"双轨合一"模式下中医学专业硕士研究生针灸学规范化培训的教学方案探讨

目前对"双轨合一"临床专业硕士研究生培养计划缺乏完整统一的内容和要求,本文以中医学主干学科《针灸学》为例,制定了亚专科层面统一的教学培养方案细则,在方案中明确了教学管理构建,创新了教学方法和考核办法.我们将以制定单一亚专科层面的规范化培训教学培养方案为基础,再逐步形成多学科人才培养方案体系,以期培养合格优秀的规范化培训住院医师.     

颈性眩晕针灸治疗方案的初步优选

目的:对颈性眩晕的针灸治疗方案进行初步优选。方法:选取2014年1月至2015年6月南京市中医院病房及门诊收治的颈性眩晕患者72例为研究对象,采用正交设计,研究穴位及针刺角度方向、针刺深度、针刺根数、留针时间4因素3水平的9组不同搭配组合方案,以颈性眩晕症状与功能评估量表为观察指标,初步确定颈性眩晕针刺治疗优选方案。结果:针灸选穴针刺方向、针刺深度、针刺根数3因素不同水平在临床疗效方面差有统计学意义异,而留针时间差异无统计学意义。结论:颈性眩晕优化治疗初选,采用脑空透风池、脑户透风府,中刺或深刺,应用排针,留针1 h,可以获得相对最佳的疗效。     

中医药对肺纤维化大鼠肺组织超微结构的影响

肺纤维化是一种发病机制尚不明确的慢性炎症性肺疾病,中医药(包括针灸)等治疗方法在对其治疗上有着独特的优势。随着现代医学科学技术的发展,许多新的研究手段逐渐应用于肺纤维化的研究,本文查阅近十余年来应用透射电子显微镜研究肺纤维化的文献,总结了传统中医药及针灸治疗对肺纤维化超微结构的影响,以期获得临床用药的实验室基础。     

近5年针灸延缓衰老的机制研究述评

随着现代经济的发展以及生活水平的提高,延缓衰老、延长寿命逐渐成为人们关注的焦点。针灸疗法以其特有的优势被广泛运用到衰老相关疾病的预防和治疗中,其机制探索也得到进一步深入。本文从针灸参与清除自由基损伤,延缓脑老化、免疫老化以及调控衰老相关基因、蛋白入手,对近5年针灸延缓衰老的机制研究作一述评,以促进针灸临床的发展以及新科研思路的开拓。     

针刺联合间充质干细胞移植的实验研究进展

间充质干细胞（mesenchymal stem cells,MSCs）是机体的起源细胞,是形成人体各种组织器官的始祖细胞。因其具有自我复制和多向分化的能力,可在特定条件下转变成为多种构成人体组织或器官的细胞。针刺联合MSCs移植的研究已取得了一定的进展,显示出潜在的应用前景。本文整理、总结了近10年来针刺联合MSCs移植疗法的实验研究文献,以治疗不同种类疾病为切入点,综述目前针刺联合MSCs移植疗法的基础实验研究进展。针刺联合MSCs移植的生物学机制可能与针刺能增加MSCs 的存活率、诱导MSCs定向分化有关。但是,针刺联合MSCs移植要作为一项常规技术应用于临床实践,其内在机制尚需进一步研究阐明。     

超微针刀颈枕快速松解术结合颈椎微调法治疗青年颈椎曲度异常

目的:观察超微针刀颈枕快速松解术结合颈椎微调法治疗青年颈椎曲度异常患者的临床疗效和安全性。方法:自2016年11月至2018年10月治疗青年颈椎曲度异常88例,因失访而实际获完整临床资料86例,男37例,女49例;年龄20～40(30.55±5.21)岁;病程1～42(14.21±7.38)个月。86例分为两组,44例采用超微针刀颈枕快速松解术结合颈椎微调法治疗(治疗组),42例采用常规针刺结合推拿治疗(对照组)。治疗组1次/周,对照组3次/周,3周为1个疗程。分别于治疗前、治疗3周结束、治疗结束后1个月随访时记录颈痛量表(NPQ)评分(并计算百分率)、颈椎活动度(ROM)评分,治疗前与治疗结束1个月随访时记录颈椎生理曲度D值,并评定治疗结束时和1个月随访时两组临床疗效。治疗期间同时要求患者注意纠正日常不良姿势,睡觉保持低枕位,每日早、晚用高低适中的柱形枕置于颈后,颈椎后伸状态下平睡0.5 h。结果:对照组脱落2例,两组患者均未出现不良反应。与治疗前比较,两组治疗后各个观察时点颈痛评分、颈椎活动度评分、颈椎生理曲度D值均显著改善(均P0.05);组间比较,治疗3周结束及1个月后随访时,治疗组颈痛NPQ评分改善优于对照组,组间比较差异均有统计学意义(均P0.05),治疗前后不同时间点颈痛NPQ评分的差异有统计学意义,即存在时间效应(F=203.63,P=0.000),时间因素和分组因素存在交互效应(F=4.964,P=0.012);两组颈椎活动度的ROM评分组间比较差异均无统计学意义(均P0.05),治疗前后不同时间点颈椎活动度ROM评分的差异有统计学意义,即存在时间效应(F=240.32,P=0.000),但时间因素和分组因素并不存在交互效应(F=0.311,P=0.734)。治疗结束1个月后随访时颈椎生理曲度D值的改善程度治疗组优于对照组,差异有统计学意义(P0.05);治疗结束时治疗组总有效率为90.91%(40/44),高于对照组的80.95%(34/42,P0.05);治疗结束后1个月随访时,治疗组总有效率为84.09%(37/44),对照组有效率为76.19%(32/42,P0.05),两组疗效差异无统计学意义。结论:超微针刀颈枕快速松解术结合颈椎微调法能有效恢复颈椎生理曲度,缓解颈椎疼痛,改善颈椎活动度,安全性较好,是治疗症状型青年颈椎曲度异常患者的有效方法。     

