【摘要】：目的通過觀察“溫通法”針刺為主治療神經(jīng)性耳鳴的臨床療效及影響,設(shè)置常規(guī)針刺對(duì)照組進(jìn)行比較,客觀評(píng)價(jià)兩種針刺治療的療效差異,從而豐富針灸治療神經(jīng)性耳鳴的手段,為臨床篩選出更有效、更便捷的治療方案。方法將符合納入標(biāo)準(zhǔn)的62例神經(jīng)性耳鳴患者,采用隨機(jī)數(shù)字分組法隨機(jī)分為治療組和對(duì)照組,其中治療組32例,對(duì)照組30例。治療組采用溫通法的針刺治療方法,對(duì)照組采用常規(guī)針刺治療。兩組均每日治療1次,10次作為1個(gè)療程,每1個(gè)療程結(jié)束后,囑患者休息1天,再繼續(xù)下1個(gè)療程,總共治療3個(gè)療程。3個(gè)療程治療結(jié)束后,通過比較兩組患者的耳鳴癥狀及各項(xiàng)積分對(duì)比,進(jìn)行臨床療效觀察,客觀評(píng)價(jià)兩種方法治療神經(jīng)性耳鳴的差異性。結(jié)果(1)臨床療效對(duì)比:經(jīng)3個(gè)療程治療后,治療組(溫通法組):治愈8例,顯效15例,有效7例,無效2例,總有效率為93.75%;對(duì)照組(常規(guī)針刺組):治愈3例,顯效13例,有效6例,無效8例,總效率為73.33%。兩組治療后療效對(duì)比經(jīng)統(tǒng)計(jì)學(xué)分析,P0.05,有顯著統(tǒng)計(jì)學(xué)意義。(2)耳鳴嚴(yán)重程度各項(xiàng)指標(biāo)對(duì)比:治療組在治療前后的對(duì)比,經(jīng)過秩和檢驗(yàn)分析后,治療組在治療前后過程中,以上各項(xiàng)的P0.05,其中耳鳴出現(xiàn)的環(huán)境、持續(xù)的時(shí)間、對(duì)睡眠影響、對(duì)生活工作影響以及總體感受P0.01,差異具有顯著的統(tǒng)計(jì)學(xué)意義。對(duì)照組在治療前后的對(duì)比,經(jīng)過秩和檢驗(yàn)分析后,其中耳鳴持續(xù)的時(shí)間、對(duì)睡眠影響、對(duì)情緒的影響以及總體感受均P0.05,差異具有統(tǒng)計(jì)學(xué)意義;對(duì)耳鳴出現(xiàn)的環(huán)境及生活工作方面,P0.05,無差異,沒有統(tǒng)計(jì)學(xué)意義。(3)耳鳴嚴(yán)重程度評(píng)估指標(biāo)及評(píng)分標(biāo)準(zhǔn)(簡稱“青島標(biāo)準(zhǔn)”)對(duì)比:治療前兩組各項(xiàng)癥狀積分間比較,均P0.05,無顯著統(tǒng)計(jì)學(xué)差異,具有可比性;經(jīng)過3個(gè)療程治療,兩組患者各項(xiàng)癥狀積分比較經(jīng)秩和檢驗(yàn)分析,其中耳鳴出現(xiàn)環(huán)境及對(duì)睡眠影響方面,P0.05,差異無統(tǒng)計(jì)學(xué)意義。在耳鳴持續(xù)的時(shí)間、對(duì)情緒的影響、生活工作及總體感受幾個(gè)方面,P0.05,差異有統(tǒng)計(jì)學(xué)意義。結(jié)論(1)經(jīng)過三個(gè)療程治療后,兩組患者中治療組(溫通法組)總有效率93.75%,對(duì)照組(常規(guī)針刺組)總有效率73.33%,通過對(duì)比,兩種針刺療法均能有效治療氣血瘀阻型神經(jīng)性耳鳴,但溫通法針刺療法的臨床療效要優(yōu)于常規(guī)針刺法,而且溫通法針刺療法在愈顯率及總有效率上均優(yōu)于常規(guī)針刺療法。(2)兩種針刺療法均能改善氣血瘀阻型神經(jīng)性耳鳴患者的各項(xiàng)癥狀及功能,但溫通法為主針刺療法在改善患者的耳鳴響度及相關(guān)癥狀(出現(xiàn)環(huán)境、持續(xù)時(shí)間、對(duì)睡眠、情緒、生活工作及總體感受的影響)方面具有顯著的統(tǒng)計(jì)學(xué)意義,所以治療組(溫通法組)在提高患者生活質(zhì)量和工作環(huán)境等方面要優(yōu)于常規(guī)針刺療法。(3)溫通法和常規(guī)針刺療法均能有效地降低患者耳鳴持續(xù)時(shí)間、改善患者睡眠質(zhì)量及耳鳴對(duì)情緒方面的影響,降低患者對(duì)耳鳴的總體感受,但以溫通法為主的針刺療法不僅能通過艾灸及針刺的雙重效應(yīng)對(duì)患耳進(jìn)行刺激作用,通過針體將艾條之熱能傳到耳部深處,使溫?zé)嶂畾馔高_(dá),針至病所,通其經(jīng)脈,并調(diào)其氣血,使耳部瘀阻之經(jīng)氣得到疏通,氣血調(diào)和,經(jīng)絡(luò)暢通,“壅塞”之耳竅得以濡養(yǎng),改善耳部供血及血液循環(huán),促進(jìn)周圍組織新陳代謝,最終達(dá)到扶正祛邪、平衡陰陽,提高治療效果,達(dá)到治療目的。因此溫通法在治療氣血瘀阻型神經(jīng)性耳鳴方面具有獨(dú)特的優(yōu)勢,溫通法的治療效果確切,操作簡單、取穴簡便、安全有效,利于臨床的推廣。
[Abstract]:Objective To observe the clinical effect and influence of "Wen Tong" acupuncture in the treatment of neurogenic tinnitus, set a comparison between the conventional acupuncture control group and objectively evaluate the difference of the curative effect between the two kinds of acupuncture treatment, so as to enrich the means of acupuncture and moxibustion for the treatment of neurogenic tinnitus, and to screen out a more effective and convenient treatment scheme. 62 patients with neurogenic tinnitus were randomly divided into the treatment group and the control group, with 32 cases in the treatment group and 30 in the control group. The treatment group was treated with the method of warming through the acupuncture, and the control group was treated with conventional acupuncture. The two groups were treated 1 times a day and 10 times as 1 courses. After every 1 course of treatment, the patients were asked to rest After 1 days, then continued the next 1 courses, after a total of 3 courses of treatment for.3 course of treatment after the end, by comparing the symptoms of ringing in the two groups of patients and the overall comparison, to observe the clinical effect, objectively evaluate the difference between the two methods of treating neurogenic tinnitus. Results (1) comparison of clinical efficacy: after 3 courses of treatment, the treatment group (Wen Tong Group): 8 cases were cured, 15 cases were effective, 7 cases were effective, 2 cases were invalid, the total effective rate was 93.75%. The control group (routine acupuncture group): cured 3 cases, 13 cases, effective 6 cases and 8 cases, the total efficiency