【作者】 王军；

【导师】 孙申田；

【作者基本信息】 黑龙江中医药大学 ， 针炙推拿学， 2009， 博士

【摘要】 目的：通过设计定制的有源方波电脉冲回馈性检测系统(EPDS)，发掘新的腧穴电测量方法，并应用于特发性面神经麻痹患者的迎香穴导电状态的测量，以观察比较头针和体针的三种不同方法对特发性面神经麻痹的针刺效应，为临床治疗特发性面神经麻痹中不同针刺方法的选择、针刺取穴的选择、分期治疗中不同方法的选择、针刺效应大小的检测提供可靠的实验依据。方法：1．设计一个定制有源方波电脉冲的回馈性检测系统(EPDS)，在相同环境和物理条件下：应用任意函数波型发生器，向被测腧穴发送定制的方波连续交流电脉冲，并用串联的双通道数字式存储示波器检测和记录腧穴反馈的电信号，取用正向脉冲的稳态电压Vs作为测量指标。应用Oringe7．0图形和数据分析软件，对电信号图形信息加以还原、拟合和数据采集。2．随机选择健康男女15名，检测其迎香穴和其它穴位导电状态，进行多次、多因素影响下的测量观察，利用其波型图像动态地观测，分析相关数据。3．门诊随机选定30名面神经麻痹患者，随机分为三组，每组1 0人，分别应用针刺健侧合谷穴，头针百会穴，头针健侧运动区三种处理方法后，测量其左右迎香穴在针刺前后的导电状态，取稳态电压Vs为指标数据，进行对比研究。应用SPSS13．0统计处理软件对信号数据信息进行统计学处理。(1)比较针刺前健侧和患侧迎香穴导电状态的差别。(2)比较应用每种处理方法后迎香穴导电状态的前后差别和双侧差别。(3)比较不同针方法组别，对患侧迎香穴导电状态影响差别。(4)动态观察体针和头针刺未行针和按刺激量行针时导电状态的波型图像变化。结果：1．应用定制方波有源的电脉冲回馈性检测系统(EPDS)，发现一种可以稳定、准确地表达腧穴的导电状态的新方法。即通过在定制方波脉冲下，正向脉冲波内，被测腧穴所显示的稳态电压Vs值，来反映该腧穴当时的导电状态。Vs值越大，说明被测腧穴阻抗越低，导电性越好；Vs值越小，说明被测腧穴阻抗越高，导电性越差。2．通过EPDS检测系统动态观测健康人的双侧迎香穴导电状态的波型图像，二者波型完全一致，稳态电压Vs线高低无明显差异。3．经EPDS检测系统，发现特发性面神经麻痹患者：健侧迎香穴导电状态优于患侧，健侧迎香穴稳态电压Vs值明显高于患侧(P＜0．05)。4．经EPDS检测系统，发现针刺健侧合谷穴组：双侧迎香穴均出现稳态电压Vs值的明显升高(p＜0．05)；针刺健侧后合谷后，双侧对比，患侧升高明显，呈显著性差异(p＜0．05)。5．经EPDS检测系统，发现头针百会组：针刺后，双侧迎香穴均出现稳态电压Vs值的明显升高(p＜0．05)；双侧对比，迎香穴Vs值无显著差异(p＞0．05)。6．经EPDS检测系统，发现头针健侧运动区组：针刺后，双侧迎香穴稳态电压Vs值均有明显提升(p＜0．05)；双侧对比，患侧迎香穴Vs提高明显，二者差异显著(p＜0．05)。7．以针刺后患侧迎香穴稳态电压Vs为指标，三个针刺方法组两两比较，经SPSS软件分析，均有显著性差异(p＜0．05)，按其对患侧迎香穴Vs提高大小排列依次为：头针运动区组＞头针百会组＞体针合谷组。8．通过EPDS检测系统，动态观测到所有患者在进针而未加刺激时，双侧迎香穴动态波型及稳态电压Vs基线显示均与未针刺时观测到的相同，均无明显变化。结论：1．应用定制方波有源的电脉冲回馈性检测系统(EPDS)，发现一种可以稳定、准确地表达腧穴的导电状态的新方法。这对于经穴电特性检测方法的研究和应用有重要的意义。2．应用EPDS检测系统，可以显示健康人双侧迎香穴导电状态无差别。而特发性面神经麻痹患者左右迎香穴的导电状态不平衡，其患侧明显下降。提示，EPDS的方法可以通过腧穴电测量来检测疾病状态和健康状态。健康的迎香穴导电好，病侧的迎香穴导电差。3．头针和体针均可明显提高特发性面神经麻痹患者患侧迎香穴的导电状态，从腧穴电测量角度证实二者均为治疗特发性面神经麻痹有效方法。也说明可以运用腧穴电测量的方法，对针灸治疗的有效方法(手法)加以初筛。4．三个针刺组别对患侧迎香穴的导电状态提升，相比较其效应大小的依此为：头针运动区组＞头针百会组＞体针合谷组。提示头针在治疗面瘫过程中的针刺效应是十分优异，临床中不容忽视。头针百会穴组对双侧迎香穴导电状态均有提升且针刺效应强度适中，提示百会可以作为治疗面神经麻痹初期至后期的常规穴位，始终加以应用。头针面运动区针刺效应较强，提示其可以在面神经麻痹中后期的治疗中加以应用。体针合谷针刺效应较轻，提示可以在面神经麻痹早期治疗中就加以应用。可以见这种腧穴电测量的方法可以应用于针刺不同方法(手法)的筛选和针刺不同方法(手法)介入时机的选择。5．针刺健侧的头针运动区对患侧迎香穴导电状态提升更明显，提示特发性面神经麻痹的头针选穴，应重点选择病患对侧的头针面运动区。说明腧穴电测量可以应用于针刺穴区的选择。6．任何一种针刺方法必须达到一定的刺激量才能产生相关的针刺效应，提示在临床中需要注意针刺应达到刺激量以保证临床疗效。腧穴电测量可以用来观察不同手法刺激量下腧穴导电状态的改善程度，对针刺手法刺激量的规范化有重要意义。更多还原

【Abstract】 Objective:To observe and compare effects of scalp and the body acupuncture ofthe three different methods of acupuncture on Bell palsy by using poweredby designing a customized feedback square wave Electric Pulsed-wave ModeDetection System(EPDS),explore new acu-points power measurementmethod,electric acu-point measurement system,and applied to patientswith Bell palsy by Ying Xiang(LI20)of the conductive state ofmeasurement,which can provide experimental evidence for choosingdifferent acupuncture methods,varied acu-points and electric acu-pointdetection for the clinical treatment of Bell palsy.Method:Firstly,design a customized active feedback square wave ElectricPulsed-wave Mode Detection System(EPDS),in the same environment andphysical conditions:the application of arbitrary wave function generator,the measured acu-points to send customized for AC square wave pulse,andseries of dual-channel digital storage oscilloscope to detect and record theelectrical signals acu-points feedback,access to a positive pulse voltage Vsfor the steady-state measure.Application Oringe7.0 graphics and dataanalysis software,the graphics information to restore the signal,fitting anddata acquisition;Secondly,randomly selected 15 healthy male and females to test the