩晕患者随机分为两组,每组各70例。对照组给予针灸治疗,观察组在对照组的基础上联合使用天麻素。疗程结束后,比较两组患者治疗疗效、眩晕残碍程度评定量表(dizziness handicap inventory,DHI)评分,经颅多普勒(TCD)数值及ET-1与CGRP水平。结果:观察组总治疗有效率为97.1%,明显高于对照组的74.3%的总有效率,比较有统计学差异(P0.05)。治疗后,观察组的眩晕DHI评分显著低于对照组治疗后评分,比较有统计学差异(P0.05)。TCD数值方面,与对照组相比,观察组治疗后左椎动脉(LVA),右椎动脉(RVA)及基底动脉(BA)参数数值增高的程度更明显,比较均有统计学意义(P均0.05)。观察组治疗后血浆ET-1水平显著低于对照组水平,CGRP水平显著高于对照组水平,比较均有统计学意义(P均0.05)。结论:针灸联合天麻素治疗颈源性眩晕疗效可靠,并且可以显著降低患者血清ET-1水平,升高CGRP水平,值得临床上进一步研究。     

颈椎复元丹结合力学平衡枕治疗椎动脉型颈椎病

目的:探讨口服颈椎复元丹及外用力学平衡枕治疗椎动脉型颈椎病的临床可行性及效果。方法:2011年3月-2013年4月治疗组对160例椎动脉型颈椎病患者采用颈椎复元丹结合颈椎力学平衡枕治疗,对照组160例服用天麻蜜环菌片配合颈椎牵引治疗,10 d为1个疗程,休息1 d后,开始下1个疗程,两组均治疗3个疗程。治疗后1年主要从治疗前后经颅多普勒超声,颈椎弓顶距变化、颈椎眩晕症状与功能评分及临床疗效进行疗效评定。结果:检测结果显示,治疗组椎基底动脉收缩峰期及舒张末期的血流量、弓顶距的改善、颈椎眩晕症状与功能评估积分的改善明显大于对照组,比较差异有统计学意义(P<0.05)。临床疗效评定,治疗组有效率96.2%,对照组有效率72.5%,比较差异有统计学意义(P<0.05)。结论:颈椎复元丹结合颈椎力学平衡枕治疗椎动脉型颈椎病疗效显著,能改善颈椎的生理曲度,提高椎动脉的顺应性从而增加脑部的血供,重建颈椎生物力学的稳定性。     

舒筋通络颗粒治疗颈椎病172例

目的:探讨舒筋通络颗粒治疗神经根型颈椎病和椎动脉型颈椎病的临床疗效.方法:回顾性分析了2010年5月至2011年5月门诊及住院的神经根型及椎动脉型颈椎病患者共172例.两型颈椎病的对照组均予以常规牵引治疗、相同手法推拿治疗,治疗组在对照组治疗方法基础上给予口服舒筋通络颗粒,1袋/次,3次/d,疗程1个月.结果:①神经根型颈椎病治疗组总有效率(85.45％)高于对照组(69.77％)(P＜0.05);神经根型颈椎病组在疼痛、压痛、上肢麻木、颈部活动受限、压顶试验和臂丛神经牵拉试验比较,差异具有统计学意义(P＜0.05),治疗组优于对照组,除对照组治疗后上肢肌力变化小明显外,两组治疗后其余观察项目均比治疗前改善(P＜0.05).②椎动脉型颈椎病治疗组总有效率(92.86％)明显高于对照组(76.74％)(P＜0.05);椎动脉型颈椎病患者在主要的症状、体征消失方面,两组头痛、眩晕、压顶试验方面比较,差异有统计学意义(P＜0.05),治疗组优于对照组;而转颈试验比较差异不具有统计学意义.结论:舒筋通络颗粒治疗神经根型颈椎病和椎动脉型颈椎病,在临床疗效和主要症状、体征消失方面有显著疗效.     

Hemodynamic Influence of Arteria Vertebralis Type Cervical Spondylosis Treated by Needling Yuzhen （BL 9） and Fengchi （GB 20）

为观察针刺治疗颈性眩晕的疗效及血流动力学改变,将66例患者随机分为玉枕和风池穴组、颈夹脊(C4-6)穴组,观察治疗前后颈性眩晕症状与功能评分变化及椎动脉彩色多普勒血流显像(CDFI)变化.两组治疗后评分增加,组间差异显著(P＜0.05),治疗后眩晕度评分增加,组间差异显著(P＜0.05).针刺玉枕和风池穴能显著改善颈性眩晕症状,增加椎动脉血流速度,且疗效优于夹脊穴.     

