本文關鍵詞： TIA 通督調神 針刺 FLAIR FVH　出處：《安徽中醫(yī)藥大學》2016年碩士論文　論文類型：學位論文

【摘要】：目的:本研究選取70例符合納入標準的短暫性腦缺血發(fā)作(TIA)的患者為對象,經過觀察比較通督調神針刺組和藥物對照組對FLAIR序列血管高信號(FVH)的影響,討論通督調神針刺療法治療TIA患者的臨床療效,以此說明該種方法治療TIA患者的有效性。為其在腦卒中方面的預防提供依據。方法:共篩選出70例符合納入標準的短暫性腦缺血發(fā)作(TIA)的患者,全部來自安徽中醫(yī)藥大學第二附屬針灸醫(yī)院門診及住院的病人,采取隨機原則將70例病人分為針刺治療組與藥物對照組各35例。針刺治療組主穴選取大椎、百會、啞門、風府、命門、頸夾脊�；颊呙刻煲淮�,針刺得氣后留針,分別在進針后第10分鐘、第20分鐘、第30分鐘各行針1次,共留針30分鐘。藥物對照組患者服用尼莫地平片(尼莫同,國藥準字H20003010,德國拜爾公司生產)30mg,一日3次。兩組患者都以3周作為一個療程,一共治療2個療程。兩組患者在治療前、治療第1、6、12個月后分別行FLAIR序列檢查,并在治療前后參照《中風病先兆證診斷與療效評定標準》進行中醫(yī)癥狀評分,分別記錄治療后第1、6和12個月內兩組患者腦梗死的發(fā)生率。進而比較兩組方法的臨床療效。數據分析采用SPSS17.0統(tǒng)計軟件。結果:(1)中風先兆的中醫(yī)癥狀評分治療兩個療程后,針刺治療組較治療前評分顯著下降,差異有統(tǒng)計學意義(P0.01)。西藥對照組較治療之前比較評分顯著下降,差異有統(tǒng)計學意義(P0.01)。針刺組與藥物組比較,評分下降更明顯,差異有統(tǒng)計學意義(P0.05)。說明針刺組與藥物組都能改善患者癥狀,并且治療組優(yōu)于對照組,在改善患者的癥狀上更明顯。(2)FVH的改變治療前兩組患者均發(fā)現(xiàn)有FVH,具有可比性。治療1個月后檢測兩組患者FVH,治療組為2例,對照組為1例,經統(tǒng)計學分析,卡方值=0.348,P=0.5550.05,無統(tǒng)計學意義。6個月后檢測兩組患者fvh,治療組為3例,對照組為5例,經統(tǒng)計學分析,卡方值=0.565,p=0.4520.05,無統(tǒng)計學意義。12個月后檢測兩組患者fvh,治療組為5例,對照組為15例,經統(tǒng)計學分析,卡方值=7.00,p=0.0080.05,有統(tǒng)計學意義。(3)腦梗死的發(fā)生率治療后,一個月內兩組均未出現(xiàn)腦梗死;6個月內,治療組和對照組出現(xiàn)腦梗死病例分別為2例、4例,經統(tǒng)計學分析,卡方值=0.729,p=0.3930.05,無統(tǒng)計學意義。12個月內,治療組和對照組出現(xiàn)腦梗死病例分別為3例、10例,經統(tǒng)計學分析,卡方值=4.629,p=0.0310.05,有統(tǒng)計學意義。(4)安全性評估70例tia患者在治療前后,均未見針刺及藥物不良反應,以及各項實驗室指標在治療前和治療后也未見明顯異常。所以本次研究采用的兩種治療方法都是安全可靠的。結論:(1)針刺組和藥物組兩種方法都能有效治療tia,改善患者的臨床癥狀,減少出現(xiàn)fvh,從而降低腦卒中的發(fā)生。且通督調神針刺組在治療tia患者,改善臨床癥狀方面優(yōu)于藥物對照組。(2)由結果2和3可知,兩種治療方法均能減少出現(xiàn)fvh的患者,從而降低腦梗死的發(fā)生率,針刺組無論是在治療期間還是治療之后出現(xiàn)fvh的患者少,發(fā)生腦梗死的概率低,而藥物組在治療期間1個月后只發(fā)現(xiàn)了1例fvh,也沒有出現(xiàn)腦梗死,而在治療結束后6個月、12個月內隨著出現(xiàn)fvh的增多,腦梗死的發(fā)生率也在上升,說明針刺組在治療tia,有效預防腦卒中方面優(yōu)于藥物組,遠期療效好。(3)雖然針刺組較藥物組遠期療效顯著,但在停止針刺治療后也出現(xiàn)了少數fvh,發(fā)生了腦梗死,所以我們應該要間歇性進行針刺治療tia患者,這樣才能更加有效的預防腦卒中的發(fā)生。而藥物組在患者服藥期間有效的控制了fvh的出現(xiàn)以及腦梗死的發(fā)生,但是患者停止服藥之后就出現(xiàn)了fvh患者,發(fā)生了腦梗死,到12個月發(fā)生腦梗死的概率更高,沒有預防腦卒中的遠期療效,所以服用西藥的患者應該持續(xù)的服用藥物,從而有效的預防腦卒中的發(fā)生。(4)按國際標準化的針灸取穴簡便、治療規(guī)范、無不良反應和毒副作用,是治療TIA安全有效的方法,值得我們臨床推廣。
[Abstract]:Objective: This study selected 70 patients met the inclusion criteria of transient ischemic attack (TIA) patients as the research object, through observation and comparison of Tongdu Tiaoshen acupuncture group and drug control group of FLAIR series high signal (FVH) vascular effects, clinical curative effect discussion Tongdu Tiaoshen acupuncture therapy in the treatment of TIA patients. In order to show the effectiveness of the TIA patients were treated with this method. Provide the basis for the stroke prevention. Methods: the selected 70 patients met the inclusion criteria of transient ischemic attack (TIA) patients, all from Anhui University of traditional Chinese medicine acupuncture is the second hospital outpatient and inpatient patients, taken randomly the principle of the 70 patients were divided into acupuncture group and drug control group with 35 cases in each group. The acupuncture group selected Baihui, Dazhui main points, yamen, Fengfu, Mingmen, Cervical Jiaji acupuncture patients. Once a day, was left after the gas, respectively in tenth minutes after the needle, second 0 minutes, thirtieth minutes each time a total of 1 needle, the needle for 30 minutes. The drug control group were treated by Nimodipine Tablets (nimedipine, Zhunzi H20003010, Germany Bayer) 30mg, 3 times a day. The two groups were 3 weeks as a course of treatment, a total of 2 courses of treatment in two groups. Before treatment, treatment after 1,6,12 months were examined by FLAIR sequence, and the symptoms of Chinese medicine according to "apoplexy omen syndrome diagnosis and curative effect evaluation standard. Before and after treatment, treatment after 1,6 and 12 months of the two groups of patients the incidence of cerebral infarction were recorded. Clinical efficacy and comparison of two group method. Data were analyzed by SPSS17.0 statistical software. Results: (1) the score of TCM symptoms of apoplexy after two courses of treatment, the acupuncture treatment group than before treatment were significantly decreased, the difference was statistically significant (P0.01). The western medicine group compared with before treatment were significantly more 涓嬮檷,宸紓鏈夌粺璁″鎰忎箟(P0.01).閽堝埡緇勪笌鑽墿緇勬瘮杈，

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