【作者】 杨世敏；

【导师】 庄礼兴；

【作者基本信息】 广州中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 研究背景:帕金森病是一种常见的神经系统变性疾病,也是中老年常见的致残疾患之一,该病的临床表现主要为:运动减少、骨骼肌张力增高和静止时的肌肉震颤。这一组特殊的症状群1817年首先由英国医生巴金森(Parkinson)所描述,故命名为PD。PD在世界各地调查患病率分布极不一致。欧美各国白种人调查患病率为66-187/10万,日本为37-80.6/10万。我国标化率为10.8/10万,世界标化率为15.0/10万,我国帕金森患病率低于西方发达国家。PD很少在40岁之前发生,在不同的临床和病因学研究中,早发和晚发PD主要是以40岁作为确定的界限。很多人群调查表明男性的发病比女性高。PD的治疗作为12世纪神经科学重要的研究疾病之一,帕金森病(PD)目前尚无办法根治,且早期诊断率较低,各种客观诊断和检测指标还在研究当中、尚不成熟。当前PD治疗的目的主要在于控制临床症状,仍以左旋多巴制剂为主,左旋多巴制剂治疗经2-5年内常出现诸多副作用,如恶心、呕吐、厌食、血压轻度降低、直立性低血压、“剂末现象”、“开关现象”、运动障碍、精神异常等,也有15%左右的病人根本无效,且长期服药则副作用越明显、越重,并且存在疗效减退等。导致很多病人最后无法坚持治疗。为了减小西药毒副作用、增强临床疗效,目前人们越来越重视中医和针灸的治疗方法。临床资料显示针灸在治疗PD方面是行之有效的一种方法,但是目前国内外在此方面的研究却相对较少。研究目的:颤三针治疗帕金森的临床研究研究方法:将62例患者,随机分为治疗组和对照组,每组31例病人。分别采用颤三针和西药治疗,观察两组患者的临床症状、运动工作、生活质量等方面,来评价两组的治疗效果。研究结果:1、治疗结束后,两组除面部表情、吞咽、言语其他各项均得到改善,治疗组疗效优于对照组;两组的面部表情均有改善,两组改善无差异;治疗结束后,言语、吞咽无改善。2、治疗结束后,两组生活质量均得到改善。治疗组疗效优于对照组。治疗结束后,治疗组临床治愈1例,明显进步16例,进步5例,稍有进步4例,无效5例,总有效率83.87%;对照组临床治愈0例,明显进步9例,进步6例,稍有进步7例,无效9例,总有效率70.96%。经Ridit分析,Z=2.03,P=0.03(P＜0.05),差异有统计学意义。提示:治疗结束后,治疗组疗效优于对照组。研究结论:颤三针能够改善帕金森病人的临床症状,提高生活质量。更多还原

【Abstract】 Background:Parkinson’s disease(PD) is a neurological condition that is commonly seen in the elderly,characterized by motor impairment,slowing of physical movement,muscle rigidity,and tremor at rest.The disease is named after the English physician James Parkinson,who made a detailed description of the disease in his essay published in 1817.The prevalence of the disease differs throughout the world.It is most prevalent in Europe and the America,estimated at a rate of 66-187 in 100,000,and Japan at a rate of 37-80.6 in 100,000.The standardized rate in China is 10.8 in 100,000, while that of the world is 15.0 in 100.000.Our rate is far less than the world standard.PD rarely occurs at an age below 40 years old,and the occurrence rate in male is much higher than in female.At present,there is no cure for PD,researches to discover novel drug to treat PD has put into focus.It is a progressive disorder,which makes early diagnosis difficult.Moreover,many diagnostic measures,such as scans, have yet been standardized.Medications for PD can only provide relief from the symptoms.Currently.levodopa(L-dopa) is the most widely used form of treatment.It is transformed into dopamine in the dopaminergic neurons by L-aromatic amino acid decarboxylase.However,long-term use(2-5 years) of L-dopa may induce numerous side-effects,such as nausea,vomiting,anorexia, low blood pressure,the "end of dose" effect,the "on-off" effect. kinematic impairment,and cognitive and behavioral symptoms.Medication is ineffective in approximately 15%of the patients,and the daily dosage would only worsen the symptoms.In hope to minimize the side effect of oral medication,acupuncture as a complementary treatment has become more recognized for its effectiveness and minimal side-effect.However,limited number of researches has been done to prove its effect in the treatment of PD.Objective:To investigate the curative effect of using tremor three needles in the treatment of Parkinson’s Disease.Method:A total of sixty PD patients were randomly divided into treatment and control groups,each having 30 patients.The treatment group used acupuncture,mainly tremor three needles,and the control group used mainstream medication(L-dopa).Their clinical symptoms,physical activity, quality of life were observed and recorded before and after treatment.Results:1.After treatment,all indeces in the treatment group significantly improved, except for facial expression,swallowing ability and speech,as compared to the control group.The facial expression in both groups improved,but the change in difference between the groups was not significant.As for swallowing and speech,both groups did not improve after treatment.2.The quality of life significantly improved in the treatment group,as opposed to the control group.After treatment,the treatment group consisted of the following:1 patient clinically recovered,16 extreme improvements,5 moderate improvements,4 slight improvements,5 ineffective:the total effective rate was 83.87%.The control group consisted of 0 patient clinically recovered,9 extreme improvement.6 moderate improvement,7 slight improvement,9 ineffective:the total effective rate was 70.96%.After Ridit anaiysis,Z=2.03,P=0.03(p＜0.05), the change in improvement between the two groups was significant,thus, the treatment group was more effective in the treatment of PD than the control group.Conclusions:The use of tremor three needles in the treatment of PD is effective and can improve the patients’ symptoms and quality of life.更多还原