高血压合并颈椎病患者物理干预后的转归及机制探讨

Effects of physical intervention on hypertension patients with cervical spondylosis

目的观察初发高血压合并颈椎病患者，经颈椎关节粘连松懈术治疗及改善生活习惯后血压的转归，为颈型高血压的诊断和治疗开辟新的途径。方法在门诊2011年5月1日至2013年4月30日就诊的5000例初发高血压患者中筛选出符合研究条件的患者160人[血压在（140-159）／（90～99）mmHg之间]。随机分成两组，A组采用颈椎关节粘连松懈术推拿治疗一个疗程，并严格按照制定的生活习惯、日常姿势和颈部运动方式进行干预；B组给予小剂量的钙离子拮抗剂或小剂量血管紧张素抑制剂治疗，随访4周。在治疗前及治疗后1周、2周、4周，均行24h动态血压监测，观察患者24h平均血压情况。结果治疗4周后，B组仅头痛眩晕、视物模糊、畏光、胸闷胸痛的症状有所改善，两组间比较无明显统计学意义（P〉0．05），而耳鸣、听力下降、疲惫乏力等症状，A组改善明显，且显著优于B组（P〈0．01）。治疗前A、B两组24h平均血压无差异（P〉0．05），治疗4周后，A组患者24h平均血压均明显下降并维持在正常水平，与治疗前相比有明显差异（P〈0．05），而B组患者的血压虽有所下降但未能恢复至正常，与治疗前比较无统计学意义（P〉0．05）；而与B组相比，A组患者经4周治疗后的24h平均血压明显下降，且两组间比较有统计学意义（P〈0．05）。结论对于初发高血压患者，应注意颈椎病的筛查，尽早地发现高血压合并颈椎病者，并及时进行合理治疗，避免误诊漏诊，从而提高高血压的治愈率。

Objective To observe the outcome of blood pressure in patients with cervical spondylosis who were newly diagnosed hypertension after Adhesion-loosening Technique and better the way of life. Methods 160 patients were collected and divided into two groups randomly. Group A with cervical Adhesion-loosening Technique for a period of treatment, were strictly intervened by stated living habits and daily Postures and movements of the neck. Group B were given the small dose of calciumion antagonists or low-dose of angiotensin inhibitor, all patients were performed by a 24 hour ambulatory blood pressure monitoring in the first week, the second week and the fourth week before and after treatment. Observe and record the average blood pressure of the patients after following up for 4 weeks. Results After 4 weeks, only headache and dizziness, blurred vision, photophobia, chest pain symptoms improved in group B, However, there were no significant differences （P〉0.05）, While in A group, tinnitus, hearing loss, fatigue and other symptoms improved, and there were significant differences compared with B group（P〈0.01）. The blood pressure of patients in group A declined gradually and maintained at a normal levelafter treatment （P〈0.05）. While there was a decrease in the blood pressure of patients in group B but failed to return to normal（P〉0.05）. Compared with group B, the 24-hour average blood pressure of patients in group A decreased obviously after treatment for 4 weeks（P〈0.05）. Conclusion In order to improve the cure rate of high blood pressure,we should pay attention to screening of cervical spondylosis and giving them proper treatment in time for patients with newly diagnosed hypertension.