發(fā)布時(shí)間：2018-01-03 01:45

  本文關(guān)鍵詞：補(bǔ)瀉針?lè)ㄖ委熤酗L(fēng)后失眠的臨床觀(guān)察及神經(jīng)遞質(zhì)機(jī)理研究　出處：《廣州中醫(yī)藥大學(xué)》2016年博士論文　論文類(lèi)型：學(xué)位論文

  更多相關(guān)文章： 缺血性腦卒中后失眠 燒山火 透天涼 神經(jīng)遞質(zhì) 5-HT 5-HIAA

【摘要】：目的：通過(guò)臨床病例的收集及動(dòng)物實(shí)驗(yàn),分析補(bǔ)瀉針?lè)ㄖ委熑毖阅X卒中后失眠患者的療效、動(dòng)物模型血清中5-HT和5-HIAA神經(jīng)遞質(zhì)的影響,探討其分子機(jī)理。方法：本課題研究分為臨床研究及動(dòng)物實(shí)驗(yàn)研究?jī)蓚�(gè)方面：(1)臨床研究納入病例共70例,隨機(jī)法,分為①針刺組,②對(duì)照組,每組35例。受試者中途退出而剔除的病例共10例,最終收集病例60例,其中①針灸組30例,②對(duì)照組30例。干預(yù)手段：1基礎(chǔ)干預(yù)所有入患者均按中風(fēng)內(nèi)科常規(guī)處理。進(jìn)行對(duì)癥治療及支持治療,包括控制血壓、血糖、血脂、體溫,吸氧,維持水、電解質(zhì)及酸堿平衡,予阿司匹林并使用改善腦部血液循環(huán)及腦細(xì)胞活化劑等。所有患者均做基本康復(fù)治療(包括良肢位的擺放、床邊坐位平衡、水平移動(dòng)、平衡訓(xùn)練、站立床訓(xùn)練、主被動(dòng)運(yùn)動(dòng)、作業(yè)療法等)。2針刺組基礎(chǔ)取穴(虛證實(shí)證共有)：印堂,神庭,百會(huì),四神聰,血管舒縮區(qū),操作手法：平補(bǔ)平瀉,出現(xiàn)酸脹后留針30分鐘；虛證配穴：神門(mén),足三里,太溪；其中復(fù)式手法選穴：足三里,其他配穴操作手法同基礎(chǔ)取穴操作手法。足三里復(fù)式手法具體操作：采用燒山火式補(bǔ)法,即分天人地三層,天層：約2-5mm,人層：約6-9mm,地層：10-12mm,操作者左手作切壓手,右手施針,囑病人自然鼻吸口呼,隨其呼氣將針淺刺入天層(一進(jìn))；操作者順時(shí)針捻轉(zhuǎn)針柄3次,同時(shí)配合緊按慢提的手法,之后再隨患者呼氣再刺入人層(二進(jìn)),同樣重復(fù)上述操作進(jìn)入地層(三進(jìn)),重復(fù)上述捻轉(zhuǎn)提插手法,若未產(chǎn)生熱感時(shí),術(shù)者可用指甲由上向下輕刮針柄,以催氣至。如果患者仍無(wú)熱感,可將針提到天層(一退),復(fù)同前法進(jìn)行操作,以上三進(jìn)一退重復(fù)三次,待患者感覺(jué)熱時(shí),將針緩緩地退出皮膚,并要用干棉簽快速壓迫針孔。實(shí)證配穴：丘墟,太沖,大陵；其中復(fù)式手法選穴：丘墟,其他配穴操作手法同基礎(chǔ)取穴操作手法。丘墟復(fù)式手法具體操作：采用透天涼式瀉法,同樣分天人地三層,天層：約2-5mm,人層：約6-9mm,地層：10-12mm,操作者左手作切壓手,右手施針,與燒山火相反,囑病人作口吸鼻呼,隨其吸氣將針深刺入地層(一進(jìn))；操作者逆時(shí)針捻轉(zhuǎn)針柄6次,同時(shí)配合輕按重提的手法,隨患者吸氣再退入人層(一退),重復(fù)上述操作,再隨患者吸氣退入天層(二退),操作同前,完畢后隨患者吸氣將針輕壓入地層,共重復(fù)此過(guò)程3次,以期待患者出現(xiàn)涼感；留針至該次治療結(jié)束與其他穴位同時(shí)出針。針具選用直徑0.25mm,長(zhǎng)40mm漢醫(yī)牌不銹鋼毫針以上方法每日1次；治療時(shí)間選在下午3-6點(diǎn),共治療10次,周一至五連續(xù)治療5次,周六周日休息2天,治療結(jié)束時(shí)觀(guān)察療效。3對(duì)照組口服舒樂(lè)安定。每次1mg,周一至五每晚睡前服1次,周六周日休息2天,共服10天,治療結(jié)束時(shí)觀(guān)察療效。治療前、停止治療后第一天、第五天分別記錄患者臨床癥狀、匹茲堡睡眠質(zhì)量指數(shù)表并用睡眠監(jiān)測(cè)儀監(jiān)測(cè)睡眠質(zhì)量。(2)動(dòng)物實(shí)驗(yàn)研究SPF級(jí)健康SD大鼠84只,造模成功后得到32只,分為4組①正常組(8只)②模型組(8只),③針刺組(8只),④西藥組(8只)。造模方法：使用血管內(nèi)拴線(xiàn)阻斷法制造中風(fēng)模型,中風(fēng)模型再腹腔注射PCPA制造缺血性腦卒中后失眠。干預(yù)措施：①A.正常組,B.模型組失眠組空抓,不予任何處理。C.針刺組：印堂、神庭、百會(huì),四神聰。針具選用華佗牌0.22x5mm皮內(nèi)針,針刺手法：平補(bǔ)平瀉,留針30min,針刺時(shí)間周一至五每日上午9：00-10：00,周六周日休息2天,共連續(xù)治療10次。②D.西藥組：實(shí)驗(yàn)第3天開(kāi)始舒樂(lè)安定(艾司唑侖)生理鹽水溶液灌胃治療。按成人催眠劑量10mg/天,用人鼠給藥劑量體表面積折算公式計(jì)算出大鼠給藥劑量為0.92mg/kg。每日上午10：00～11：00給大鼠灌胃。結(jié)果：1.補(bǔ)瀉針刺及口服舒樂(lè)安定能降低缺血性腦卒中后失眠患者中醫(yī)證候積分2.補(bǔ)瀉針刺及口服舒樂(lè)安定能降低缺血性腦卒中后失眠患者匹茲堡睡眠質(zhì)量指數(shù)3.根據(jù)缺血性腦卒中后失眠患者副反應(yīng)量表(TESS)評(píng)分,補(bǔ)瀉針刺比口服舒樂(lè)安定更低,副作用更小,證明該治療手段有效。4.參照參照國(guó)家藥品監(jiān)督管理局發(fā)布的《中藥新藥臨床研究指導(dǎo)原則》療效評(píng)定標(biāo)準(zhǔn),舒樂(lè)安定治療缺血性腦卒中后失眠療效比補(bǔ)瀉針刺好。5.血管內(nèi)拴線(xiàn)阻斷法加腹腔注射PCPA法能制造能制造缺血性腦卒中后失眠大鼠動(dòng)物模型。6.針刺及舒樂(lè)安定溶液灌胃能提高動(dòng)物模型血清中5-HT和5-HIAA含量,兩者效果相當(dāng)。結(jié)論：1.證實(shí)了復(fù)式補(bǔ)瀉針刺能緩解缺血性腦卒中患者失眠狀態(tài)。為下一步實(shí)驗(yàn)提供臨床試驗(yàn)證明。下一步實(shí)驗(yàn)將是復(fù)式補(bǔ)瀉針?lè)▽?duì)照不分證型平補(bǔ)平瀉的針?lè)?