针刺前后椎-基底动脉供血不足患者脑血管功能相关指标的变化

Alterations of the related indexes of cerebrovascular function in patients with vertebrobasilar insufficiency before and after acupuncture treatment

目的:观察针刺对椎-基底动脉供血不足患者脑血管功能的影响,分析其可能的作用机制。方法:选择2002-08/2004-05在广西中医学院附属瑞康医院针灸推拿科就诊的60例椎-基底动脉供血不足患者。穴取风池(双)、肩中俞(双),采用缓慢捻转进针法对患者治疗,留针20～30min,每隔5min行针1次,1次/d,6次为1疗程,每疗程后休息1d。所有患者在治疗前、治疗5个疗程后采用经颅多普勒检测椎-基底动脉供血不足患者左椎动脉、右椎动脉及基底动脉治疗前后收缩期峰流速、舒张期末峰流速、平均峰流速、脉动指数以及血管弹性指标,观察其指数的改变情况。结果:纳入患者60例全部进入结果分析。①治疗效果评价:总有效率86.7%。②平均峰流速治疗前后的变化情况:动脉血流速度变慢患者治疗后左、右椎动脉和基底动脉平均峰流速为(27.57±4.69),(26.37±5.85),(33.54±4.23)cm/s,明显高于治疗前[(23.65±4.31),(23.27±4.17),(29.67±4.55)cm/s,P<0.05～0.01]。动脉血流速度增快患者治疗后左、右椎动脉及基底动脉平均峰流速为(42.27±3.26),(43.35±5.72),(50.49±4.37)cm/s,明显低于治疗前[(48.27±3.47),(46.03±4.03),(55.94±3.40)cm/s,P<0.05～0.01]。③脉动指数变化情况:患者左右椎动脉、基底动脉的脉动指数治疗后分别为0.92±0.26,0.88±0.33,1.19±0.33,均低于治疗前(1.27±0.15,1.18±0.14,1.38±0.17),差异有统计学意义(P<0.05～0.01)。④血管弹性指数的变化情况:椎-基底动脉供血不足综合征患者左、右椎动脉及基底动脉其血管弹性指数治疗后分别为0.51±0.27,0.52±0.26,0.54±0.21,均低于治疗前(0.89±0.17,0.76±0.16,0.80±0.23),差异有统计学意义(P<0.05～0.01)。结论:针刺疗法可改善椎-基底动脉供血不足综合征患者脑动脉血流速度,可降低其血管弹性指数及脉动指数。

AIM： To observe the effect of acupuncture on cerebrovascular function in the patients of vertebrobasilar insufficiency （VBI）, and analyze the possible mechanism. METHODS： A total of 60 patients with VBI were selected from Department of Acupuncture and Moxibustion, Affiliated Ruikang Hospital of Guangxi College of Traditional Chinese Medicine from August 2002 to May 2004. Fengchi （GB 20） and Jianzhongshu （SI 15） of double sides were adopted for the slow needle-inserting of twisting, hanging up for 20-30 minutes, 5 minutes one day, 6 days as a course, and then one-day rest after a course. All the patients were observed with Transcranial Doppler （TCD） in systolic peak flow velocity （Vs）, end-diastolic peak flow velocity （Vd）, mean peak flow velocity （Vm） and pulsatility index （PI） before and after 5-course treatment. RESULTS： All 60 patients were analyzed in the final results. ①Curative effect appraisal： The total effective rate was 86.7%. ②The effect on Vm： Vm of slowing left vertebral artery （LVA）, right vertebral artery （RVA） and basilar artery （BA） were （27.57±4.69）, （26.37±5.85）, （33.54±4.23） cm/s respectively , which were obviously higher than those before treatment [（23.65±4.31）, （23.27±4.17）, （29.67±4.55） cm/s, P 〈 0.05-0.01]. The Vm of accelerating LVA, RVA and BA were （42.27±3.26）, （43.35±5.72）, （50.49±4.37） cm/s, which were obviously lower than those before treatment [（48.27±3.47）, （46.03±4.03）, （55.94±3.40） cm/s, P 〈 0.05-0.01].③PI： The PI of LVA, RVA and BA were 0.92±0.26, 0.88±0.33, 1.19±0.33, which were lower than those before treatment （1.27±0.15, 1.18±0.14, 1.38±0.17, P 〈 0.05-0.01）.④DI： The DI of LVA, RVA and BA after therapy were 0.51±0.27, 0.52±0.26, 0.54±0.21, which were significantly lower than those before treatment （0.89±0.17, 0.76±0.16, 0.80±0.23, P 〈 0.05-0.01）. CONCLUSION： Acupuncture can reformat the Vm in VBI patients, and depress their PI and DI.