针刺“项七针”治疗椎动脉型颈椎病临床疗效观察

Acupuncture at “seven acupoints on neck” for cervical spondylosis of vertebral artery type

目的:比较针刺"项七针"与常规针刺、西药甲磺酸培他司汀口服治疗椎动脉型颈椎病的疗效,探寻治疗椎动脉型颈椎病的有效疗法。方法:将90例患者随机分为针刺组、西药组和项七针组,每组30例。针刺组参照普通高等教育"十一五"国家级规划教材《针灸学》中有关"眩晕"治疗腧穴处方,针刺风池、百会等穴;项七针组针刺风府、风池、天柱、完骨,两组均每日1次,6次为一疗程,疗程间休息1 d,治疗2个疗程。西药组给予口服甲磺酸倍他司汀片,每天3次,每次1片,治疗2周。观察3组患者治疗前后眩晕症状与功能评分及患者左椎动脉(LVA)、右椎动脉(RVA)、基底动脉(BA)的平均血流速度及搏动指数(PI)、阻力指数(RI)的变化情况,并比较3组的临床疗效。结果:项七针组总有效率为93.3%(28/30),优于针刺组的76.7%(23/30)和西药组的70.0%(21/30,均P<0.05)。3组治疗后症状与功能评分均较治疗前提高(均P<0.05),且提高程度项七针组优于针刺组和西药组(均P<0.05)。项七针组、针刺组治疗后BA、LVA、RVA平均血流速度较治疗前提高(均P<0.05),而西药组治疗前后差异无统计学意义(均P>0.05);项七针组BA、LVA、RVA平均血流速度较西药组和针刺组提高更显著(均P<0.05),针刺组优于西药组(均P<0.05)。3组治疗后PI、RI均较治疗前下降(均P<0.05),项七针组较西药组和针刺组下降更显著(均P<0.05),针刺组优于西药组(均P<0.05)。结论:针刺"项七针"治疗椎动脉型颈椎病临床疗效优于常规针刺与西药甲磺酸倍他司汀,可明显改善眩晕症状,同时能够改善患者脑部供血。

Objective To compare the efficacy difference among acupuncture at ＂seven acupoints on neck＂, acupuncture at regular acupoints and betahistine mesilate tablet for cervical spondylosis of vertebral artery type, and to explore the effective treatment for cervical spondylosis of vertebral artery type. Methods Ninety patients were randomly divided into a regular acupuncture group, a medication group and a neck-seven-acupoint group, 30 cases in each group. According to the acupoints prescription for vertigo in ＂11 th Five-Year＂ Nation Textbook Acupuncture and Moxibustion, the patients in the regular acupuncture group were treated with acupuncture at Fengchi（GB 20） and Baihui（GV 20）, etc.; the patients in the neck-seven-acupoint group were treated with Fengfu（GV 16）, Fengchi（GB 20）, Tianzhu（BL 10） and Wangu（GB 12）; the two groups were treated once a day, 6 treatments were taken as one course; there was an interval of 1 day between course and totally two course were given. The patients in the medication group were treated with betahistine mesilate tablets, 1 tablet each time, 3 times a day, for 2 weeks. The vertigo symptom and function score, mean blood flow velocity of left vertebral artery（LVA）, right vertebral artery（RVA）, basilar artery（BA） as well as pulsatile index（PI） and resistance index（RI） were observed, and the clinical efficacy of the three groups was compared. Results The total effective rate was 93.3%（28/30） in the neck-seven-acupoint group, which was superior to76.7%（23/30） in the regular acupuncture group and 70.0%（21/30） in the medication group（both P〈0.05）. The vertigo symptom and function score were all improved after treatment in the three groups（all P〈0.05）, and the improvement in the neck-seven-acupoint group was superior to those in the regular acupuncture group and medication group（both P〈0.05）. The mean blood flow velocity of LVA, RVA and BA was all improved after treatment in the neck-seven-acupoint group and regular acupuncture group（all P〈0.05）, which was not significant in the medication group（all P〉0.05）. The improvement of mean bloodflow velocity in the neck-seven-acupoint group was superior to those in the medication group and regular acupuncture group（all P〈0.05）; the improvement in the regular acupuncture group was superior to that in the medication group（all P〈0.05）. PI and RI were all reduced after treatment in the three groups（all P〈0.05）; the reduction in the neck-seven-acupoint group was more significant those those in the medication group and regular acupuncture group（all P〈0.05）, and the reduction in the regular acupuncture group was superior to that in the medication group（all P〈0.05）. Conclusion Acupuncture at ＂seven acupoints on neck＂ has better clinical efficacy than regular acupuncture and betahistine mesilate tablets, which could obviously improve vertigo and brain blood supply.