针刀疗法治疗颈源性眩晕的临床疗效研究

目的:观察针刀疗法治疗颈源性眩晕的临床疗效。方法:将符合纳入标准的80例颈源性眩晕患者随机分为治疗组与对照组,治疗组40例,采用针刀疗法治疗;对照组40例,采用针灸治疗;半个月为1个疗程。观察两组治疗前后眩晕症状与功能、TCD数值和颈椎X线的变化情况。结果:治疗组运用针刀疗法治疗后在眩晕症状与功能计分、TCD数值、颈椎X线变化方面均有明显改善,与治疗前相比,差异具有显著意义(P0.01);且明显优于对照组。结论:针刀疗法治疗颈源性眩晕疗效显著,值得临床推广使用。     

Treatment of 65 Cases of Cervical Vertigo Treated by Acupuncture plus Medication

目的：观察针灸配合葛根素治疗颈性眩晕的疗效。方法：将110例颈性眩晕患者分为治疗组和对照组。治疗组65例以针灸配合葛根素治疗，对照组45例采用西药治疗。结果：治疗组痊愈33例，有效29例，无效3例，总有效率95，38％。对照组痊愈12例，有效23例，无效10例，总有效率为77．87％，两组总有效率比较，治疗组疗效优于对照组（P〈0．01）。结论：针灸中药并用治疗颈性眩晕疗效优于西药治疗。     

消眩止晕片治疗颈性眩晕痰瘀内阻证的临床观察

目的:探讨消眩止晕片治疗颈性眩晕痰瘀内阻证的疗效及对氧化应激和血清内皮素(ET)-1,5-羟色胺(5-HT)和一氧化氮(NO)水平的影响。方法:筛选符合要求就诊的颈性眩晕患者118例为研究对象,参照数字表法随机分为对照组和治疗组各59例。对照组采用正骨联合针刺治疗。治疗组在对照组治疗的基础上口服消眩止晕片,5片/次,3次/d。两组患者均进行3周的连续治疗。比较两组患者颈性眩晕症状与功能评估量表(ESCV)评分、眩晕障碍量表(DHI)评分、椎-基底动脉血流速度、生活质量及临床疗效。检测两组患者血清超氧化物歧化酶(SOD),丙二醛(MDA),ET-1,5-HT和NO水平。结果:治疗后,治疗组ESCV评分显著高于对照组,DHI评分明显低于对照组(P 0. 01)。治疗组治疗后患者左椎动脉、右椎动脉及基底动脉血流速度均显著高于对照组(P 0. 01)。治疗组患者的临床总有效率为98. 25%,高于对照组的83. 93%(P 0. 05)。治疗后,治疗组患者SF-36量表各项评分均显著高于对照组(P 0. 01)。治疗后,治疗组患者血清SOD,NO水平均显著高于对照组,MDA,ET-1和5-HT水平均明显低于对照组(P 0. 01)。结论:在正骨联合针刺治疗的基础上,加服消眩止晕片治疗颈性眩晕疗效显著,调节患者体内氧化应激及血清ET-1,5-HT和NO水平可能与其临床疗效有关。     

短刺法针刺治疗颈源性头痛的疗效观察

[目的]观察短刺法针刺对颈源性头痛的治疗效果。[方法]将80例患者随机分为2组,每组40例,观察组采用短刺法针刺,对照组采用常规针刺。治疗前后观察头痛视觉模拟评分值变化。[结果]两组疼痛视觉模拟评分(VAS)评分与疗前差异均有统计学意义(P0.05);两组治疗后比较,组间差异有统计学意义(P0.05),观察组优于对照组。观察组临床治愈25例,显效11例,有效4例,无效0例,愈显率为90.0%;对照组临床治愈18例,显效11例,有效9例,无效2例,愈显率为72.5%,两组愈显率差异有统计学意义(P0.05)。[结论]短刺法针刺治疗颈源性头痛的疗效较常规针刺显著。     

仰卧位拔伸旋转复位法治疗颈性眩晕65例分析

目的:探讨仰卧拔伸复位法治疗颈性眩晕的作用及对调整寰枢关节位移方面的影响。方法:2007年8月～2012年3月将收治的65例颈性眩晕患者采用仰卧拔伸复位法治疗,每周治疗3次,4周为1个疗程。结果:经过治疗后,患者临床症状明显减轻。颈椎张口位X线显示寰枢关节位置有明显改善。脑部TCD示椎基底动脉血流明显改善。结论:仰卧拔伸复位法能有效恢复寰枢关节的正常位置,减少和消除其对椎动脉的刺激和压迫,以改善眩晕症状。     

