【作者】 阮德明；

【导师】 李玉堂；

【作者基本信息】 南京中医药大学 ， 针灸推拿学， 2009， 博士

【摘要】 本课题分为理论研究、临床研究两个大部分。在导师的指导下,以浮针为工具,治疗支气管哮喘急性发作期的疗效观察。一、文献综述部分对针灸治疗支气管哮喘之研究现状进行了总结、分析。本文参考了大量文献,对支气管哮喘的定义、中医认识及其机理、临床进行了较为全面的总结。对肺俞穴的中西医学认识进行了系统回顾,对其定义、中医主病、俞穴定位与针刺方法、实验及临床研究进行了全面论述。对浮针疗法的产生和发展进行了系统总结,对其理论及临床研究进行了综述。二、临床研究部分目的:通过浮针肺俞穴的治疗,观察轻中度支气管哮喘急性发作期的临床疗效,综合评价浮针疗法平喘作用及对人体的安全性和临床推广应用的研究。方法:①选用随机数字表将试验病例随机分为浮针组、西药对照组。从治疗前一周开始停服一切试验用药以外的药物,患者就诊前己经常规使用吸入激素者,观察期间维持原吸入激素量不变。②浮针组30例。取穴:肺俞（双侧）,腧穴定位依据国标《经穴部位》选定。针具:浮针针具（中号,南京派福医学科技有限公司提供）。操作方法:取伏卧位,确定进针点,常规消毒,浮针从肺俞穴对准风门穴的方向进针,透过皮肤后将针身平贴皮下在疏松结缔组织中穿行,不行提插、捻转。进针完毕,皮下扫散30分钟后退出。治疗5次,每天一次,共5天。对照组30例:用西药茶碱缓释片,每次200mg,每天两次口服。5天为一疗程,疗程期间不休息。观察指标:哮喘主要症状、体征（喘息、气短、咳嗽、咳痰、哮鸣音）的变化。肺功能测定:最大呼气流量（PEF）、第一秒用力呼气容积（FEV₁）,第一秒用力呼气率（FEV₁%）。结果:①浮针组与对照组,两组间及两组内最大呼气流量（PEF）比较:浮针组治疗前后比较差异非常显著（P＜0.01）,对照组治疗前后比较差异非常显著（P＜0.01）。说明浮针肺俞穴和口服茶碱缓释片均对哮喘患者的PEF水平有较好的改善作用。浮针组和对照组治疗前比较没有显著性差异（P＞0.05）,说明治疗前两组患者的PEF水平没有显著差异;治疗后比较没有显著性差异（P＞0.05）,说明浮针肺俞穴和口服茶碱缓释片对哮喘患者的PEF水平改善作用没有显著性差异。②浮针组与对照组,两组间及两组内第一秒用力呼气容积（FEV₁）比较:浮针组治疗前后比较差异非常显著（P＜0.001）,对照组治疗前后比较差异非常显著（P＜0.001）。说明浮针肺俞穴和口服茶碱缓释片均对哮喘患者的FEV₁水平有显著的改善作用,口服茶碱缓释片差异更显著。浮针组和对照组治疗前比较没有显著性差异（P＞0.05）,说明治疗前两组FEV₁水平有可比性;治疗后比较没有显著性差异（P＞0.05）,说明浮针肺俞穴和口服茶碱缓释片对哮喘患者的FEV₁水平改善作用没有显著性差异。③浮针组与对照组,两组间及两组内第一秒用力呼气率（FEV₁%）比较:浮针组治疗前后比较差异非常显著（P＜0.01）,对照组治疗前后比较差异显著（P＜0.01）。说明浮针肺俞穴和口服茶碱缓释片均对哮喘患者的FEV₁%水平有较好的改善作用。浮针组和对照组治疗前比较没有显著性差异（P＞0.05）,说明治疗前两组FEV₁%水平有可比性;治疗后比较没有显著性差异（P＞0.05）,说明浮针肺俞穴和口服茶碱缓释片对哮喘患者的FEV₁%水平改善作用没有显著性差异。④两组间及两组内症状评分比较:浮针组治疗前后比较差异非常显著（P＜0.01）,对照组治疗前后比较差异非常显著（P＜0.01）。说明浮针肺俞穴和口服茶碱缓释片均对哮喘患者的症状评分有较好的改善作用。浮针组和对照组治疗前比较没有显著性差异（P＞0.05）,说明治疗前两组症状评分有可比性;治疗后比较没有显著性差异（P＞0.05）,说明浮针肺俞穴和口服茶碱缓释片对哮喘患者症状评分改善作用没有显著性差异。⑤两组间疗效比较:浮针组和对照组疗效比较没有显著性差异（P＞0.05）,说明浮针肺俞穴和口服茶碱缓释片对哮喘患者疗效作用没有显著性差异。⑥安全性评价证明安全可靠。结论:浮针肺俞穴对支气管哮喘患者的最大呼气流量（PEF）、第一秒用力呼气容积（FEV₁）、第一秒用力呼气率FEV₁%、症状评分均有确切的改善作用,并且安全性好,与口服茶碱缓释片作用比较,差异不显著。浮针在肺俞穴上治疗对支气管哮喘患者的疗效与口服茶碱缓释片（氨茶碱片）相当,差异不显著。更多还原

