针刺治疗椎—基底动脉供血不足（VBI）性眩晕的临床观察

【作者】 芦晓宏；

【导师】 李文金；

【作者基本信息】 辽宁中医药大学 ， 针灸推拿学， 2010， 硕士

【摘要】 目的:以临床疗效、经颅多普勒、血脂、血液流变学为研究手段,设西药西比灵(盐酸氟桂利嗪)为对照组,探讨以补益气血,通经活络为原则针刺治疗椎--基底动脉供血不足性眩晕的疗效和机理,为针刺治疗椎--基底动脉供血不足性眩晕提供理论依据。方法:将符合入选标准的60例椎--基底动脉供血不足患者,按照随机数字表法随机分为针刺治疗组30例,西比灵(盐酸氟桂利嗪)对照组30例。治疗组采用补益气血,通经活络法治疗,主穴为足三里、三阴交、风池、百会、颈夹脊,配穴按辩证取穴。对照组采用口服西比灵治疗。治疗组以上穴位每日固定时间针刺一次,8天为一疗程,疗程期间休息2天,连续3个疗程。对照组西比灵5mg,每晚一次,睡前口服,28天为一疗程。在两组治疗前和治疗后检测下列指标:(1)用临床疗效评定眩晕等主要临床症状和体征的变化;(2)经颅多普勒(TCD)检查双侧椎动脉(VA)、基底动脉(BA)的收缩期峰流速(Vs)、舒张期末峰流速(Vd)、平均峰流速(Vm)以及血管搏动指数(PI);(3)血脂的胆固醇(TC)、甘油三脂(TG)、高密度脂蛋白胆固醇(HDL--C)、低密度脂蛋白胆固醇(LDL--C);(4)血流变中全血粘度(高切,中切,低切)、血浆粘度、红细胞聚集指数(%)等指标。结果:1治疗组临床治愈10例,治愈率(33.33%);显效8例,显效率(26.67%);有效10例,有效率(33.33%);无效2例,无效率(6.67%);总有效29例,总有效率(93.33%)。对照组临床治愈5例,治愈率(16.67%);显效6例,显效率(20%);有效12例,有效率(40%);无效7例,无效率(23.33%);总有效23例,总有效率(76.67%)。经统计学分析,两组疗效有非常显著性差异(P<0.01),治疗组优于对照组。2治疗前后经颅多普勒、血脂、血液流变学等实验室指标变化均有统计学意义(P<0.05—P<0.01),而对照组仅部分指标有改善。结论:本病乃气血不足,气血不能上荣于脑致清窍失养;或气虚推动无力,导致水湿痰饮代谢障碍,导致脉道不利,因虚致血瘀为其病机。通过针刺足三里、三阴交、风池、百会、颈夹脊,以补益气血,通经活络为原则治疗椎--基底动脉供血不足(VBI)性眩晕,得出结论如下:1针刺风池等穴可减轻椎--基底动脉供血不足(VBI)性眩晕、耳鸣、视物不清、恶心呕吐等症状。2针刺风池等穴对椎--基底动脉供血不足(VBI)性眩晕患者有改善椎—基底动脉供血、降血脂、改善血液粘度等作用。3针刺风池等穴对椎--基底动脉供血不足(VBI)性眩晕无毒副作用,优于西比灵。4针灸治疗椎基底动脉供血不足性眩晕可能通过以下机制完成:(1)针灸对血管的舒缩功能有双向调节作用,可以降低血管阻力,增强缺血部血管代偿能力,也可缓解血管痉挛,调整脑血流的低灌状态,从而增加脑血流量。(2)通过调整机体脂质代谢过程中多种酶的功能,使血脂被更快地转化、利用,从而使胆固醇快速转化为胆汁酸及类固醇激素,清除外周组织中过多的胆固醇,减少其在动脉内壁上脂质的沉积,从而降低血脂含量,达到降脂效果(3)针刺能改善血液聚,粘倾向相关的病理机制,改善红细胞和血小板的质量。5本法疗效确切,立法有据,操作简单,且费用低、风险小、起效快,值得临床推广应用和进一步研究。更多还原