电针加悬灸百会治疗颈性眩晕疗效观察

目的观察电针加悬灸百会治疗颈性眩晕的临床疗效。方法将78例颈性眩晕患者随机分为治疗组40例和对照组38例。治疗组采用电针结合悬灸百会治疗,对照组采用单纯电针治疗,1个疗程后统计疗效。结果治疗组总有效率为95.0%,对照组为84.2%,两组比较差异具有统计学意义（P〈0.05）。结论电针加悬灸百会是一种治疗颈性眩晕的有效方法。     

The effect of the combination of acupuncture and kinesiotherapy on upper cross syndrome based on mechanical balance principle – A randomized clinical trial: 浅析基于力学平衡原理针刺结合运动疗法治疗上交叉综合征疗效观察 -- 随机对照试验

ObjectiveTo observe the clinical effect of combined acupuncture and kinesiotherapy on upper cross syndrome (UCS) by a parallel randomized clinical trial.MethodsA total of 45 patients with UCS were recruited from the outpatients of Acupuncture-Moxibustion, Tuina and Rehabilitation Department of the First Affiliated Hospital of Hunan University of Chinese Medicine, the students of Hunan University of Chinese Medicine and the patients from the nearby communities in accordance with the inclusion criteria. Using the random number table method, they were divided into a combined treatment group (acupuncture plus kinesiotherapy, 23 cases) and a simple kinesiotherapy group (22 patients). Treatment for 4 weeks was one course, and two consecutive courses were required. The visual analog scale (VAS) score, the score of the assessment scale for cervical spondylosis, the value of surface electromyography (root mean square, RMS), and the cervical curvature value were used in the evaluation. The allocation scheme was concealed from the outcome assessors.ResultsThe data from 23 cases of the combined treatment group and 22 cases of the simple kinesiotherapy group were analyzed. Before treatment, the differences were not statistically significant in the general conditions, VAS score, assessment score of cervical spondylosis, cervical curvature value, and RMS in UCS patients between the two groups (all P > 0.05). After treatment, the VAS score was reduced compared with that before treatment in both groups (all P < 0.05). In two courses of treatment, the VAS score decreased as compared with that in one course of treatment in both groups (both P < 0.05), and the VAS score in the combined treatment group decreased more obviously after each course of treatment (both P < 0.05). The RMS decreased compared with that before treatment in each group (both P < 0.05), and the decrease in the combined treatment group was more obvious (P < 0.05). After treatment of each course, the assessment score was all increased as compared with that before treatment in two groups (all P < 0.05). In two courses of treatment, the assessment score was increased as compared with that in one course of treatment in both groups (both P < 0.05), and the score in the combined treatment group was increased more obviously in the two courses of treatment (P < 0.05). Regarding either the intra-group comparison or the inter-group comparison before and after treatment, the differences were not statistically significant (all P > 0.05), suggesting no obvious improvement of cervical curvature in the two courses of treatment in patients with UCS. However, cervical curvature tended to improve in the combined treatment group. The total effective rate was significantly different between the two groups (P < 0.05), indicating that the total effective rate in the combined treatment group was better than that in the simple kinesiotherapy group.No any adverse reactions occurred.ConclusionCombined treatment with acupuncture, kinesiotherapy, and kinesiotherapy alleviated pain, relieved the symptoms and physical signs, and improved the daily movement of the patients. However, the combined treatment of acupuncture and kinesiotherapy had a much better effect on UCS.     

透刺法为主治疗颈性眩晕症临床疗效观察及对脑血流速度的影响

目的：探讨透刺法为主治疗颈性眩晕症的临床疗效及其作用机理。方法：将120例颈性眩晕症患者随机分为治疗组和对照组，每组60例。治疗组采用透刺法为主，对照组采用传统针刺法，进行对照观察。同时对治疗前后的脑血流速度变化用经颅多普勒超声观察。结果：治疗组总有效率：91．67％，对照组总有效率：78．33％。经统计学处理，两组疗效差异有显著性意义（P〈0．05）。透刺法治疗后MCA、ACA、PCA最高平均血流速度明显改善，与同组治疗前比较P〈0．05或P〈0．01。治疗组与对照组治疗后比较P〈0．05，差异有显著意义。结论：透刺法为主治疗颈性眩晕症，能够改善眩晕症状，是目前治疗此疾病的有效方法之一。     