【Abstract】 This study includes two main parts, literature review and clinic study of bronchial asthma therapy during acute episode （treat by） with Fu’s acupuncture.一、Literature reviewBased on current research of acupuncture treatment for bronchial asthma, this study summarizes, analyzes and researches this method.Systematic review and analysis of Feishu point is realized on variables such as definition, operation position, mechanism, clinic observation research and research of Feishu point from the Western and Eastern point of view.Systematic review of the appearance and development of Fu’s acupuncture, summary of clinical researches and Fu’s acupuncture theory.二、Clinic studyObjective of study: By Fu’s acupuncture treatment at Feishu point, clinic observations on mild to moderate degrees of bronchial asthma during acute episode. This study integrates and evaluates the effects of Feishu acupoint therapy for asthma and researches its safety to human body as well as clinical treatment development.Methodology:①The Patients are randomly divided into two groups, one is Fu’s acupuncture group （treatment group） and another is western medicine group （control group）. One week before beginning the treatment, the patients should stop taking any medicine except the experimental ones. Patients, who have already taken hormone as usual, can maintain the original dosage during the treatment course.②Fu’s acupuncture group includes 30 cases. Acupoint: Feishu （on both sides）. Feishu point is chosen according to national standards《Acupoint location》. Acupuncture tool: Fu’s subcutaneous needling （FSN）, （medium type, Nanjing FSN Medical Appliances Co.ltd）. Manipulative method: take a prone position, locate the insertion point, routine disinfection, needle insertion direction at Feishu point is aligned with Fengmen point, penetrates quickly the needle through the skin till the needle casing is stable under skin where the loose connective tissue goes through, shouldn’t be pushed or twirled. After inserting subcutaneous needle completed, remove after 30 minutes swaying in subcutaneous layer. Treatment time is 5 times, with one time every day. Control group has 30 cases: take Theo-Dur tablet, dose 200mg.po.bid. Five days make up one treatment course, no rest during course. Observed indicators: the variations of main symptoms of asthma and physical signs （gasp, short breathe, have cough, expectoration, wheezing tone）. Pulmonary function tests: Peak expiratory flow （PEF）, Forced expiratory volume in the first second （FEV₁）, Forced expiratory rate in the first second （FEV₁%）.Results:①The Fu’s acupuncture and control group, PEF comparison: Fu’s acupuncture group’s treatment has significant difference between pre- and post-treatment （P<0.01）, control group’s treatment has significant difference between pre- and post-treatment （P<0.01）. It proves that effects of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ PEF level both has been much improved. Before treatment, Fu’s acupuncture and control group’s therapy have no remarkable difference （P>0.05）, it’s clearly that before treatment, both patient groups’ PEF level has not much difference; and after treatment also has not much difference （P>0.05）, it’s obviously that the improved effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ PEF level has not noticeable difference.②The Fu’s acupuncture and control group, FEV₁ comparison: Fu’s acupuncture group’s treatment has significant difference between pre- and post -treatment （P<0.001）. Control group’s treatment has highly significant difference between pre- and post-treatment （P<0.001）. It proves that effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ FEV₁ level both has good improvement. Before treatment, Fu’s acupuncture and control group’s therapy have no remarkable difference （P>0.05）, it’s clearly that before treatment, both groups’ FEV₁ level has comparability; and after treatment also has not much difference （P>0.05）, it’s obviously that the improved effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ FEV₁ level has not noticeable difference.③The Fu’s acupuncture and control group, FEV₁% comparison: Fu’s acupuncture group’s treatment has significant difference between pre-and posttreatment （P<0.01）. Control group’s treatment has clear difference between pre- and post-treatment （P<0.01）. It proves that effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ FEV₁% level both has been much improved. Before treatment, Fu’s acupuncture and control group’s therapy have no remarkable difference （P>0.05）, it’s clearly that before treatment, both groups’ FEV₁% level has comparability; and after treatment also has not much difference （P>0.05）, it’s obviously that the improved effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ FEV₁% level has not noticeable difference.④Symptom grade comparison of two groups: Fu’s acupuncture group’s treatment has significant difference between pre- and post-treatment （P<0.01）. Control group’s treatment has significant difference between pre- and post-treatment （P<0.01）. It proves that effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ symptom grade both has good improvement. Before treatment, Fu’s acupuncture and control group’s symptoms grade have no remarkable difference （P>0.05）, it’s clearly that before treatment, both groups’ symptom grade has comparability; and after treatment also has not much difference （P>0.05）, it’s obviously that the improved effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients’ symptom grade has not noticeable difference.⑤Curative effect comparison of two groups: therapeutic effect of Fu’s acupuncture and control group has not much difference （P>0.05）. It proves that curative effect of Fu’s acupuncture at Feishu point and taking Theo-Dur medicine on asthma patients has not obvious difference.⑥Safe evaluation can proof therapy’s safety and reliabilityConclusion: In this study, effects of Fu’s acupuncture at Feishu point on bronchial asthma patients’ peak expiratory flow （PEF）, forced expiratory volume in the first second （FEV₁）, forced expiratory rate in the first second （FEV₁%）, symptom grade both exactly has improvement, safety is also high, and has not obvious difference. Curative effect of Fu’s acupuncture at Feishu point therapy and taking Theo-Dur medicine treatment on bronchial asthma patients is equivalent, not clearly different.更多还原