YingXiang conductive point and other points,and for many,many factorsaffecting the measurement under observation,use of its images dynamically-wave observations,analysis of relevant data;Thirdly,30 randomly selected patient inpatients with Bell Palsy wererandomly divided into three groups,respectively,the application of contralateral acupunctureHegu(LI 14),scalp acupoint-Baihui(DU20),scalpcontra lateral motor area after the three treatment methods,measurement of its Ying Xiang around the acupuncture points near the conductive state,steady-state voltage Vs from the data for the indicators to process thecomparative study.Four scientific issues were testified in this study:(1)Comparison of contra lateral and ipsilateral acupuncture before Yingxiang-point difference between conductive state(2)to compare the application ofeach approach Ying Xiang points after conducting a state of bilateraldifferences and the difference before and after.(3)To compare differentmethods of needle groups,on the side Ying Xiang conductive state of theimpact of differences in point.(4)Dynamic observation of body acupunctureneedle and the first line did not stimulate the amount of the needle and byfirms conducting state of the needle when the image changes in wave.SPSS13.0 application was using to process these statistical data.Results:1.Application of custom Electric Pulsed-wave Mode Detection System(EPDS)can be found in a stable and accurate expression of the conductivestate of acupoints new method.That is,square-wave pulse through thecustom,the positive pulse,the measured acupoints shown the value of thesteady-state voltage Vs,to reflect the acupoints conductive state at the time.The greater the value of Vs on the measured impedance acupoints lowerconductivity,the better;Vs value of the smaller shows that the higher themeasured impedance acupoints,the poorer the conductivity.2.EPDS detection system through the dynamic observation of bothhealthy people Yingxiang conductive state wave images,both exactly thesame wave,steady-state voltage Vs no significant difference between highand low lines.3.Detection system by the EPDS was found in patients with Bell palsy:Yingxiang contra lateral superior side hole conductive state,steady-statepoint contra lateral Xiang Ying was significantly higher than the Vs voltageside,there are(P＜0.05). 4.Detection system by the EPDS was found contra lateral Heguacupuncture group:acupuncture after bilateral Yingxiang point values ofsteady-state voltage Vs has improved significantly(p＜0.05);Hegu aftercontra lateral acupuncture after bilateral contrast,increased significantlyaffected,showing significant difference(p＜0.05)5.Detection system by the EPDS and found that scalp Baihui groups:acupuncture after bilateral Yingxiang point values of steady-state voltage Vshas improved significantly(p＜0.05);bilateral comparison,Ying XiangPoint Vs didn’t affect significantly improve,significant difference(p＞0.05).6.Detection system by the EPDS and found that motor areas contralateral scalp groups:acupuncture after bilateral Yingxiang point values ofsteady-state voltage Vs has improved significantly(p＜0.05);bilateralcomparison,Ying Xiang Point Vs affected significantly improve,significantdifference(p＜0.05)7.To acupuncture points after the Yingxiang-side voltage Vs forsteady-state targets,three methods of Section 22 of acupuncture compared toanalysis by SPSS software,were significantly different(p＜0.05),according