同樣穴位、同樣針具,目的是證實(shí)按辯證論治理論施行針灸治療比不按辯證論治針灸治療有效。2.補(bǔ)瀉針刺治療腦卒中后失眠副作用效果優(yōu)于口服舒樂(lè)安定。3.血管內(nèi)拴線(xiàn)阻斷法加腹腔注射PCPA發(fā)可能是腦卒中后失眠模型的有效造模方法。4.針刺能提高動(dòng)物模型血清中5-HT和5-HIAA含量。因?yàn)樵撃Ｐ褪窃谌毖阅X卒中后失眠狀態(tài),根據(jù)針灸后中樞性神經(jīng)遞質(zhì)改變的結(jié)果,證明了在腦缺血病理狀態(tài)下針灸治療能改變生物原胺類(lèi)中樞性神經(jīng)遞質(zhì)的含量,特別是與情緒焦躁或抑郁密切相關(guān)的5-HT和5-HIIA物質(zhì)的含量,從而起到治療失眠的動(dòng)物實(shí)驗(yàn)證據(jù)。也為進(jìn)一步動(dòng)物實(shí)驗(yàn)以證明按辨證論治施行的補(bǔ)瀉針?lè)芊駜?yōu)于不按辨證論治施行的無(wú)補(bǔ)瀉差異的針刺手法提供動(dòng)物實(shí)驗(yàn)證據(jù)。
[Abstract]:Objective: through the collection of clinical cases and animal experiments, clinical analysis of patients with insomnia in the treatment of ischemic stroke after reinforcing acupuncture, effect of 5-HT and 5-HIAA in serum of neurotransmitters in animal models, and explore its molecular mechanism. Methods: This study consists of two clinical studies and animal experiments: (1) clinical research in 70 cases, were randomly divided into acupuncture group, the control group, 35 cases in each group. The subjects dropped out and removed in 10 cases, the final total of 60 cases were collected, including the acupuncture group of 30 cases, 30 cases of the control group. Intervention: 1 of all patients into intervention according to the conventional medical treatment for stroke. Symptomatic treatment and supportive treatment, including control of blood pressure, blood glucose, blood lipid, body temperature, oxygen, water, electrolyte and acid-base balance, aspirin use and improve blood circulation to the brain and brain cell activator were all. The patients had basic rehabilitation (including good limb position, the bed sitting balance, horizontal movement, balance training, standing bed training, passive movement, occupational therapy and so on).2 based acupuncture acupuncture group (total deficiency of empirical): Yintang, shenting, Baihui, Sishencong, vasomotor area. Operation manual: reinforcing reducing, the needle for 30 minutes after the emergence of acid bilges; deficiency of acupoints of Shenmen, Zusanli, Taixi; the complex technique of acupoints: Zusanli acupoints, manipulation and other basic operating practices. Zusanli acupoints complex technique of concrete operation: fill mining method Shaoshanhuo, namely and three layer, layer about 2-5mm, one day: layer: about 6-9mm, 10-12mm, operator formation: left hand cut pressure hand, right hand needle, the symptoms of natural nasal suction call, with the breath will be shallow needle into the sky (a) layer; the operator clockwise twisting the needle handle 3 times. At the same time with the pressing and slow lifting technique Then, with the patient breath to penetrate into the layer (Er Jin), who also repeat the above operation into the ground (San Jin), repeat the twirling lifting and thrusting manipulation, if not to generate heating, patients can nail down from the upper