头穴透刺治疗椎-基底动脉供血不足性眩晕

Penetrating needling on head points for vertigo caused by vertebral-basilar arterial blood-supply insufficiency

目的:观察头穴透刺和分型针刺治疗椎-基底动脉供血不足性眩晕症的疗效差异。方法:将60例椎-基底动脉供血不足性眩晕症患者分为头穴透刺组和分型针刺组,每组30例。头穴透刺组穴取百会透前顶、率谷透曲鬓、玉枕透天柱,行透刺配合电针治疗;分型针刺组依据证型不同取相应腧穴,风阳上扰型取肝俞、行间等,痰浊上蒙型取阴陵泉、丰隆等,气血亏虚型取百会、血海等,肝肾阴虚型取肝俞、肾俞等,行针刺配合电针治疗。10次为一疗程,连续治疗2个疗程后比较两组疗效、症状及体征积分,并且行经颅多普勒(TCD)检查观察治疗前后大脑前动脉(ACA)、大脑中动脉(MCA)、大脑后动脉(PCA)的血流动力学改变。结果:头穴透刺组总有效率为96.7%(29/30),优于分型针刺组的83.3%(25/30)(P<0.05);两组治疗后眩晕程度、眩晕频率、持续时间、伴随症状各项积分均较治疗前明显降低(均P<0.05),且头穴透刺组改善更明显(均P<0.05);两组治疗后双侧MCA、ACA、PCA最高平均血流速度均明显下降(P<0.05,P<0.01),且头穴透刺组下降更明显(均P<0.05)。结论:采用头穴透刺疗法能明显缓解椎-基底动脉供血不足性眩晕症患者的眩晕症状,减少发作次数,改善伴随症状,临床疗效明显优于分型针刺组。

Objective To observe the differences in therapeutic effect between penetrating needling on head points and acupuncture of syndrome division in the treatment of vertigo caused by vertebral-basilar arterial blood supply insufficiency. Methods Sixty cases of vertigo caused by vertebral-basilar arterial blood-supply insufficiency were divided into 2 groups： a penetrating needling on head points group （group A） and an acupuncture of syndrome division group （group B）, 30 ca ses in each one. In group A, penetrating needling technique was applied from Baihui （GV 20） towards Qianding （GV 21）, Shuaigu （GB 8） towards Qubin （GB 7） and Yuzhen （BL 9） towards Tianzhu （BL 10）. Electric stlmulation was added. In group B, the acupoints were selected according to syndromes. For example, upper disturbance of wind yang： Ganshu （BL 18）, Xingjian （LR 2） ,etc. were selected; upper disturbance of turbid phlegm： Yinlingquan （SP 9）, Fenglong （ST 40） ,etc. were selected; qi and blood deficiency： Baihui （GV 20）, Xuehai （SP 10） ,etc. were selected; liver and kidney yin deficiency.- Ganshu （BL 18）, Shenshu （BL 23）, etc. were selected. Electric stimulation and needling manipulation were conducted on those aeupoints. Ten treatments made one session. After continuous 2 sessions of treatment, the efficacy, symptom score and physical sign score were compared between two groups. Transcranial Doppler （TCD） examination was done to observe hemodynamic changes of anterior cerebral artery （ACA）, middle cerebral artery （MCA） and posterior cerebral artery （PCA） before and after treatment. Results The total effective rate in group A was 96.7% （29/30） that was obviously better than 83.3% （25/30） in group B （P〈0.05）. The scores of vertigo degree, vertigo frequency, duration and accompanied symptoms after treatment were lower obviously as compared with those before treatment in two groups （all P〈0.05）. The improvements in group A were much significant （all P〈0. 05）. The highest mean velocity（Vm） of bilateral MCA, ACA and PCA were apparently reduced after treatment in two groups （P〈0.05, P〈0. 01）. The improvements in group A were much more apparently （all P〈0. 05）. Conclusion The penetrating needling on head points can effectively relieve vertigo caused hy vertebral-basilar arterial blood-supply insufficiency, reduce the attack frequency and improve in its accompanied symptoms. Its clinical efficacy is significantly superior to that in acupuncture of syndrome division group.