本文選題：椎動脈型頸椎病　切入點(diǎn)：針刺　出處：《廣州中醫(yī)藥大學(xué)》2017年博士論文　論文類型：學(xué)位論文

【摘要】：目的:本臨床實(shí)驗(yàn)根據(jù)隨機(jī)對照的科研設(shè)計(jì)原則將90名受試者分為針刺結(jié)合壓灸組、單純針刺組、壓灸組進(jìn)行比較研究。應(yīng)用頸性眩暈癥狀與功能評估量表、經(jīng)顱多普勒(TCD)檢查、頸椎X線檢查、WHO生存質(zhì)量測定量表(WHOQOL-BREF)分別在治療前后對受試者進(jìn)行評分,對數(shù)據(jù)進(jìn)行統(tǒng)計(jì)分析,探討針刺結(jié)合壓灸法、單純針刺、藥物治療椎動脈型頸椎病的效果對比,闡明針刺結(jié)合百會壓灸治療椎動脈型頸椎病的臨床意義。方法:本研究的96名椎動脈型頸椎病患者病例來源為臺灣中醫(yī)診所。按完全隨機(jī)1:1:1的比例分為三組:針刺結(jié)合壓灸組、單純針刺組、藥物組,每組32例。西醫(yī)診斷標(biāo)準(zhǔn)參照《第三屆全國頸椎病專題座談會紀(jì)要》關(guān)于椎動脈型頸椎病的西醫(yī)診斷標(biāo)準(zhǔn),中醫(yī)辨證分型標(biāo)準(zhǔn)參照中國中醫(yī)藥管理局《中醫(yī)病證診斷療效標(biāo)準(zhǔn)》制定的椎動脈型頸椎病的中醫(yī)證候診斷標(biāo)準(zhǔn),將椎動脈型頸椎病分為以下五個證型:肝陽上擾型、瘀血內(nèi)阻型、痰濁阻竅型、肝腎陰虛型、氣血虧虛型。針刺結(jié)合壓灸組的針刺主穴為病變椎體夾脊穴、風(fēng)池(雙),百會穴行壓灸法,留針30分鐘,間斷性行針2-3次。療效觀察具體項(xiàng)目包括:《頸性眩暈癥狀與功能評估量表》、WHO生存質(zhì)量測定量表(WHOQOL-BREF)、顱內(nèi)椎—基底動脈的收縮期峰值血流速度(Vp)及舒張末期峰值血流速度(Vd)。關(guān)于椎動脈型頸椎病的療效評定標(biāo)準(zhǔn)參照2002年頒發(fā)《中藥新藥臨床研究指導(dǎo)原則》中有關(guān)頸椎病療效評定標(biāo)準(zhǔn)進(jìn)行修改制定。結(jié)果:治療前,針刺結(jié)合百會壓灸組、單純針刺組、藥物組在性別、年齡、病程、中醫(yī)辨證分型、頸性眩暈癥狀與功能評估量表、WHO生存質(zhì)量測定量表、椎—基底動脈的收縮期峰值血流速度(Vp)及舒張末期峰值血流速度(Vd)差異經(jīng)分析均無統(tǒng)計(jì)學(xué)意義,說明三組的一般基線資料具有可比性。1.頸性眩暈癥狀與功能評估量表①眩暈指標(biāo)得分比較經(jīng)過三周的治療后,針刺結(jié)合百會壓灸組、單純針刺組、藥物組的眩暈癥狀均有不同程度的好轉(zhuǎn),且針刺結(jié)合百會壓灸療法的臨床療效比單純針刺、藥物治療明顯。遠(yuǎn)期療效方面,針刺結(jié)合百會壓灸、單純針刺更有優(yōu)勢,且針刺結(jié)合百會壓灸組的遠(yuǎn)期療效要優(yōu)于藥物組。②頸肩痛指標(biāo)得分比較治療三周后,針刺結(jié)合百會壓灸組、單純針刺組的頸肩疼痛評分與藥物組進(jìn)行兩兩比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪調(diào)查時,三組的頸肩疼痛評分組間差異不明顯(P0.05)。三周治療結(jié)束后,針刺結(jié)合百會壓灸、單純針刺可緩解椎動脈型頸椎病患者的頸肩疼痛癥狀,而藥物治療對于改善患者的頸肩疼痛癥狀無療效。隨訪數(shù)據(jù)表明,三種不同療法對于改善椎動脈型頸椎病患者的頸肩疼痛癥狀,在時效性方面均未能獲得良好的遠(yuǎn)期效果。③頭痛指標(biāo)得分比較三周的治療后,單純針刺組、藥物治療組的頭痛評分進(jìn)行組間比較無統(tǒng)計(jì)學(xué)意義(P0.05)。治療三周后,針刺結(jié)合百會壓灸、單純針刺組、藥物治療均可改善椎動脈型頸椎病的頭痛癥狀,但三種療法的臨床療效差異不明顯。在療效時間維持方面,針刺結(jié)合百會壓灸對于緩解椎動脈型頸椎病的頭痛癥狀,與單純針刺、藥物治療相比較,可獲得較好的遠(yuǎn)期療效。④日常生活及工作得分比較治療三周后,針刺結(jié)合百會壓灸組、單純針刺組的日常生活及工作評分與藥物組比較具有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪時,針刺結(jié)合百會壓灸組的日常生活及工作評分與藥物治療相比較,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療三周后,針刺結(jié)合百會壓灸、單純針刺組、藥物治療對于椎動脈型頸椎病患者的日常生活及工作均有良好的促進(jìn)作用,但三種療法的療效差異不明顯。對于改善椎動脈型頸椎病患者的日常生活及工作方面,針刺結(jié)合百會壓灸的療效要優(yōu)于藥物治療。⑤心理及社會適應(yīng)得分比較組內(nèi)比較:無論是治療后,還是隨訪時,三組椎動脈型頸椎病患者的心理及社會適應(yīng)評分,與治療前相比較均有不同程度的改善,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。組間比較:治療三周后,針刺結(jié)合百會壓灸組的心理及社會適應(yīng)評分與單純針刺組、藥物組比較均具有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪時,三組的組間差異無統(tǒng)計(jì)學(xué)意義(P0.05)。2.WHO生存質(zhì)量測定量表比較經(jīng)過三周的治療后,針刺結(jié)合百會壓灸組的WHO生存質(zhì)量測定量表評分與單純針刺組、藥物組比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪時,針刺結(jié)合百會壓灸組的WHO生存質(zhì)量測定量表評分與藥物組比較有統(tǒng)計(jì)學(xué)意義(P0.05)。治療三周后,三種不同療法均可改善椎動脈型頸椎病患者的WHO生存質(zhì)量測定量表評分,且針刺結(jié)合百會壓灸要優(yōu)于單純針刺、藥物治療。在遠(yuǎn)期療效方面,藥物組與針刺結(jié)合百會壓灸組、單純針刺組相比不甚理想。3.椎—基底動脈的收縮期峰值血流速度(Vp)及舒張末期峰值血流速度(Vd)比較三周治療后,針刺結(jié)合百會壓灸、單純針刺、藥物治療均能升高椎動脈型頸椎病患者異常降低的椎—基底動脈收縮期峰值血流速度(Vp),與治療前比較均有統(tǒng)計(jì)學(xué)意義(P0.05)。隨訪時:三組的椎—基底動脈收縮期峰值血流速度(Vp)與治療前相比較差異不明顯(P0.05)。組間比較:無論是三周的治療結(jié)束后,還是隨訪調(diào)查時,三組椎—基底動脈收縮期峰值血流速度(Vp)進(jìn)行組間兩兩比較均無統(tǒng)計(jì)學(xué)意義(P0.05)。治療后,針刺結(jié)合百會壓灸組、單純針刺組、藥物治療組椎動脈型頸椎病患者的椎—基底動脈舒張末期峰值血流速度(Vd)與治療前比較均無統(tǒng)計(jì)學(xué)差異(P0.05)。隨訪時:三組的椎—基底動脈舒張末期峰值血流速度(Vd)與治療前相比較差異不明顯(P0.05)。無論是三周的治療結(jié)束后,還是隨訪調(diào)查時,三組椎—基底動脈舒張末期峰值血流速度(Vd)組間差異不明顯(P0.05)。4.總體療效評價由統(tǒng)計(jì)結(jié)果可知,三組治療后頸椎病總體療效對比有統(tǒng)計(jì)學(xué)差異(P0.05),針刺結(jié)合百會壓灸組的臨床治愈率為12.9%;顯效率為38.7%;有效率為35.5%;無效率為12.9%;總有效率為87.1%。單純針刺組的臨床治愈率為9.7%;顯效率為29.0%;有效率為32.3%;無效率為29.0%;總有效率為71.0%。