针灸联合三参通络汤对后循环缺血性孤立性眩晕老年患者脑血流及血管内皮功能的影响

Effect of Acupuncture Combined with Sanshen Tongluo Decoction on Cerebral Blood Flow and Vascular Endothelial Function in Elderly Patients with Posterior Circulation Ischemic Isolated Vertigo

目的观察针灸联合三参通络汤对后循环缺血性孤立性眩晕老年患者脑血流动力学状态及血管内皮功能的影响。方法选取2018年2月至2021年2月,于四川省中医药科学院中医研究所诊治的后循环缺血性孤立性眩晕老年患者140例为研究对象,采用随机数字表法将其分为试验组与对照组,每组70例。对照组给予阿司匹林肠溶片、甲磺酸培他司汀片口服,胞二磷胆碱注射液静脉滴注,辅以针灸治疗;试验组在对照组基础上联合三参通络汤治疗。比较两组临床疗效,治疗前、治疗2周后椎基底动脉[左椎动脉(LVA)、右椎动脉(RVA)、基底动脉(BA)]血流速度,血液流变学状态(全血黏度高切、全血黏度低切、血浆黏度)变化及血管内皮功能[降钙素基因相关肽(CGRP)、内皮素-1(ET-1)]水平。结果治疗2周后,试验组总有效率高于对照组(P<0.05);两组LVA、RVA、BA血流速度均较治疗前提高,且试验组高于对照组(P<0.05);两组全血黏度高切、全血黏度低切、血浆黏度均较治疗前降低,且试验组低于对照组(P<0.05);两组血清CGRP水平均较治疗前提高,且试验组高于对照组;ET-1水平均较治疗前降低,且试验组低于对照组(P<0.05)。结论针灸联合三参通络汤治疗后循环缺血性孤立性眩晕老年患者,可有效改善其脑血流动力学、增加脑血流量、改善临床症状,且疗效确切,机制可能与其调节CGRP、ET-1水平,促进血管舒张功能恢复有关。

Objective To observe the effect of acupuncture combined with Sanshen Tongluo decoction on cerebral hemodynamic status and vascular endothelial function in elderly patients with posterior circulation ischemic isolated vertigo.Methods A total of 140 elderly patients with posterior circulation ischemic isolated vertigo who were treated in the Institute of Traditional Chinese Medicine of Sichuan Academy of Traditional Chinese Medicine from February 2018 to February 2021 were selected as the research subjects.The patients were divided into experimental group(n=70)and control group(n=70)by random number table method.The control group was given oral administration of aspirin enteric-coated tablets and betahistine mesylate tablets,intravenous drip of citicoline injection,and supplemented treatment of acupuncture.And the experimental group was treated with Sanshen Tongluo decoction on the basis of the control group.Clinical efficacy,as well as blood flow velocities of vertebral basilar arteries left vertebral artery(LVA),right vertebral artery(RVA),basilar artery(BA),changes in hemorheological status(whole blood high-shear viscosity,whole blood low-shear viscosity,plasma specific viscosity)and vascular endothelial function calcitonin gene-related peptide(CGRP),endothelin-1(ET-1)before treatment and after 2 weeks of treatment were compared between the two groups.Results After 2 weeks of treatment,the total effective rate of the experimental group was higher than that of the control group(P<0.05).Blood flow velocities of LVA,RVA and BA in both groups were improved compared with those before treatment,and those in the experimental group were faster than those in the control group(P<0.05).Whole blood high-shear viscosity,whole blood low-shear viscosity and plasma specific viscosity in both groups were reduced compared with those before treatment,and those in the experimental group were lower than those in the control group(P<0.05).Serum CGRP levels in both groups were higher than those before treatment,and those in the experimental group were higher than those in the control group,while Serum ET-1 levels in both groups were lower than those before treatment,and those in the experimental group were lower than those in the control group(P<0.05).Conclusion Acupuncture combined with Sanshen Tongluo decoction can effectively improve cerebral hemodynamics,increase cerebral blood flow,and improve symptoms in elderly patients with posterior circulation ischemic isolated vertigo,with an exact efficacy.And its mechanism may be related to the regulation of CGRP and ET-1 levels,and promotion of recovery of vasodilation function.