针刺配合电针治疗脑卒中后强哭强笑的疗效观察

[目的]通过观察电针疗法治疗卒中后病理性哭笑(PLC),观察治疗前后患者的智能状态(MMSE)、社会行为能力(BBS)、日常生活功能(ADL)、汉密尔顿抑郁量表(HAMD)评定、血清5-羟色胺(5-HT)浓度的变化,评价电针疗法治疗卒中后病理性哭笑的临床疗效。[方法]将60例卒中后病理性哭笑患者采用随机数字表法分为治疗组、对照组各30例。在基础治疗的同时,治疗组采用针刺配合电针疗法,对照组口服西药治疗,1周为1个疗程,共治疗3个疗程。于治疗前后对两组患者MMSE、BBS、ADL、HAMD、5-HT浓度进行测定,将结果进行统计学分析。[结果]两组患者治疗后MMSE、BBS、ADL、HAMD、5-HT浓度比较差异均有统计学差异(P0.01或P0.05),两组患者治疗后组间比较亦有统计学差异(P0.01)。[结论]电针疗法可明显改善卒中后病理性哭笑患者的MMSE、BBS、ADL、情志变化及5-HT浓度,其疗效优于西药治疗。     

泽泻汤加味治疗痰浊中阻型颈性眩晕54例临床观察

目的 观察泽泻汤加味治疗痰浊中阻型颈性眩晕患者的临床疗效.方法 将108例痰浊中阻型颈性眩晕患者随机分为治疗组和对照组各54例,治疗组口服泽泻汤加味,对照组口服甲磺酸倍他司汀(敏使朗)治疗,两组均连续治疗2周后评价临床疗效,比较治疗前后两组主要症状评分、脑血流动力学指标[包括左侧椎动脉(LVA)、右侧椎动脉(RVA)、基底动脉(BA)]水平,并观察不良反应.结果 治疗组总有效率为85.18％,对照组总有效率为66.67％,治疗组明显优于对照组(P＜0.05).与治疗前比较,两组治疗后眩晕、头痛、恶心、耳鸣积分差异均有统计学意义(P＜0.05),治疗组效果更加显著(P＜0.05).与治疗前比较治疗组在改善LVA、RVA、BA方面差异均有统计学意义(P＜0.05),而对照组仅在改善LVA方面差异有统计学意义(P＜0.05);与对照组比较,治疗组在改善LVA、BA方面效果更加显著(P＜0.05).结论 泽泻汤加味能有效改善痰浊中阻型颈性眩晕症状、脑血流动力学,具有较好的安全性.     

多功能套针浮刺疗法治疗神经根型颈椎病——一项随机对照观察研究＊

目的 评价多功能套针浮刺疗法对神经根型颈椎病的临床疗效。方法 选取256例神经根型颈椎病患者，按随机数字表法分为观察组与对照组各128例。观察组应用多功能套针浮刺疗法进行干预，对照组为常规针刺治疗。两组患者均治疗7天。分别于治疗前后观察两组患者的简化McGill疼痛问卷（SF-MPQ）、国际标准颈椎功能障碍指数（NDI）和田中靖久颈椎病症状20分法量表评分，并于治疗结束后3个月观察复发率。结果 两组患者治疗后的SF-MPQ量表评分、NDI量表评分及田中靖久颈椎病症状20分法评分与治疗前相比均有改善（P<0.05），且观察组优于对照组（P<0.05）；两组患者于治疗后3个月随访，SF-MPQ量表评分与治疗后相比均有改善，且观察组优于对照组（P<0.05）；观察组临床疗效总有效率为96.88%，愈显率为81.25%；对照组总有效率为78.13%，愈显率为46.88%，观察组优于对照组（P<0.05）。结论 应用多功能套针浮刺疗法治疗神经根型颈椎病临床疗效显著，见效较快，可有效降低其复发率，且作用稳定，效果持久，值得临床推广应用。     