was statistically analyzed after 73.33%. two group treatment, P0.05, there were significant statistical significance. ((2) the treatment group was treated before and after treatment. After the analysis of the rank sum test, the P0.05 in the treatment group before and after the treatment, the environment in which the tinnitus appeared, the duration of the tinnitus, the influence on the sleep, the influence on the life work and the overall feeling of the P0.01, the difference has significant statistical significance. The duration of the tinnitus, the influence on sleep, the influence on the mood and the overall feelings were P0.05, and the difference was statistically significant. There was no difference in the environment and life work of the tinnitus. (3) the evaluation index of the severity of the tinnitus and the standard of grading ("Qingdao standard") were compared: the two groups before the treatment. After 3 courses of treatment, the symptom scores of the two groups were analyzed by the rank sum test, and the environment of the tinnitus and the effect on sleep, P0.05, were not statistically significant. The duration of the tinnitus, the influence of the emotion, the life work, and the difference of the symptoms were compared. P0.05, the difference was statistically significant. Conclusion (1) after three courses of treatment, the total effective rate of the two groups of patients (Wen Tong Group) was 93.75% and the control group (conventional acupuncture group) had a total effective rate of 73.33%. Through comparison, the two kinds of acupuncture therapy could effectively treat the type of nervous tinnitus with Qi and blood stasis type, but the method of Wen Tong acupuncture treatment was effective. The clinical curative effect is superior to the conventional acupuncture method, and the warming through method is superior to the conventional acupuncture therapy in the healing rate and the total effective rate. (2) the two kinds of acupuncture therapy can improve all the symptoms and functions of the patients with Qi and blood stasis type neurogenic tinnitus, but the method of acupuncture is the main method to improve the ringing and related symptoms of the patients. The present environment, duration, influence on sleep, emotion, life work and overall feelings have significant statistical significance, so the treatment group (Wen Tong Group) is better than the conventional acupuncture in improving the quality of life and working environment of the patients. (3) both warm and conventional acupuncture can effectively reduce the durations of tinnitus in patients. In the meantime, the effect of sleep quality and tinnitus on the emotion of the patients was improved and the overall feeling of tinnitus was reduced. However, the acupuncture therapy based on the method of warming through moxibustion and acupuncture can not only stimulate the affected ears, but also pass the heat of the bar to the deep of the ear through the needle body, so that the warm air is permeable, and the needle goes to the disease place. Meridian, and adjust its Qi and blood, so that the ear stasis of the meridian to get dredging, Qi and blood harmonization, smooth channels and channels, "choked" ear orifices can be nourishing, improve the ear blood supply and blood circulation, promote the metabolism of surrounding tissue, finally achieve positive dispel evil, balance Yin and Yang, improve treatment effect, to achieve therapeutic purposes. Therefore Wen Tong method in the treatment of Qi and blood stasis There is a unique advantage in the treatment of tinnitus type. The therapeutic effect of warming and dredging therapy is exact, simple operation, simple, safe and effective, and is conducive to clinical promotion.
【學(xué)位授予單位】：云南中醫(yī)學(xué)院
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R246.81

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