刺络放血联合针刺治疗心肝火旺型耳鸣疗效观察

Observation on the clinical effect of bloodletting combined with acupuncture on tinnitus of type of hyperactivity of heart-liver fire

目的观察比较翳风、心俞、肝俞刺络放血联合针刺、单纯西药与单纯针刺治疗心肝火旺型耳鸣的临床疗效差异,寻求最优疗法。方法选择2018年5月—2019年8月陕西省中医医院诊治的90例发病1个月内的心肝火旺型耳鸣患者,按随机数字表法分为刺络放血组30例、针刺组30例和西药组30例。刺络放血组选穴以翳风、心俞、肝俞为主,2次/d,隔日1次,3次/周;同时配合针刺治疗,针刺取穴以翳风、听宫、听会为基础,1次/d,每周5次。针刺组只予针刺治疗。西药组予前列地尔静脉滴注,盐酸氟桂利嗪胶囊、甲钴胺胶囊口服。3组均治疗4周。对比3组治疗前后耳鸣严重程度量表、耳鸣残疾评估量表(THI)、汉密尔顿焦虑量表(HAMA)、汉密尔顿抑郁量表(HAMD)评分,并评估临床疗效。结果治疗后3组患者耳鸣严重程度评分及THI、HAMA、HAMD评分与治疗前比较均明显降低(P均<0.05),且刺络放血组各项评分均明显低于其余2组(P均<0.05),针刺组耳鸣严重程度评分和THI评分明显低于西药组(P均<0.05);HAMA、HAMD评分针刺组和西药组间差异均无统计学意义(P均>0.05)。刺络放血组总有效率为93.3%(28/30),明显高于针刺组的80.0%(24/30)和西药组的70.0%(21/30),差异有统计学意义(P均<0.05),而针刺组与西药组间差异无统计学意义(P>0.05)。刺络放血组愈显率为63.3%(19/30),高于针刺组的36.7%(11/30)和西药组的13.3%(4/30),差异有统计学意义(P均<0.05),且针刺组高于西药组(P<0.05)。结论翳风、心俞、肝俞刺络放血联合针刺治疗发病1个月内的心肝火旺型耳鸣疗效优于单纯针刺和单纯西药治疗。

Objective It is to observe and compare the difference in clinical efficacy bewwen the therapy with Yifeng,Xinshu,Ganshu bloodletting combined with acupuncture,and the therapy with western medicine and simple acupuncture in the treatment of tinnitus of type of hyperactivity of heart-liver fire,and to seek the best treatment method.Methods A total of 90 patients with tinnitus of type of hyperactivity of heart-liver fire who were treated in Shaanxi Provincial Hospital of Traditional Chinese Medicine from May 2018 to August 2019 were randomly divided into bloodletting group with 30 cases,acupuncture group with 30 cases and western medicine group with 30 cases according to the random number table method.In the bloodletting group,Yifeng,Xinshu and Ganshu were the main points selected,twice per day,once every other day,3 times a week;at the same time,acupuncture treatment was performed,the acupuncture points were selected based on Yifeng,Tinggong,and Tinghui,once a day,5 times a week.The acupuncture group was only treated with acupuncture.The western medicine group was treated with alprostadil by intravenous injection,and flunarizine hydrochloride capsules and metazolamide capsules by oral administration.All the three groups were treated for 4 weeks.The scores of tinnitus severity scale,tinnitus handicap inventory(THI),the Hamilton anxiety scale(HAMA),and the Hamilton depression scale(HAMD)were compared among the three groups,and to evaluate the clinical efficacy.Results After treatment,the scores of tinnitus severity scores,THI,HAMA,and HAMD of the three groups were significantly lower than those before treatment(P<0.05),and the scores of each index of the bloodletting group were significantly lower than those of the other two groups(P<0.05),the tinnitus severity score and THI score of the acupuncture group were significantly lower than those of the western medicine group(P<0.05),but there was no significant difference in the HAMA and HAMD scores between the acupuncture group and the western medicine group(P>0.05).The total effective rate of bloodletting group was 93.3%(28/30),which was significantly higher than 80.0%(24/30)of the acupuncture group and 70.0%(21/30)of the western medicine group(P<0.05),there was no significant difference in the total effective rate between the acupuncture group and the western medicine group(P>0.05).The recovery rate of the bloodletting group was 63.3%(19/30),which was significantly higher than 36.7%(11/30)of the acupuncture group and 13.3%(4/30)of the western medicine group(P<0.05).The recovery rate of the acupuncture group was significantly higher than that of the western medicine group(P<0.05).Conclusion Yifeng,Xinshu,Ganshu bloodletting combined with acupuncture is more effective than acupuncture and western medicine in the treatment of tinnitus of hyperactivity of heart-liver fire within 1 month of onset.