藥物組的臨床治愈率為6.7%;顯效率為26.7%;有效率為33.3%;無效率為33.3%;總有效率為66.7%。以上數(shù)據(jù)表明,針刺結(jié)合百會壓灸治療椎動脈型頸椎病臨床療效顯著,可較好地改善椎動脈型頸椎病患者頭暈癥狀,促進(jìn)頸部功能的恢復(fù),其臨床療效要好于單純針刺治療和口服甲磺酸倍他司汀治療。結(jié)論:由以上研究數(shù)據(jù)可得知如下結(jié)論:①對于改善頸性眩暈癥狀與功能評估量表方面,針刺結(jié)合百會壓灸可較好地緩解椎動脈型頸椎病的眩暈、頸肩痛、頭痛癥狀,針刺結(jié)合百會壓灸療法的臨床療效比單純針刺、藥物治療明顯。關(guān)于眩暈的遠(yuǎn)期療效對比方面,針刺結(jié)合百會壓灸、單純針刺更有優(yōu)勢,且針刺結(jié)合百會壓灸組的遠(yuǎn)期療效要優(yōu)于藥物組。但隨訪數(shù)據(jù)表明,三種不同療法對于改善椎動脈型頸椎病患者的頸肩疼痛癥狀,在時效性方面均未能獲得良好的遠(yuǎn)期效果。此外,治療三周后,針刺結(jié)合百會壓灸、單純針刺組、藥物治療對于椎動脈型頸椎病患者的日常生活及工作均有良好的促進(jìn)作用,但三種療法的療效差異不明顯。對于改善椎動脈型頸椎病患者的日常生活及工作方面,針刺結(jié)合百會壓灸的療效要優(yōu)于藥物治療。②關(guān)于WHO生存質(zhì)量測定量表方面,治療三周后,三種不同療法均可改善椎動脈型頸椎病患者的WHO生存質(zhì)量測定量表評分,且針刺結(jié)合百會壓灸要優(yōu)于單純針刺、藥物治療。在遠(yuǎn)期療效方面,藥物組與針刺結(jié)合百會壓灸組、單純針刺組相比不甚理想。③椎動脈型頸椎病TCD觀察指標(biāo)方面,三周治療后,針刺結(jié)合百會壓灸、單純針刺、藥物治療均能升高椎動脈型頸椎病患者異常降低的椎—基底動脈收縮期峰值血流速度(Vp)。但遠(yuǎn)期療效對比方面,三組的椎—基底動脈收縮期峰值血流速度(Vp)與治療前相比較差異不明顯。針刺結(jié)合百會壓灸組、單純針刺組、藥物治療組對于改善椎動脈型頸椎病患者的椎—基底動脈舒張末期峰值血流速度(Vd)無明顯作用。
[Abstract]:Objective: This clinical experiment research according to the design principles of randomized 90 subjects were divided into acupuncture combined with compressive moxibustion group, acupuncture group, moxibustion group pressure were compared. The application of cervical vertigo symptoms and functional assessment scale, transcranial Doppler (TCD) examination, X-ray examination of cervical spine, scale to determine the quality of life of WHO (WHOQOL-BREF) was assessed on the subjects before and after treatment, statistical analysis of data, to explore the effects of acupuncture and moxibustion pressure, acupuncture, contrast agents for the treatment of vertebral artery type of cervical spondylosis, elucidate the clinical significance of acupuncture Baihui pressure moxibustion treatment of vertebral artery type of cervical spondylosis. Methods: the study of 96 cases artery type of cervical spondylosis patients from Taiwan Chinese medicine clinic. The ratio of 1:1:1 were randomly divided into three groups: acupuncture combined with compressive moxibustion group, acupuncture group, drug group, 32 cases in each group. The diagnostic standard of Western medicine according to < Third National neck Vertebral disease symposium summary > diagnostic criteria of Western Medicine on vertebral artery type of cervical spondylosis, TCM syndrome differentiation standard reference Chinese administration of traditional Chinese medicine "of TCM syndrome diagnosis and treatment standard > the cervical spondylosis of vertebral artery type of TCM syndrome diagnosis standard, the vertebral artery type of cervical spondylosis is divided into the following five types liver Yang on the disturbance type, blood stasis, phlegm, yin deficiency of liver and kidney, deficiency of Qi and blood type. Acupuncture combined with acupuncture moxibustion group as the main point of pressure vertebral body Jiaji, Baihui, Fengchi (double) line pressing moxibustion, intermittent needle needle for 30 minutes, 2-3 times. To observe the curative effect of specific projects include:" cervical vertigo symptoms and functional assessment scale >, scale to determine the quality of life of WHO (WHOQOL-BREF), peak systolic velocity of intracranial vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd). The criteria for evaluation of curative effect on vertebral artery type of cervical spondylosis with reference to 200 2 years by the "Chinese medicine clinical research guiding principles > about cervical spondylosis therapeutic effect evaluation standard of modified formulation. Results: before treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug group in gender, age, course of disease, TCM syndrome, cervical vertigo symptoms and function assessment scale. Determination of the quality of life of WHO, the peak systolic velocity of vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd) by analyzing the differences were not statistically significant, indicating the general baseline data of three groups have comparable evaluation of cervical vertigo symptoms and.1. function scale of index scores after the three treatment of vertigo the week after acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug group the vertigo symptoms were improved in varying degrees, and the clinical curative effect of combined acupuncture and moxibustion Baihui pressure than simple acupuncture treatment, the long-term effect is obvious. Acupuncture combined with moxibustion, acupuncture Baihui pressure, more advantages, and the long-term curative effect of acupuncture combined with moxibustion Baihui pressure group than the drug group. The neck pain index scores were compared after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure group, neck and shoulder pain scores and the drug group compared 22 acupuncture group, the difference was statistically significant (P0.05). The follow-up survey, neck and shoulder pain scores between the three groups no significant difference (P0.05). After three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture can relieve the patients with vertebral artery type of cervical spondylosis neck and shoulder pain, and drug treatment has no effect for improving patients with neck and shoulder pain symptoms. Follow up data show that the three kinds of therapy for patients with vertebral artery type of cervical spondylosis neck and shoulder pain, on the other hand have failed to obtain a good long-term effect. The treatment of headache index scores were compared after three weeks of pure needle Acupuncture group, headache drug treatment group scores were compared between the groups was not statistically significant (P0.05). After three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture group, drug therapy can improve the vertebral artery type of cervical spondylosis headache symptoms, but the clinical curative effect of three treatments was not obvious in time. Maintain curative effect acupuncture combined with Moxibustion on Baihui, alleviate the pressure of vertebral artery type of cervical spondylosis headache symptoms, and acupuncture and drug treatment compared, can obtain better long-term effect. The daily life and work scores were compared after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group work and daily life score and drug group compared with statistical significance (P0.05). During follow-up, acupuncture combined with daily life and work pressure score and drug treatment compared to Baihui moxibustion group, the difference was statistically significant (P0.05). After three weeks of treatment, acupuncture Baihui pressure Moxibustion, acupuncture group, drug treatment to promote the role of daily life and work of patients with vertebral artery type of cervical spondylosis is good, but the effect is not obvious difference between the three kinds of therapy. To improve the daily life and work of patients with vertebral artery type of cervical spondylosis, drug treatment is superior to the curative effect of acupuncture combined with moxibustion Baihui pressure. 