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SPECT-rCBF观察眼针治疗中风病即时效应
【作者】 冯瑶；
【导师】 周鸿飞；
【作者基本信息】 辽宁中医药大学 ， 针灸推拿临床， 2009， 硕士
【摘要】 目的:彭氏眼针疗法是我院著名老中医彭静山教授于1973年发明的一种微针疗法,30余年来广泛应用于临床,尤其是对缺血性中风疗效显著。本试验以缺血性中风患者为研究对象试图利用99mTc-ECDSPECT脑灌注显像技术研究彭氏眼针疗法对缺血性中风患者局部脑血流量（rCBF）的影响,进一步探讨彭氏眼针疗法治疗中风病的作用机制。材料与方法:选择辽宁中医药大学附属医院、中国医科大学附属第四医院2008年1月至2008年10月期间神经内科,符合中医诊断为中风（中经络）急性期,西医诊断为动脉粥样硬化性血栓性脑梗塞的患者8例,将入选病例进行编号、记录观察项目,先行SPECT检查,空腹口服过氯酸钾400mg,以封闭脉络丛、甲状腺和鼻粘膜,减少显影剂的吸收和分泌;30分钟后静脉注射显影剂双半胱乙酯(99mTc-ECD),立即进行数据采集,并记录结果,根据中医辨证论治原则,将入选病例进行辨证分型,具体分型为:风痰火亢、痰热腑实、风痰瘀阻、气虚血瘀、阴虚风动五型。根据辨证取穴原则:眼针主穴:取上焦区、下焦区。眼针配穴:风痰火亢型加肝区、肾区、脾区;风痰瘀阻型加肝区、脾区;痰热腑实型加胃区、大肠区;气虚血瘀型加心区、脾区;阴虚风动型加肝区、肾区。对入选患者分别取不同的眼区穴位施眼针治疗,病人取仰卧位,常规消毒后,采用外刺法,与皮肤呈10°-15°角沿皮刺入穴位,进针得气后留针20分钟,不行针。出针时,以刺手的拇、食指捏持针柄,轻轻转动后缓慢出针1/2,然后慢慢出针,拔针后即刻用干棉球按压针孔,宜按压1～3分钟。眼针操作完毕,按照之前的程序再次行SPETC检查,并记录结果。两次成像均在相同条件下行处理,用目测法和半定量分析法计算治疗前后rCBF的变化,并经统计学分析二者的差异。结果:1.目测法:患者眼针治疗后脑部的8个区域均表现为放射性分布浓聚,而且患者眼针治疗后病灶处的放射性较治疗前呈现明显的放射性分布浓聚。2.半定量法:患者眼针治疗后平均脑血流速度较眼针治疗前明显增高;患者眼针治疗前后局部脑血流量对比有显著变化,患者眼针治疗后脑部的8个区域的脑血流量ROI摄取比值均较眼针治疗前明显增高,而且病灶处的脑血流量ROI摄取比值增高情况较其他区域更加明显。结论:1.眼针疗法可以明显改善缺血性脑中风患者的脑供血。2.眼针疗法改善脑供血的机制可能为改善病灶周围的半暗带组织供血。3.眼针疗法治疗中风病的即时效应是存在而且有效的。
【Abstract】 Purpose:Pang eye-acupuncture therapy in our hospital is well-known Professor Peng Jingshan old Chinese medicine in 1973,invented a micro-needle therapy, more than 30 years,is widely used in clinical,especially for the efficacy of ischemic stroke significantly.In this study,patients with ischemic stroke in this study attempted to use 99mTc-ECDSPECT cerebral perfusion imaging study of Pang’s eye-acupuncture therapy in patients with ischemic stroke on local cerebral blood flow（rCBF） the impact of Pang’s eyes to further explore the treatment of stroke,acupuncture mechanisms of disease.Material and method:Objective:Methods:Liaoning University of Traditional Chinese Medicine Affiliated Hospital,China Medical University Fourth Hospital from January 2008 to October 2008 during the Department of Neurology,in line with the traditional Chinese medicine diagnosis of stroke（in Meridian） acute phase,diagnosis of Western medicine atherosclerotic thrombosis in patients with cerebral infarction 8cases.Arrangements will be selected number of cases, recorded observation of the project,first SPECT examination,potassium chlorate have been fasting oral 400mg,to be closed choroid plexus,thyroid and nasal mucosa to reduce the reagent,the absorption and secretion;30 minutes after the intravenous ECD reagent(99mTc-ECD),an immediate data collection,and record the results,in accordance with the principles of TCM syndrome differentiation, will be selected Syndromes cases,the specific sub-type as follows:Wind Fire Kang,heat-fu indeed,the wind resistance phlegm and blood stasis,qi deficiency and blood stasis,deficiency of five pneumatic type.Selection based on the principle of differentiation:the main points the needle eye:from the focal areas,areas under the coke.Eye with the needle point:Kang-based Canadian Wind Fire liver,kidney area,spleen;wind phlegm and blood stasis type resistance increases liver,spleen area;heat bowel real increase stomach area,the large intestine area;increase heart qi deficiency and blood stasis area,spleen; deficiency type pneumatic increase liver and kidney area.Patients were selected from different areas of the eye acupuncture points Shi eye,the patient in supine position from conventional disinfection,the use of outside the barbed law,and the skin was 10°-15°angle along the skin piercing points,the needle into the needle was left after the gas 20 minutes,no needles.When the needle to Spurs hand thumb and index finger pinch handle needle holders,gently rotate the needle after the slow 1/2,and then slowly the needle,Needle with a dry cotton ball immediately after the push pin should press 1 to 3 minutes.End of the needle eye operation,in accordance with the procedures before the line once again SPETC inspection,and record the results.Two imaging conditions are down in the same treatment,using visual and semi-quantitative analysis method to calculate the changes in rCBF before and after treatment,and by the statistical analysis of differences between the two.Results:1.Visual method:after treatment in patients with brain needle eye of the performance of eight regions for the uptake of radioactive distribution,and after treatment in patients with eye lesions needle Department of radioactive than the pre-treatment showed significant uptake of radioactive distribution.2.Semi-quantitative method:the needle eye in patients with cerebral blood flow after treatment the average faster than the needle eye before treatment was significantly increased;Needle eye before and after treatment in patients with regional cerebral blood flow compared with significant changes in the treatment of patients with eye needle in the brain after the eight regional cerebral blood flow ROI uptake ratios than those of the needle eye before treatment was significantly increased,and cerebral blood flow lesions Department ROI uptake ratios higher than in other regions the situation becomes even more evident.Conclusion:1.Eye-acupuncture therapy can be significantly improved in patients with ischemic stroke of the cerebral circulation.2.Eye-acupuncture therapy to improve cerebral blood supply may be to improve the mechanism of lesion penumbra around the blood supply organization.3.Eye-acupuncture therapy in the treatment of stroke patients and the existence of an immediate effect is effective.