药枕盐熨疗法对椎动脉型颈椎病血流动力学变化的影响及疗效观察

目的:采用药枕盐熨疗法干预椎动脉型颈椎病,分析其对双侧椎-基动脉血流动力学变化的影响,并对患者症状、颈椎功能以及临床疗效进行观察。方法:将80例椎动脉型颈椎病患者采用SPSS 17.0软件随机序列生成模块按1∶1比例分为观察组和对照组,每组40例。观察组以大青盐为中药热导体,采用长柱形药枕进行盐熨治疗,对照组予以颈椎牵引加蜡疗干预,2组均治疗4周。经颅多普勒超声(TCD)检查,对2组治疗前后双侧椎-基底动脉血流速度及不对称性、搏动指数(PI)进行比较,采用《颈性眩晕症状与功能评估量表》(ESCV)评定患者症状程度与功能变化,根据《中医病证诊断疗效标准》评估临床疗效。结果:①治疗前,2组双侧椎-基底动脉血流速度与不对称性、PI、ESCV评分组间比较,差异均无统计学意义(P>0.05)。②干预4周后,2组血流速度减慢患者双侧椎-基底动脉收缩期峰值血流速度的均值[(LVA+RVA)Vp/2]、舒张末期血流速度均值[(LVA+RVA)Vd/2]较治疗前均显著升高(P<0.05),2组血流速度增快患者(LVA+RVA)Vp/2较治疗前明显降低(P<0.05),(LVA+RVA)Vd/2下降不如(LVA+RVA)Vp/2显著;组间比较,仅观察组中血流速度减慢患者(LVA+RVA)Vp/2较对照组显著升高(P<0.05)。③2组治疗后PI较治疗前均下降(P<0.05),观察组中血流速度减慢患者PI较对照组更明显(P<0.05)。④双侧椎-基底动脉血流速度不对称性结果显示,治疗后观察组双侧椎-基底动脉收缩期峰值血流速度的差值[|LVA-RVA|Vp]较治疗前明显下降,差异有统计学意义(P<0.05);2组ESCV评分治疗后均较治疗前显著提高(P<0.05),观察组[(23.13±3.15)分]高于对照组[(21.73±3.39)分],差异无统计学意义(P>0.05);2组疗效比较,差异无统计学意义(P>0.05),且均未见不良反应。结论:药枕盐熨疗法作用于椎动脉型颈椎病,能明显改善椎-基动脉血流状况,有效缓解椎动脉型颈椎病患者的症状,提高颈椎功能。

Hemodynamics Change and Clinical Efficacy on Cervical Spondylosis of Vertebral Artery Type Treated by Hot Compress Therapy with Medicinal Salt Pillow

Objective:To investigate the effect of hot compress therapy with medicinal salt pillow on cervical spondylosis of vertebral artery type,and to observe the effects on symptoms,cervical function and clinical effect of patients.Methods:A total of 80 patients with cervical spondylosis of vertebral artery type were randomly divided into observation group and control group according to the proportion of 1∶1 used by SPSS 17.0 software random sequence generation module,with 40 cases in each group.The patients in observation group were treated by hot compress therapy with medicinal salt pillow filled with Daqing salt as a heat conductor,and the patients in control group were treated by wax therapy and cervical traction.After 4 weeks of treatment,transcranial doppler ultrasound(TCD)was used to compare the blood flow velocity and asymmetry,and pulsatile index(PI)of the bilateral vertebro-basilar artery before and after treatment in the two groups.The cervical vertigo symptom and function assessment scale(ESCV)was used to evaluate the degree of symptoms and function of patients,and the clinical efficacy was evaluated according to the therapeutic standard of traditional Chinese medicine.Results:1)There were no statistical differences between the two groups before treatment for the indicators of blood flow velocity and asymmetry,PI of the bilateral vertebro-basilar artery and the score of ESCV(P>0.05).2)After four weeks treatment,the mean of peak systolic blood flow velocity[(LVA+RVA)VP/2]and the mean of end diastolic blood flow velocity[(LVA+RVA)Vd/2]of the bilateral vertebro-basilar artery in both groups with slow blood flow velocity were significantly higher than those before treatment(P<0.05).For the patients in both groups with rapid blood flow velocity,the(LVA+RVA)Vp/2 was obviously lower than that before treatment(P<0.05),and the decrease of(LVA+RVA)Vd/2 was not as significant as that of(LVA+RVA)Vp/2.Compared with the control group,the improvement of(LVA+RVA)Vp/2 in the observation group with slow blood flow velocity after treatment was more significant(P<0.05).3)The PI was reduced after treatment in the two groups,and the reduction in observation group with slow blood flow velocity was superior to that in the control group after treatment(P<0.05).4)The asymmetry of blood flow velocity showed that the difference of peak systolic blood flow velocity of bilateral vertebro-basilar artery[|LVA-RVA|Vp]in the observation group was dropped significantly after treatment(P<0.05).The ESCV scores were both improved after treatment for the two groups(P<0.05),with the scores of observation group(23.13±3.15)higher than the control group(21.73±3.39),however,the difference was not statistically significant(P>0.05).There was no statistically significant difference of clinical efficacy between the two groups(P>0.05),and no adverse reactions were observed in either groups.Conclusion:The effect of hot compress therapy with medicinal pillow filled with salt can significantly improve the blood flow of bilateral vertebro-basilar artery,effectively relieve the symptoms of cervical spondylosis of vertebral artery type and improve the function of cervical vertebra.