组穴针刺配合整脊手法对神经根型颈椎病患者颈部血流速度、颈椎功能、疼痛介质及血浆内皮素影响

Effects of Acupuncture at Group Points and Chiropractic Manipulation on Cervical Blood Flow Velocity,Cervical Vertebra Function,Pain Mediators and Plasma Endothelin in Patients with Cervical Spondylotic Radiculopathy

目的探讨组穴针刺配合整脊手法对神经根型颈椎病患者颈部血流速度、颈椎功能、疼痛介质及血浆内皮素的影响。方法选择2019年1月—2020年3月于黑龙江中医药大学附属第二医院住院治疗的92例神经根型颈椎病患者进行前瞻性研究,根据随机数字表法将纳入研究的病例分为针刺组和对照组。给予两组患者基础治疗联合整脊手法治疗,针刺组在此基础上行组穴针刺治疗。7 d为1个疗程,两组患者均连续治疗3个疗程。疗程结束后统计疗效。对比两组患者治疗前后中医证候积分、颈部血流速度、颈推功能障碍指数量表(NDI)评分及血清前列腺素(PGE2)、P物质(SP)和血浆内皮素(ET)含量。结果治疗后针刺组疗效分级情况明显优于对照组(P<0.05);治疗后两组中医证候积分均下降(P<0.05),且针刺组明显低于对照组(P<0.05);治疗后两组患者两侧椎动脉血流速度、血流量均升高(P<0.05),且针刺组明显高于对照组(P<0.05);治疗后两组患者NDI评分均下降(P<0.05),且针刺组明显低于对照组(P<0.05);治疗后两组患者血清PGE2、SP含量均降低(P<0.05),且针刺组明显低于对照组(P<0.05);治疗后两组患者血浆ET含量均降低(P<0.05),且针刺组明显低于对照组(P<0.05)。结论组穴针刺配合整脊手法对神经根型颈椎病患者疗效较好,可有效改善患者颈椎功能,改善颈部血液循环,其作用机制可能与抑制内皮素的释放并减少疼痛介质的分泌有关。

Objective To explore the effects of acupuncture on acupoints combined with chiropractic manipulation on cervical blood flow velocity,cervical spine function,pain mediators and plasma endothelin in patients with cervical spondylotic radiculopathy.Methods 92 patients with radiculopathy cervical spondylosis who were hospitalized in our hospital from January 2019 to March 2020 were selected for prospective study.According to the random number table method,the included cases were divided into acupuncture group and control group.Two groups of patients were given basic treatment combined with chiropractic treatment,and the acupuncture group was treated with acupuncture on the acupuncture points on this basis.7 days is a course of treatment,and both groups of patients were treated for 3 consecutive courses.The curative effect was counted after the treatment.The TCM syndrome scores,neck blood flow velocity,NDI score,serum prostaglandin(PGE2)content,substance P(SP)content and plasma endothelin(ET)content were compared between the two groups before and after treatment.Results After treatment,the curative effect classification of the acupuncture group was significantly better(P<0.05);after treatment,the scores of TCM syndromes in both groups decreased(P<0.05),and acupuncture was significantly lower(P<0.05);The blood flow velocity and blood flow of both vertebral arteries of the latter two groups increased(P<0.05),and the acupuncture group was significantly higher(P<0.05);after treatment,the NDI scores of the two groups decreased(P<0.05),and the acupuncture group was significantly lower(P<0.05);after treatment,the serum PGE2 and SP levels of the two groups were both reduced(P<0.05),and the acupuncture group was significantly lower(P<0.05).After treatment,the plasma ET content of the two groups of patients was reduced(P<0.05),and the acupuncture group was significantly lower(P<0.05).Conclusion Group acupuncture combined with chiropractic manipulation has a good effect on patients with cervical spondylotic radiculopathy,which can effectively improve the cervical spine function and blood circulation in the neck.The mechanism of action may be related to inhibiting the release of endothelin and reducing the secretion of pain mediators.