5. Psychological and social adaptation score comparison group comparison: both after treatment or follow-up, psychological and social three groups of patients with cervical spondylosis of vertebral artery type adaptation score, compared with before treatment were improved, the difference was statistically significant (P0.05). Comparison between groups: after three weeks of treatment with acupuncture psychological and social pressure to score Baihui moxibustion group and acupuncture group, drug group were statistically significant (P0.05). During follow-up, there was no significant difference among the three subgroups (P0.05) scale was used to measure the quality of life of.2.WHO Compared with after three weeks of treatment, the determination of scale and the acupuncture group with acupuncture Baihui WHO quality of life pressure moxibustion group, drug group were statistically significant (P0.05). During follow-up, determination of scale and the medication group was statistically significant compared with acupuncture Baihui WHO pressure moxibustion group's quality of life (P0.05). After three weeks of treatment, the determination of scores of three different therapies can improve patients with vertebral artery type of cervical spondylosis WHO quality of life, and the acupuncture combined with compressive moxibustion on Baihui is superior to acupuncture and drug treatment. In the long-term effect, drug group and acupuncture combined with moxibustion Baihui pressure group compared with the acupuncture group is not ideal the peak systolic velocity.3. of vertebrobasilar artery (Vp) and diastolic peak flow velocity (Vd) three weeks after treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture, drug treatment significantly increased the vertebral artery type of cervical spondylosis patients with different Often lower basilar artery peak systolic velocity (Vp), compared with before treatment were statistically significant (P0.05). Follow up: three groups of vertebrobasilar artery peak systolic velocity (Vp) compared with before treatment, no significant difference (P0.05). Comparison between groups: whether it is the end of treatment three after a week, or the follow-up survey, three groups of vertebrobasilar artery peak systolic velocity (Vp) were compared between the 22 groups had no statistical significance (P0.05). After the treatment, acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug treatment of patients with vertebral artery type of cervical spondylosis group of vertebrobasilar artery diastolic at the end of peak flow velocity (Vd) before and after treatment were no statistically significant difference (P0.05). Follow up: three groups of vertebrobasilar artery diastolic peak flow velocity (Vd) compared with before treatment, no significant difference (P0.05). It is the end of three weeks of treatment, but also Is the follow-up survey, three groups of vertebrobasilar artery diastolic peak flow velocity (Vd) there was no significant difference between groups (P0.05.4.) to evaluate the overall curative effect from the statistical results, the three groups after treatment compared with the overall curative effect of cervical spondylosis had statistically significant difference (P0.05), the clinical cure rate was 12.9% with acupuncture and moxibustion Baihui pressure; the effective rate was 38.7%; the effective rate was 35.5%; no efficiency was 12.9%; the total efficiency of clinical 87.1%. acupuncture group the cure rate was 9.7%; the effective rate was 29%; the effective rate was 