scraping needle handle, to rush to gas. If the patient is still no heat, the needle that day (back), double layer with method of operation, more than a retreat San Jin repeated three times for patients with thermal sensation, the needle slowly out of the skin, and use dry cotton swab quickly. The empirical distribution point: compression pinhole Qiuxu, Taichong, Daling; the complex technique of acupoint selection: Qiuxu. Other acupoints with acupuncture manipulation based manipulation. Qiuxu complex technique of concrete operation: the story is cool reducing method, also divided to three layers of heaven, the day: about 2-5mm, one layer: about 6-9mm, 10-12mm, operator formation: left hand cut pressure hand, right hand needle, contrary to burn, will patients with nasal suction call. The suction needle piercing the deep stratum (a); the operator counterclockwise twisting the needle handle 6 times, at the same time with the light by repeated practices, with the patient inhale again back into the one layer (back), repeat the above operation, then with the patient inhale back into the day (Er Tui), with the operation layer,. After the patients inhale the needle light into the formation, is this process is repeated 3 times, in the hope of patients with cool feeling to the end; the needle treatment with other acupoints and needle. The needle with diameter 0.25mm, length 40mm - brand stainless steel needle above 1 times a day; the treatment time in the afternoon 3-6 for 10 times, Monday, to five for 5 consecutive times, Saturday Sunday 2 days off at the end of the treatment efficacy of.3 control group estazolam. Every Monday to five 1mg, 1 times every night before bedtime, Saturday Sunday rest for 2 days, a total of 10 days, to observe the curative effect after treatment. Before treatment. The first day after cessation of treatment And fifth days were recorded in patients with clinical symptoms, Pittsburgh sleep quality index and quality monitor of sleep sleep. (2) animal experimental study on SPF 84 healthy SD rats, after the success of the model are 32, divided into 4 groups: normal group (8 rats), model group (8 rats). The acupuncture group (8 rats), the western medicine group (8). Modeling methods: the use of endovascular occlusion sukwan manufacturing model of stroke, stroke model by intraperitoneal injection of PCPA after ischemic stroke insomnia. Interventions: A. normal group, B. model group, the insomnia group caught, without any treatment.C. acupuncture group: Yintang, shenting, Baihui, Sishencong. Needle selection of Hua Tuo brand 0.22x5mm intradermal needle, acupuncture, reinforcing reducing, needle 30min, acupuncture time on Monday to five 9:00-10:00 every morning, Saturday Sunday rest 2 days, total for 10 consecutive times. The western medicine group D.: experiment third days start SURAZEPAM (Ai Si Midazolam) normal saline gavage