【作者】 陈孟成；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2012， 博士

【摘要】 目的：观察温针百会穴配合电针颈夹脊穴治疗椎动脉型颈椎病的临床疗效,及对经颅多普勒(TCD)的影响,证实该方法的有效性,为临床治疗椎动脉型颈椎病提供新思路和新方法。方法：本研究选取2011年6月至2012年2月在广州中医药大学第一附属医院针灸科住院或门诊治疗的椎动脉型颈椎病患者,将符合纳入标准的60例患者以1：1的比例,按照就诊的先后顺序随机分配到治疗组和对照组。治疗上,两组均选用百会穴、病变椎体相应夹脊穴和风池穴(双),其中治疗组采用温针百会穴配合电针颈夹脊穴的治疗方法,对照组采用针刺百会穴配合电针颈夹脊穴的治疗方法,每周治疗5次,连续治疗5次后,休息2天,继续针刺,治疗10次为一个疗程。治疗前、疗程结束后进行TCD检测,同时记录各临床评价量表。本研究采用症状量化积分,《椎动脉型颈椎病患者临床症状、体征及患者日常生活工作及心理评估》量表进行疗效评价,同时采用经颅多普勒超声(TCD)检测基底动脉、左椎动脉和右椎动脉收缩期和舒张期的血流速度变化。所有的数据最后均采用SPSS13.0统计软件进行统计分析。结果：1.采用症状量化积分进行疗效评价,治疗组30例患者,治愈9例,显效11例,有效7例,无效3例,总有效率为90%,愈显率为66.7%；对照组30例患者,治愈5例,显效6例,有效12例,无效7例,总有效率为76.7%,愈显率为36.7%。经卡方检验,两组总有效率比较,差异无统计学意义(P>0.05)；两组愈显率比较,差异有显著性意义(P<0.05)。2.治疗前后症状量化积分变化比较,治疗后两组患者的症状量化积分均较治疗前增加,经t检验,其差异有非常显著性意义(P<0.01)；组间比较,差异无统计学意义(P>0.05)。3.采用《椎动脉型颈椎病患者临床症状、体征及患者日常生活工作及心理评估》量表进行疗效评价,治疗组30例患者,治愈10例,显效12例,有效6例,无效2例,总有效率为93.7%,愈显率为77.3%；对照组30例患者,治愈6例,显效8例,有效10例,无效6例,总有效率为80.0%,愈显率为46.7%。经卡方检验,两组总有效率比较,差异无统计学意义(P>0.05)；两组愈显率比较,差异有显著性意义(P<0.05)。4.治疗后两组患者的基底动脉与双侧椎动脉的VS均有所增快,经t检验,与治疗前相比有非常显著性差异(P<0.01)；组间比较,差异有显著性意义(P<0.05),治疗组基底动脉和双侧椎动脉的Vs值明显大于对照组。5.治疗后两组患者的基底动脉与双侧椎动脉的Vd均有所增快,经t检验,与治疗前相比有非常显著性差异(P<0.01)；组间比较,差异有显著性意义(P<0.05),治疗组基底动脉和双侧椎动脉的Vd值明显大于对照组。结论：1.经过一疗程治疗后,温针百会穴配合电针颈夹脊穴可以提高患者的愈显率；2.经过一疗程治疗后,温针百会穴配合电针颈夹脊穴可以增加患者基底动脉与双侧椎动脉收缩期、舒张期的血流速度；3,根据观察的数据和统计的结果,可以推断：椎动脉型颈椎病的症状改善与椎一基底动脉供血增加有关。更多还原

【Abstract】 ObjectiveTo investigate the clinical efficacy of the cervical vertebral artery disease by warming needle Baihui with neck Jiaji of electro-acupuncture treatment, and observing the impact of transcranial Doppler (TCD), confirming the val idity of the method for clinical treatment of cervical vertebral artery disease and providing new methods for clinical.MethodsCases from the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine and Acupuncture inpatient or outpatient treatment, from June2011to February2012.60patients met the inclusion criteria in a1:1ratio, in accordance with the order of treatment were randomly assigned to treatment and control groups. Treatment group were treated with warming needle Baihui with neck Jiaji and control group were treated with acupuncture the Baihui with the neck Jiaji, continuous treatment for5times, rest for two days, continue to acupuncture as a course of14days. Record the clinical assessment scale. In this study, symptoms quantify the integral scale of the cervical vertebral artery in patients with clinical symptoms, signs, and the daily life of patients and psychological assessment "for efficacy evaluation, using transcranial Doppler ultrasound (TCD) detection of the basilar artery, left vertebral artery and right vertebral artery systolic and diastolic blood flow velocity changes. All data last SPSS13.0statistical software for statistical analysis.Results1. Symptoms of quantization points for efficacy evaluation, the treatment group30patients,9cases were cured,11cases markedly effective,7cases effective, ineffective in3cases, total effective rate was90%; the control group of30patients, five cases cured, markedly effective in6cases,12cases effective, ineffective in7cases, the total effective rate was76.7%. By the chi-square test, two groups of the total effective rate was no Bignificant difference (P>0.05); two sets of effective rate, the difference was significant (P<0.05).2. The treatment of symptoms before and after quantization integral change after treatment, two groups of patients with symptoms of quantization points compared with treatment increased, the difference is very significant (P<0.01) by test; between the two groups, the difference was not statistically significance (P>0.05).3. With cervical vertebral artery in patients with clinical symptoms, signs and patient’s daily life and work, and psychological assessment scale for efficacy evaluation, treatment group,30patients,10cases cured,12cases markedly effective, effective in6cases,2cases ineffective. The total effective rate was93.7%; control group of30patients,6cases cured,8cases were markedly effective,10cases effective,6cases ineffective, total effective rate of80.0%. By the chi-square test, two groups of the total effective rate was no significant difference (P>0.05); two sets of effective rate, the difference was significant (P<0.05).4. Two groups after treatment in patients with basilar artery and bilateral vertebral artery in the VS were increased by t test, compared with before treatment have a very significant difference (P<0.01); between the two groups, there was significant difference significance (P<0.05), treatment group was significantly higher.5. After treatment, patients with basilar artery and bilateral vertebral artery Vd were increased, by t test, compared with before treatment have a very significant difference (P<0.01); between the two groups, there was significant difference significance (P<0.05), treatment group was significantly higher.Conclusion1. Warm needle Baihui point with the EA neck Jiaji can increase the effective rate of this disease;2. Warm needle Baihui point with the electric needle neck Jiaji can increase the blood flow velocity of the basilar artery and bilateral vertebral artery systolic and diastolic;3. According to the observed data and the survey results can be inferred: the improvement in symptoms of vertebral artery type of cervical spondylosis increase in vertebral-basilar artery.更多还原