通督活血汤联合推拿手法治疗椎动脉型颈椎病效果及患者血流动力学指标水平分析

The effects of the Tongdu Huoxue decoction plus massage on vertebral artery type cervical spondylosis and an analysis of the patients’ hemodynamic index levels

目的:分析通督活血汤联合推拿手法治疗椎动脉型颈椎病的效果及此联合疗法对患者血流动力学指标水平的影响。方法:选择2019年10月-2020年10月在佛山市中医院推拿门诊接受治疗的67例椎动脉型颈椎病患者作为研究对象,依据其入院病床号单双数将其分为对照组(单数,33例)与观察组(双数,34例)。对照组单行推拿治疗,观察组在推拿手法治疗基础上结合通督活血汤进行治疗。比较两组治疗前后的X线检查指标(椎体水平位移、颈椎弧度、屈伸活动范围)变化情况、中医证候积分(头晕目眩、昏倒、颈部风寒发作)改善情况、血流动力学指标[椎动脉-基底动脉平均血流速度(Mean Velocity,Vm)、椎动脉-基底动脉血管搏动指数(Pulsation Index,PI)、脑血管阻力指数(Resistance Index,RI)]水平、血管功能细胞因子[内皮素(Endothelin,ET)、神经元特异性烯醇酶(Neuron-specific Enolase,NSE)]水平,对比两组的用药安全性。结果:经过治疗,观察组椎体水平位移与对照组相比较低,颈椎弧度、屈伸活动范围均高于对照组(P <0.05);观察组各项中医证候积分均低于对照组(P <0.05);观察组Vm水平较对照组高,PI、RI水平均低于对照组(P <0.05);观察组ET及NSE水平与对照组相比较低(P <0.05)。观察组治疗期间不良反应总发生率与对照组的差异无统计学意义(P> 0.05)。结论:采用通督活血汤联合推拿手法对椎动脉型颈椎病进行治疗,可显著改善患者的颈椎活动范围,合理调整其血流动力学指标水平,控制各项症状发展,有效减轻其血管内皮功能损伤,且并未增加不良反应。

Objective:To analyze the effects of the Tongdu Huoxue decoction(通督活血汤)plus massage on vertebral artery type cervical spondylosis and the influence of this comprehensive therapy on the level of hemodynamic indexes in patients.Methods:Sixtyseven cases from October 2019 to October 2020 were selected as the research objects,and were divided into the control group(33 cases)and the observation group(34 cases)according to their hospital bed numbers.The control group received massage alone,while the observation group received massage plus the Tongdu Huoxue decoction.Results:After treatment,the vertebral horizontal displacement in the observation group was lower than the control group.The cervical curvature,and flexion and extension range in the observation group were higher than the control group(P<0.05).The TCM syndrome scores in the observation group were lower than the control group(P<0.05).The level of Vm in the observation group was higher than the control group,and PI and RI levels in the observation group were lower than the control group(P<0.05).The levels of ET and NSE in the observation group were lower than the control group(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups during treatment(P>0.05).Conclusion:The Tongdu Huoxue decoction plus massage on vertebral artery type cervical spondylosis can significantly improve the cervical spine range of motion,reasonably adjust the hemodynamic index levels,control the development of various symptoms,effectively reduce the damage of vascular endothelial function,and not increase adverse reactions.