treatment. According to the adult hypnotic dose of 10mg/ day, with people in the dose conversion formula to calculate the surface area of rats with a dose of 0.92mg/kg. daily morning from 10:00 to 11:00 to rats by intragastric administration. Results: 1. reinforcing acupuncture and oral estazolam can reduce ischemic stroke the TCM Syndromes of 2. patients with insomnia reinforcing and reducing acupuncture and oral estazolam can reduce ischemic stroke patients with insomnia sleep quality index according to the Pittsburgh 3. after cerebral ischemic stroke patients with insomnia side effects scale (TESS) score, reinforcing acupuncture than estazolam lower, less side effects, the effective treatment for reference in.4. the State Drug Administration issued the "Chinese medicine clinical research guiding principles > curative effect evaluation standard, estazolam in the treatment of ischemic stroke insomnia curative effect than acupuncture reinforcing and reducing.5. in blood vessel Sukwan occlusion and intraperitoneal injection of PCPA can make manufacturing after cerebral ischemic stroke insomnia rats animal model.6. acupuncture and diazepam solution orally can increase 5-HT and 5-HIAA content in serum of the animal model, the two effects is confirmed by 1.. Conclusion: Compound reinforcing acupuncture can relieve the ischemic stroke patients with insomnia. Clinical trials that is the next step of the experiment. The next step will be double reinforcing and reducing acupuncture control syndrome type reinforcing reducing needle, the same point, the same needle is confirmed according to the dialectical theory of treatment of acupuncture treatment is not according to the dialectical treatment of acupuncture treatment of.2. reinforcing acupuncture treatment for stroke after insomnia side effect is better than the.3. estazolam sukwan endovascular occlusion and intraperitoneal injection of PCPA may be effective after stroke insomnia model modeling method of acupuncture can improve the animal model of serum.4. 5-HT and 5-HIAA content. Because the model is in the state of insomnia after cerebral ischemic stroke, according to the change of central neurotransmitter after acupuncture results proved that acupuncture treatment can change the content of the original biological amine neurotransmitter in the central state of cerebral ischemia pathological conditions, especially the content is closely related with the mood of anxiety or depression 5-HT and 5-HIIA material, so that the animal experimental evidence for the treatment of insomnia. For further animal experiments to prove that according to syndrome differentiation and treatment effect of acupuncture reinforcing reducing syndrome differentiation does not according to whether it is superior to the implementation of the treatment of diarrhea between acupuncture provided animal experimental evidence.

