【作者】 李雁；

【导师】 赖新生；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 支气管哮喘是严重影响人们健康的常见病、多发病。据粗略估计,我国约有1500-2000万哮喘患者。哮喘给社会带来沉重负担,造成误工、误学,对患者的生活质量有很大影响。随着城市化发展,现代文明生活的进步,哮喘患病率逐年上升,已成为仅次于癌症的世界第二大致死和致残疾病。因此,哮喘已成为严重的公共卫生问题,受到各国的极大关注,哮喘的防治研究随之形成一个独立的医学体系。研究目的:通过回顾历代文献,总结近年来中医药对本病的研究进展及延续导师以前的研究领域,探讨子午流注纳子针法对支气管哮喘的治疗作用,从细胞因子角度证实其治疗支气管哮喘的机理,丰富以防为主治疗治疗哮喘的措施,解决推算按时开穴的繁杂性及临床治疗时间的局限性,开启子午流注按时选穴的思维,为子午流注纳子针法临床的推广应用提供客观的依据。研究方法:临床确诊为支气管哮喘患者。纳入标准:①诊断符合支气管哮喘的标准;②治疗前哮喘病情严重程度分级为第1,2,3级。排除标准:①治疗前哮喘病情严重程度分级为第4级;②合并有肝、肾、造血系统和内分泌系统等严重原发性疾病,或伴有精神疾病患者;③凡符合纳入标准,未按规定治疗,无法判断疗效或资料不全等影响疗效判断者。按入院顺序依照随机数字表随机分为子午流注纳子针法组(观察组)和常规针法组(对照组)各30例。子午流注纳子针法组取穴:太溪_双、阴谷_双、肾俞_双,刺激方法:固定在每天的酉时治疗,快速捻转进针,平补平泻,实证适当取定喘,虚证加太渊。留针30min,每10min行针1次,约1min。常规针法组取穴:膻中、列缺_双、肺俞_双,刺激方法:在每天酉时以外的时间治疗,其余同子午流注纳子针法组。治疗每日1次,10次为1疗程,休息5天,继续下一疗程,共治疗4疗程后复查指标。观察针刺前后各项指标的水平,进行临床疗效及实验数据比较。结果:1子午流注纳子针法对哮喘控制的影响。参照南非Bateman在“GOAL”全球多中心临床试验中设定的哮喘完全控制和良好控制两种概念,治疗不能达到良好控制标准的定义为没有控制,从哮喘临床症状、肺通气功能、治疗强度等方面观察临床疗效,经过4个疗程治疗后,数据显示两种针法均可改善患者哮喘症状,子午流注纳子针法组总有效率为93.3%,常规针法组总有效率为73.3%。组间比较有显著性差异(p＜0.05),说明子午流注纳子针法较常规针法更有效。2子午流注纳子针法对哮喘中医临床疗效的影响。通过两组中医临床疗效比较,我们发现两种针法均可促进患者症状改善,观察组总有效率为93.3%,对照组总有效率为76.6%,组间比较有显著性差异(p＜0.05),说明子午流注纳子针法较常规针法更有效。3子午流注纳子针法对哮喘症状积分的影响。通过观察哮喘患者白天和夜间症状积分,显示两种针法均可降低患者症状积分,治疗前后有显著性差异(p＜0.05),组间比较观察组与对照组之间有显著性差异(p＜0.05),说明子午流注纳子针法较常规针法更有效。4子午流注纳子针法对哮喘患者肺通气功能的影响。通过测量哮喘患者呼气峰流量(PEF),显示两种针法均可提高患者呼气峰流量(PEF),治疗前后有显著性差异(p＜0.05),组间比较观察组与对照组之间有显著性差异(p＜0.05),说明子午流注纳子针法较常规针法更有效。5子午流注纳子针法对哮喘患者治疗强度的影响。通过计算哮喘患者急用短效β2受体激动剂次数,显示两种针法均可减少患者使用次数,治疗前后有显著性差异(p＜0.05),组间比较观察组与对照组之间有显著性差异(p＜0.05),说明子午流注纳子针法较常规针法更有效。6子午流注纳子针法对哮喘患者血清中IL-4的影响经过4个疗程治疗后,IL-4水平较治疗前有显著性降低,治疗前后有显著性差异(p＜0.05),提示两组患者治疗后均有效。组间比较观察组与对照组之间有显著性差异(p＜0.01),显示子午流注纳子针法较常规针法更有效。结论:(一)子午流注纳子针法能改善哮喘控制。(二)子午流注纳子针法能提高中医临床疗效。(三)子午流注纳子针法能降低哮喘症状积分。(四)子午流注纳子针法能提高哮喘患者呼气峰流量(PEF)。(五)子午流注纳子针法能降低哮喘患者治疗强度。(六)子午流注纳子针法能降低哮喘患者血清IL-4水平。以上研究结果表明,无论是哮喘临床症状,还是IL-4水平的改善方面,两组针法治疗前后均有显著的差异性,而子午流注纳子针法效果明显优于常规针法。说明子午流注纳子针法能更好的控制哮喘症状、改善肺通气功能、降低治疗强度,同时通过对IL-4的影响,从免疫学机制、气道上皮损伤与气道重构、气道神经源性炎症等方面来调控哮喘的发生发展机制,达到了治疗哮喘的目的。更多还原

【Abstract】 Bronchial asthma is a common diease which serious impacts on people’s health.According to a rough estimate,In our country there are about 15-20 million people with asthma.Asthma is a heavy burden to our society,resulting in loss of working time,moreover it has a significant impact on the quality of life of patients.With the development of modern civilization,asthma increased year by year,only after the cancer and become the world’s second largest death and disabling disease.Therefore,asthma has become a serious public health problem which is great concerned by many States.objective:By reviewing past literature,summed up chinese medicine research on the disease in recent years and continuated my mentors previous research to explore the study of nazi method of Ziwu Liuzhu acutheropy on the treatment of bronchial asthma,confirmed the mechanism of the treatment of bronchial asthma from the perspective of cytokines,riched treatments,resolving the complication of selection acupoints on time and the time limitations of clinical treatment,open a new hope for how to use nazi method of Ziwu Liuzhu acutheropy to select acupuncture pionts on time,providing objective basis to satisfied the promotion of clinical applications of nazi method of Ziwu Liuzhu acutheropy.method:Clinical patients diagnosed with bronchial asthma.Inclusion criteria:①diagnostic criteria for bronchial asthma;②pre-treatment severity of asthma for the 1,2,3-grade.exclusion criteria:①pre-treatment severity of asthma for the 4 grade;②combined serious primary disease of liver、kidney、hematopoietic system and endocrine system,the mentally illness;③meet the requirements of the standard,can not receive regular treatment,can not determine the effectiveness of treatment or insufficient information to determine those effects and so on.All the patients were randomly divided into nazi method of Ziwu Liuzhu acutheropy group(observation group) and routine acupuncture group(control group) and each group have 30 cases. Acupoints of observation group:TaiXi,Yin Gu,ShenShu.stimulate methods: fixed in you shi treatment every day,rapid contortus needle,using Dingchuan with empirical patients and TaiYuan with deficiency patients.Left the needles 30min,stimulate needles about 1min every 10mins.Acupoints of contral group:lieQue,ShanZhong,FeiShu.stimulate Methods:treatment fixed off you shi every day,rapid contortus needle,using Dingchuan with empirical patients and TaiYuan with deficiency patients.Left the needles 30min,stimulate needles about 1min every 10mins.All patients receive one treatment per day, 10 times for one course of treatment,five days to rest and