葛根二藤汤治疗椎动脉型颈椎病的临床观察

目的:观察葛根二藤汤治疗椎动脉型颈椎病的临床疗效,并探讨其对椎-基底动脉血流动力学的影响。方法:将60例患者随机分为治疗组和对照组,治疗组服用葛根二藤汤治疗,对照组服用盐酸氟桂利嗪治疗。两组均以两周为1个疗程,连续治疗2个疗程。分别观察两组患者治疗后的临床疗效,同时对两组患者治疗前后经颅多普勒(TCD),椎动脉彩色多普勒血流显像(CDFI)相关参数以及症状体征积分进行比较。结果:经过2个疗程治疗后,治疗组的临床总有效率93.3%,对照组的临床总有效率为73.3%,治疗组疗效显著高于对照组(P0.01);治疗后两组症状体征评分较治疗前明显下降(P0.05),治疗后治疗组症状体征评分明显低于对照组(P0.05);治疗后两组左右椎动脉及基底动脉收缩期峰值流速(Vs),平均流速(Vm)明显加快(P0.05),治疗后治疗组上述参数明显高于对照组(P0.05);治疗后两组左右椎动脉血管内径D明显变粗、收缩期峰值血流速度(PSV),平均血流(TAV),舒张末期血流速度(EDV)明显加快(P0.05),治疗后治疗组上述参数明显高于对照组(P0.05)。结论:葛根二藤汤对椎动脉型颈椎病患者有良好疗效,其治疗机制可能与改善椎-基底动脉的血流动力学有关。     

颈部软组织针刀松解术为主治疗颈性眩晕症临床研究

目的:观察颈部软组织针刀松解术为主治疗颈性眩晕症的疗效.方法:将86例颈性眩晕症患者,随机分为治疗组44例,对照组42例,治疗组行颈部软组织针刀闭合性松解术及手法治疗,对照组予以药物治疗,分别治疗1个疗程后,观察患者治疗前后的颈椎X线及经颅多普勒(TCD)的改变,判定其疗效.结果:治疗组治疗后患者的颈椎X线及经颅多普勒检查较治疗前均有明显的改变,且有显著差异.结论:颈部软组织针刀闭合性松解术为主治疗颈性眩晕疗效确切,与常规的药物治疗对照比较有显著的优越性.     

中药结合牵引治疗中老年神经根型颈椎病

目的:探讨扶阳宣痹汤治疗中老年神经根型颈椎病的临床疗效.方法:将98例中老年神经根型颈椎病患者随机分为治疗组48例和对照组50例,治疗组予扶阳宣痹汤口服结合颈椎牵引治疗,对照组仅予颈椎牵引,治疗20 d后比较两组疗效.结果:治疗组有效率为93.8％,对照组治有效率为80.0％,治疗组疗效优于对照组(P＜0.05).结论:扶阳宣痹汤结合牵引对中老年神经根型颈椎病有显著治疗作用.     

Clinical observation on cervical chiropractic for cervical spondylosis of vertebral artery type

Objective

To observe the curative effect of cervical chiropractic for cervical spondylosis of vertebral artery type (CSA) and to explore its possible mechanism.

Methods

Sixty CSA patients were randomly divided into two groups. Thirty patients in the treatment group were treated with chiropractic manipulation for cervical vertebrae, once every other day, 7 treatments in total. The other 30 patients in the control group received oral administration of flunarizine hydrochloride, 10 mg per night, for 14 d. Cervical vertigo and functional assessment scale and transcranial cerebral Doppler (TCD) were measured before treatment and 7 days after treatment.

Results

The total effective rate was 96.7% in the treatment group and 83.3% in the control group. The curative rate was 66.7% in the treatment group and 20% in the control group. The differences between the two groups in the total effective rate and the curative rate were statistically significant (both P<0.05). The scores of cervical vertigo symptom and functional assessment after treatment in both groups were significantly higher than those before treatment (both P<0.01); the difference between the two groups was statistically significant (P<0.05). After treatment, the maximum systolic velocity (Vs), the maximum diastolic velocity (Vd), the mean velocity (Vm), the pulsatility index (PI) and the vascular resistance index (RI) in both groups were significantly improved compared with those before the treatment (all P<0.01); there were significant differences between the two groups (all P<0.05).

Conclusion

Cervical chiropractic is an effective method for CSA, and its curative effect is better than that of flunarizine hydrochloride alone. Its mechanism may relate to correcting cervical instability.

     

Clinical Observation on Treatment of 67 Cases with Lumbar Intervertebral Disc Herniation with Abdomen Acupuncture

目的：对比腹针与体针治疗腰椎间盘突出症的，临床疗效差异。方法：将133例患者随机分为治疗组67例，对照组66例。治疗组采用腹针治疗，对照组采用体针治疗，对治疗前后症状的改善情况进行对照观察。结果：治疗组有效率95．5％，对照组有效率86．4％，两组比较差异有统计学意义（P〈0．05）；两组痊愈患者中治疗1疗程后治疗组痊愈率显著高于对照组（P〈0．05）。结论：腹针治疗腰椎间盘突出症疗效好，疗程短。