【學(xué)位授予單位】：廣州中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R246.6

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 馮天蔭;;補(bǔ)瀉的新概念[J];中國(guó)針灸;1987年01期

2 童敖齊;電針補(bǔ)瀉方法探析[J];實(shí)用中醫(yī)藥雜志;1999年06期

3 王莖,曾永蕾;“捻轉(zhuǎn)”如何定“補(bǔ)瀉”[J];針灸臨床雜志;2001年11期

4 陳家炎;虛實(shí)補(bǔ)瀉五論[J];河南中醫(yī);2004年06期

5 吳繼軍;孫淑娟;張靜;;淺議產(chǎn)后之虛實(shí)補(bǔ)瀉[J];中國(guó)民間療法;2007年02期

6 劉西明;劉輝;;試論手法之補(bǔ)瀉及其辨證應(yīng)用[J];按摩與導(dǎo)引;2007年11期

7 鐘新淵;;我對(duì)“補(bǔ)瀉”的看法[J];中醫(yī)雜志;1959年11期

8 iJ逢P(guān)+ ,iJ元德;漫娗戄刺“堒p ”與“辨氣”的體會(huì)[J];江蘇中醫(yī);1961年07期

9 黃育萬(wàn);淺談針刺“疾徐補(bǔ)瀉”與“捻轉(zhuǎn)補(bǔ)瀉”法[J];上海中醫(yī)藥雜志;1963年12期

10 于致順;;漫談補(bǔ)瀉[J];中醫(yī)藥學(xué)報(bào);1979年04期

相關(guān)會(huì)議論文 前7條

1 謝衡輝;付衛(wèi)星;;小議砭石療法補(bǔ)瀉[A];首屆全國(guó)砭石療法學(xué)術(shù)研討會(huì)論文集[C];2001年

2 廖品東;;論傳統(tǒng)中醫(yī)補(bǔ)瀉觀(guān)[A];第十二次全國(guó)推拿學(xué)術(shù)年會(huì)暨推拿手法調(diào)治亞健康臨床應(yīng)用及研究進(jìn)展學(xué)習(xí)班論文集[C];2011年

3 馮力;耿乃光;;砭石療法的補(bǔ)瀉機(jī)理及補(bǔ)瀉三十二字訣[A];首屆全國(guó)砭石療法學(xué)術(shù)研討會(huì)論文集[C];2001年

4 李昱們;劉華一;;從“五臟苦欲補(bǔ)瀉”論肝病傳脾[A];中華中醫(yī)藥學(xué)會(huì)脾胃病分會(huì)第二十四次全國(guó)脾胃病學(xué)術(shù)交流會(huì)論文匯編[C];2012年

5 李昊蓉;;中藥藥性理論名詞術(shù)語(yǔ)規(guī)范化研究——補(bǔ)瀉[A];'2008臨床中藥學(xué)學(xué)術(shù)研討會(huì)論文集[C];2008年

6 劉吉科;;傳統(tǒng)醫(yī)學(xué)疾病理論陰陽(yáng)虛實(shí)補(bǔ)瀉的解讀[A];首屆國(guó)學(xué)國(guó)醫(yī)岳麓論壇暨第九屆全國(guó)易學(xué)與科學(xué)學(xué)會(huì)研討會(huì)、第十屆全國(guó)中醫(yī)藥文化學(xué)會(huì)研討會(huì)論文集[C];2007年

7 劉兵;趙京生;;經(jīng)脈“盛瀉虛補(bǔ)”解讀與思考[A];2011中國(guó)針灸學(xué)會(huì)年會(huì)論文集（摘要）[C];2011年

相關(guān)重要報(bào)紙文章 前7條

1 徐錚;針刺要講究補(bǔ)瀉[N];醫(yī)藥養(yǎng)生保健報(bào);2006年

2 廣州中醫(yī)藥大學(xué)附屬骨傷科醫(yī)院 邊江紅;古琴指法里的虛實(shí)補(bǔ)瀉[N];中國(guó)中醫(yī)藥報(bào);2014年

3 山西省晉中市第三人民醫(yī)院 張英棟;不可盡憑虛實(shí)補(bǔ)瀉[N];中國(guó)中醫(yī)藥報(bào);2011年

4 北京中醫(yī)藥大學(xué) 翟雙慶;論五臟苦欲補(bǔ)瀉[N];中國(guó)中醫(yī)藥報(bào);2012年

5 趙京生;《內(nèi)經(jīng)》補(bǔ)瀉針?lè)ǖ牧⒁饧捌溲葑僛N];中國(guó)醫(yī)藥報(bào);2001年

6 孫敬青 謝新才;針灸也要講究補(bǔ)和瀉[N];家庭醫(yī)生報(bào);2006年

7 珍 科;針灸也講究補(bǔ)瀉[N];中國(guó)中醫(yī)藥報(bào);2006年

相關(guān)博士學(xué)位論文 前1條

1 馮健峰;補(bǔ)瀉針?lè)ㄖ委熤酗L(fēng)后失眠的臨床觀(guān)察及神經(jīng)遞質(zhì)機(jī)理研究[D];廣州中醫(yī)藥大學(xué);2016年

相關(guān)碩士學(xué)位論文 前1條

1 蘇紅梅;補(bǔ)瀉同施、調(diào)節(jié)平衡法對(duì)2型糖尿病患者減停降糖藥的臨床研究[D];云南中醫(yī)學(xué)院;2015年

，

本文編號(hào)：1371864