continue the next course of treatment,Observed the indicators after a total of 4 treatments, Comparised the clinical efficacy and experimental data.result:1 the impact of nazi method of Ziwu Liuzhu acutheropy on the asthma control in the light of Bateman of South Africa who sets the two concepts of asthma total control and good control of in "GOAL" global,multi-center clinical trials of asthma.treatment result can not achieve good control we define as no control,observing the clinical symptoms of asthma,the treatment of strength,pulmonary ventilation function,after 4 treatment courses,statistics show that two type of acupuncture methods can improve symptoms in patients with asthma,the result before and after treatment is significantly different (p＜0.05),the total effective rate of observation group is 93.3%,control group is 73.3%,comparison between observation group and control group is significant difference(p＜0.05),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than conventional acupuncture.2 the impact of nazi method of Ziwu Liuzhu acutheropy on the asthma clinical curative effect of Chinese medicineThrough the clinical effects of the two groups,we found that the two typesof acupuncture methods can improve symptoms in patients with asthma,the result before and after treatment is significant different(p＜0.05),the total effective rate of observation group is 93.3%,while the control group is 76.6%, comparison between the two groups is significant difference(p＜0.05),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than conventional acupuncture.3 the impact of nazi method of Ziwu Liuzhu acutheropy on the asthma symptoms score.Through observing symptom score of patients with asthma during the day and night,the data shows that the two Acupuncture methods can reduce the score in patients with asthma,the result before and after treatment is significantly different(p＜0.05),comparison between observation group and control group is significant difference(p＜0.05),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than conventional acupuncture.4 the impact of the nazi methodof acutheropy Ziwu Liuzhu on the asthma Pulmonary functionby measuring the peak expiratory flow(PEF),we find that the two type of acupuncture methods can increase the peak expiratory flow(PEF),the result before and after treatment is significantly different(p＜0.05),comparison between observation group and control group is significant difference(p＜0.05),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than conventional acupuncture.5 the impact of nazi method of Ziwu Liuzhu acutheropy on the asthma Treatment intensityBy calculating the number of using short-actingβ2 receptor agonist,data shows that the two group of acupuncture methods can reduce the numberber,the result before and after treatment is different(p＜0.05),comparison between observation group and control group is significant difference(p＜0.05),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than conventional acupuncture.6 the impact of nazi method of Ziwu Liuzhu acutheropy on serum levels of IL-4After four course treatments,serum levels of IL-4 before treatment is significantly lower than the level after treatment(p＜0.05),this shows the results of two groups are effective,comparison between observation group and control group is significant difference(p＜0.01),this is satisfied that nazi method of Ziwu Liuzhu acutheropy is more effective than the conventional acupuncture. conclusion:1.nazi method of Ziwu Liuzhu acutheropy can improves asthma control.2.nazi method of Ziwu Liuzhu acutheropy can improves the clinical efficacy of Chinese medicine.3.nazi method of Ziwu Liuzhu acutheropy can improves asthma symptoms score.4.nazi method of Ziwu Liuzhu acutheropy can improves the peak expiratory flow of asthma Patients(PEF).5.nazi method of Ziwu Liuzhu acutheropy can Reduces the intensity of asthma treatment.6.nazi method of Ziwu Liuzhu acutheropy can Lowers serum levels of IL-4 in patients with asthma.The above results show that,regardless of asthma Clinical sympyoms or serum levels of IL-4 improvement,before and after acupuncture treatment the results are significant different,whereas nazi method of Ziwu Liuzhu acutberopy is better than conventional acupuncture,nazi method of Ziwu Liuzhu acutheropy can better control asthma symptoms,improve pulmonary function,reduce the treatment intensity,and at the same time through the effects of IL-4,from the immunological mechanisms,airway epithelial injury,airway remodeling and gas road of neurogenic inflammation to control the development mechanisms of asthma and achieve the treating purpose of asthma.更多还原