【Abstract】 Objective: To discuss the curative effect ,and supposes the western medicine Thebes spirit treatment control group, the discussion benefits the vitality, passes after detachably for the principle acupuncture treatment Vertebrobasilar Insufficiency dizziness curative effect and the mechanism, provides the theory basis for the acupuncture treatment Vertebrobasilar Insufficiency dizziness.Methods: 60 cases of VBI were chosen and randomly divided into acupuncture treatment group of 30 cases and Sibelium control group of 30 cases in term of consulting random numeric table. The treatment group treated with therapy of activating qi and blood and fill in the gaps of dredging . The main acupoints selected were the alveolus for Fengchi(GB20), Baihui(GV20), C3-5Jiaji(EX-B2), Zusanli(ST36),Sanyinjiao(SP6), and the auxiliary acupoints were chosen according to differentiation of syndromes in treatment group.Taking Sibelium orally was chosen in control group treated with acupuncture method. The acupoints above in treatment group comprised 8 days in a course and treated once a day at certain time. They had been observed for three courses in total. Patients broke 2-3 days between two courses.5mg Sibelium were used in the control group, and only taked it in evening before going to bed. It comprised 28 days in a course. The indexes were checked between the two groups before the commencement and after the completion of three courses:(1)The main clinical symptom and physical sign of evaluating by clinical curative effect. (2)Some indexes of blood flow velocity of systolic apex(Vs),diastasis (Vd),mean(Vm)and artery pulsate index (PI) of vertebra-artery (VA) and basilar arterial (BA) checked by TCD.(3) Blood-lipid including cholesterin(TC),triglyceride((TG), high density lipoprotein(HDL-C), and low density lipoprotein(LDL-C). (4) The adhesion of the whole blood, plasma reduced degree, hematocrit and platelet adhesion reaction rate et al checked by blood rheology. Results:1 The result manifests that it were healed 10 cases,the cure rate was 33.33% ; effected 10cases,the cure rate was 33.33% ;ineffected 2,the cure rate was 6.67% ;the total effective 29 cases ,the cure rate was 93.33% in treatment group; and healed 5 cases, the cure rate was 16.67% ; effected 12cases,the cure rate was 40% ; inefficiency 7, the cure rate was 23.33% ; the total effective23 cases, rate was 76.67% in the control group .There difference between the two groups (P<0.01).The curative effect in treatment group was better than that in control group.2 There was a statistical meaning between the two groups(P<0.05- P<0.01)change of the experimental indexs by TCD, blood rheology, blood lipid . Just before the commencement and after the completion of a course of treatment. And only some indexs in control group have improved.Conclusion:Nourished, Qi inability to promote, cause moisture phlegm metabolic disorders, unsmoothness of vessels , so the deficiency of blood stasis due to its pathogenesis. Because the pathological mechanism of VBI is that qi and blood are insufficiency, and they don’t rise, and brain is failure. We acupuncture the acupoint ,as fundamental to activating qi and blood and fill in the gaps of dredginghave cured vertigo.Our conclusion is that as follows:1 Vertigo and Tinnitus symptomsv can alleviated by using acupoint .2 Vertebrobasilar Insufficiency, blood rheology,, and blood lipid can be improved by acupoint for patient.3 Acupoint have no toxic and side-effect to vertigo,it is better than Sibelium.4 Acupuncture treatment of vertebral basilar insufficiency vertigo can by completed by the mechanisms below:(1)Systolic and diastolic function of acupuncture on blood vessels have two-way regulation can reduce the vascular resistance, enhanced compensatory ability of vascular ischemia, can also reduce the vascular spasm, cerebral blood flow to adjust the low irrigation conditions, thereby increasing cerebral blood flow.(2)By adjusting the lipid metabolism in a variety of enzyme function, so that blood lipids were converted faster to use, allowing rapid conversion of cholesterol to bile acids and steroid hormones, peripheral tissue removal of excess cholesterol in the artery wall to reduce its on lipid deposition, thereby reducing blood lipid levels, to lipid-lowering effect.(3)Acupuncture can improve blood poly, sticking tendency-related pathology, improve the quality of red blood cells and platelets.5 The therapy in this study is a effective therapy and is welled grounded on law. It is worth while extensive application and deeper research by its simply-operation, low-cost,low-risk,and fast acting.更多还原