32.3%; no efficiency 29%; total clinical efficiency of 71.0%. medicine group the cure rate was 6.7%; significant efficiency 26.7%; efficiency was 33.3%; no efficiency was 33.3%; the total effective rate was 66.7%. the above data shows that the curative effect of combined acupuncture Baihui pressure moxibustion in the treatment of vertebral artery type of cervical spondylosis, can effectively improve the symptoms of dizziness in patients with vertebral artery type of cervical spondylosis, promote functional recovery of the neck. The clinical curative effect is better than simple acupuncture and oral betahistine mesylate treatment. Conclusion: according to the above research data can be informed of the following conclusions: firstly, to improve the cervical vertigo symptoms and functional assessment scale, acupuncture and moxibustion can effectively relieve the pressure on vertebral artery type of cervical vertigo, neck pain, headache symptoms the clinical curative effect of combined acupuncture Baihui, moxibustion pressing than simple acupuncture and drug treatment significantly. The long-term curative effect comparison of vertigo, acupuncture combined with moxibustion Baihui pressure, acupuncture has more advantages, and the long-term curative effect of acupuncture combined with moxibustion Baihui pressure group than the drug group. But the follow-up data showed that three kinds of therapy for patients vertebral artery type of cervical spondylosis neck and shoulder pain, on the other hand have failed to obtain a good long-term effect. In addition, after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, simple acupuncture group, drug therapy To promote the role of daily life and work of patients with vertebral artery type of cervical spondylosis is good, but the effect is not obvious difference between the three kinds of therapy. To improve the daily life and work of patients with vertebral artery type of cervical spondylosis, drug treatment is superior to the curative effect of acupuncture combined with moxibustion on Baihui pressure. The measuring scale of life quality of WHO and after three weeks of treatment, the determination of scores of three different therapies can improve patients with vertebral artery type of cervical spondylosis WHO quality of life, and the acupuncture combined with compressive moxibustion on Baihui is superior to acupuncture and drug treatment. In the long-term effect, drug group and acupuncture combined with moxibustion Baihui pressure group compared with the acupuncture group is not ideal. The vertebral artery type of cervical spondylosis TCD observation indicators, after three weeks of treatment, acupuncture combined with moxibustion Baihui pressure, acupuncture and drug treatment were increased in patients with vertebral artery type of cervical spondylosis of the abnormal decrease of vertebral basilar arteries received Systolic peak flow velocity (Vp). But the long-term curative effect comparison, three groups of vertebrobasilar artery peak systolic velocity (Vp) compared with before treatment, the difference is not obvious. Acupuncture combined with moxibustion Baihui pressure group, acupuncture group, drug treatment group to improve the vertebrobasilar artery vertebral artery type of cervical spondylosis patients the diastolic peak flow velocity (Vd) had no obvious effect.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級別】：博士
【學(xué)位授予年份】：2017
【分類號】：R246.9

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