Acupuncture for upper-extremity rehabilitation in chronic stroke: a randomized sham-controlled study

OBJECTIVE: To compare the effects of traditional Chinese acupuncture with sham acupuncture on upper-extremity (UE) function and quality of life (QOL) in patients with chronic hemiparesis from stroke. DESIGN: A prospective, sham-controlled, randomized controlled trial (RCT). SETTING: Patients recruited through a hospital stroke rehabilitation program. PARTICIPANTS: Thirty-three subjects who incurred a stroke 0.8 to 24 years previously and had moderate to severe UE functional impairment. INTERVENTIONS: Active acupuncture tailored to traditional Chinese medicine diagnoses, including electroacupuncture, or sham acupuncture. Up to 20 treatment sessions (mean, 16.9) over a mean of 10.5 weeks. MAIN OUTCOME MEASURES: UE motor function, spasticity, grip strength, range of motion (ROM), activities of daily living, QOL, and mood. All outcomes were measured at baseline and after treatment. RESULTS: Intention-to-treat (ITT) analyses found no statistically significant differences in outcomes between active and sham acupuncture groups. Analyses of protocol-compliant subjects revealed significant improvement in wrist spasticity (P<.01) and both wrist (P<.01) and shoulder (P<.01) ROM in the active acupuncture group, and improvement trends in UE motor function (P=.09) and digit ROM (P=.06). CONCLUSIONS: Based on ITT analyses, we conclude that acupuncture does not improve UE function or QOL in patients with chronic stroke symptoms. However, gains in UE function observed in protocol-compliant subjects suggest traditional Chinese acupuncture may help patients with chronic stroke symptoms. These results must be interpreted cautiously because of small sample sizes and multiple, unadjusted, post hoc comparisons. A larger, more definitive RCT using a similar design is feasible and warranted.     

豚鼠肺切除术后咳嗽模型建立及针刺肺经对其血清PGE-2、BK的影响

目的 :建立豚鼠肺切除术后咳嗽模型并进行初步评价。方法:应用50只豚鼠进行肺部手术切除并结合支气管激发咳嗽实验方法构建肺切除术后咳嗽动物模型,给予针刺干预观察豚鼠咳嗽变化结果,治疗前后测定豚鼠血浆前列腺素E-2(PGE-2)、缓激肽(BK)数值变化,以及豚鼠肺组织免疫组化形态学观察。结果:针刺治疗前后针刺肺经组BK、PGE-2出现明显变化(P<0.01),与针刺非经非穴组、模型组相比,亦具有明显统计学差异(P<0.01)。结论:成功建立了豚鼠肺切除术后咳嗽模型,针刺肺经有助于缓解豚鼠肺切除术后咳嗽,同时PGE2和BK测定出现明显改变(与针刺非经非穴组、模型组相比,P<0.01),豚鼠肺组织免疫组化形态学观察也有明显改变。     

针灸治疗中风后失眠研究进展

中风后失眠是中风患者较常见的一种并发症。针灸以其独特的治疗方法在治疗中风后失眠上取得了较好的临床疗效。本研究归纳总结了针灸治疗中风后失眠近10年的相关文献,分别从针刺治疗、穴位埋线、艾灸、耳压和综合疗法等几个方面进行阐述,并进行细致的讨论,旨在为临床工作者提供一定的参考,指导今后的研究方向。     

Acupuncture in patients with headache

We aimed to investigate the effectiveness of acupuncture in addition to routine care in patients with primary headache (> 12 months, two or more headaches/month) compared with treatment with routine care alone and whether the effects of acupuncture differ in randomized and non-randomized patients. In a randomized controlled trial plus non-randomized cohort, patients with headache were allocated to receive up to 15 acupuncture sessions over 3 months or to a control group receiving no acupuncture during the first 3 months. Patients who did not consent to randomization received acupuncture treatment immediately. All subjects were allowed usual medical care in addition to study treatment. Number of days with headache, intensity of pain and health-related quality of life (SF-36) were assessed at baseline, and after 3 and 6 months using standardized questionnaires. Of 15 056 headache patients (mean age 44.1 ± 12.8 years, 77% female), 1613 were randomized to acupuncture and 1569 to control, and 11 874 included in the non-randomized acupuncture group. At 3 months, the number of days with headache decreased from 8.4 ± 7.2 (estimated mean ± s.e. ) to 4.7 ± 5.6 in the acupuncture group and from 8.1 ± 6.8 to 7.5 ± 6.3 in the control group ( P  < 0.001). Similarly, intensity of pain and quality of life improvements were more pronounced in the acupuncture vs. control group ( P  < 0.001). Treatment success was maintained through 6 months. The outcome changes in non-randomized patients were similar to those in randomized patients. Acupuncture plus routine care in patients with headache was associated with marked clinical improvements compared with routine care alone.