to his own side hole Vs Yingxiang in order to increase the size asfollows:scalp motor area group＞scalp Baihui Group＞body acupuncturegroup Hegu.8.EPDS detection system through the dynamic observed in all patientswithout additional stimulus into the needle,the bilateral dynamic Yingxiangpoints and steady-state voltage waveform Vs baseline showed thatacupuncture is not are the same when observed,did not change significantly.Conclusion1.Application of custom Electric Pulsed-wave Mode Detection System(EPDS)can be found in a stable and accurate expression of the conductivestate of a new acu-point method.The important significance means thecharacteristics of electrical meridian for the study of detection methods and application2.EPDS application testing system can show both healthy Yingxiang-point non-conductive states.And in patients with Bell palsy Yingxiangpoints around the conductive state of imbalance,the affected side decreasedsignificantly.EPDS method can tell acupoints to detect electrical measuringhealth status and disease.Healthy Yingxiang acu-point conductive well andpatient side point-Yingxiang got poor conductivity.3.Scalp acupuncture and body acupuncture can significantly improvethe affected persons Bell palsy Yingxiang conductive state,from theperspective of electrical measuring acu-points both confirmed that thetreatment of Bell palsy effective way.Also shows that from the effectiveacu-points of the perspective of electrical measurements on the clinicaltreatment methods(technique)to the effectiveness of screening.4.Three acupuncture groups on the side of the conductive Yingxiang-state increase compared to the size of its effect on this as follows:scalpmotor area group＞scalp Baihui Group＞body acupuncture Hegu group.Tipsin the treatment of scalp in the process of Bell palsy is a very excellenteffect of acupuncture,clinical effect can not be ignored.In scalpacupuncture group Baihui,Yingxiang bilateral conductive points are toenhance the status and effect of moderate-intensity acupuncture;Baihui tipscan be used as the initial treatment of Bell palsy points to the latter part ofthe routine,and always be applied.Scalp acupuncture effect face strongmotor area,suggesting that it’s mid-and late facial paralysis can be theapplication of the treatment.Effect of acupuncture Hegu body lighter,andprompt early treatment of facial paralysis can be applied on.Acu-Points cansee this method of measuring electrical acupuncture can be used in differentways(technique)of the screening and acupuncture in different ways(technique)the timing of intervention.5.Acupuncture contra lateral motor areas of the scalp affectedYingxiang conductive state to enhance even more evident,suggesting that Bell palsy of scalp acupuncture point selection,selection should focus onpatients with contra lateral motor areas of the scalp surface.Note thatacu-points acupuncture electrical measurements can be applied to the choiceof priority.6.Any kind of acupuncture must reach a certain amount of stimulationcan produce effects related to acupuncture,suggesting that in clinicalacupuncture need to pay attention to the need to stimulate the volume toensure clinical efficacy.Acu-points can be used to observe the electricalmeasurements,the volume of different means to stimulate acu-points toimprove the level of electrical conductivity state of acupuncture to stimulatethe volume of standardized practices are important.更多还原