天麻钩藤饮辅以针刺治疗肝阳上亢型成人抽动障碍的临床观察

Clinical Efficacy of Tianma Goutengyin Combined with Acupuncture on Adult Tic Disorder with Ascendant Hyperactivity of Liver Yang

目的:观察分析天麻钩藤饮辅以针刺治疗肝阳上亢型成人抽动障碍症的临床疗效。方法:选取64例2019年1月至2020年12月至中国人民解放军联勤保障部队第九八九医院门诊及住院肝阳上亢型成人抽动障碍患者,采用随机数字表法将患者随机分为两组,对照组和观察组各32例,对照组口服西药盐酸度洛西汀胶囊,观察组口服天麻钩藤饮并辅以针刺,对两组患者各持续治疗8周,并观察临床效果。结果:与本组治疗前比较,对照组和观察组患者的中医证候积分、耶鲁综合抽动严重程度量表(YGTSS)积分、总胆汁酸(TBA)、甘油三酯(TG)、二氧化碳分压(PaCO_(2))均有明显降低,Na^(+)浓度、氧分压(PaO_(2))均有明显升高(P<0.05);治疗后,与对照组比较,观察组中医证候积分、YGTSS积分和TBA明显降低,Na^(+)浓度和PaO_(2)明显升高(P<0.05),在改善TG和PaCO_(2)上两组疗效相当。观察组临床总有效率为90.6%(29/32),明显高于对照组的64.5%(20/31)(χ^(2)=6.210,P<0.05)。观察组临床不良反应发生率为12.5%(4/32),明显低于对照组的35.5%(11/31)(χ^(2)=4.585,P<0.05)。治疗后随访半年,观察组复发率为9.4%(3/32),明显低于对照组的32.3%(10/31)(χ^(2)=5.035,P<0.05)。结论:天麻钩藤饮联合针刺治疗肝阳上亢型成人抽动障碍能够有效减轻成人抽动障碍患者的临床症状,降低TBA、TG和PaCO_(2),提升Na^(+)浓度和PaO_(2),具有不良反应小、复发率低等优点。

Objective:To observe the clinical effect of Tianma Goutengyin combined with acupuncture on adult patients with tic disorder of ascendant liver-yang hyperactivity.Method:The 64 adult patients with tic disorder of ascendant liver-yang hyperactivity who were treated in the outpatients and inpatients of the 989th Hospital of Joint Logistics Support Force of Chinese People's Liberation Army from January 2019 to December 2020 were selected and classified into the control group(32 cases)and the treatment group(32 cases)with the random number table method.The control group took oral western medicine Duloxetine Hydrochloride Enteric Capsules,and the treatment group was treated by Tianma Goutengyin and acupuncture.The treatment lasted 8 weeks for both groups and the efficacy was observed.Result:The traditional Chinese medicine(TCM)syndrome score,Yale Global Tic Severity Scale(YGTSS)score,total bile acid(TBA),triglyceride(TG),and partial pressure of carbon dioxide(PaCO_(2))were significantly lower,and the Na^(+)concentration and partial pressure of oxygen(PaO_(2))were significantly higher than those before treatment in both groups(P<0.05).After treatment,the TCM syndrome score,YGTSS score,and TBA were significantly lower,and and the Na^(+)concentration and PaO_(2) were significantly higher than in the treatment group than in the control group(P<0.05).The efficacy on TG and PaCO_(2) was similar in the two groups.The total clinical effective rate of the treatment group was 90.6%(29/32),as compared with the 64.5%(20/31)of the control group(χ^(2)=6.210,P<0.05).The incidence of clinical adverse reactions in the treatment group was 12.5%(4/32)in comparison with the 35.5%(11/31)in the control group(χ^(2)=4.585,P<0.05).The recurrence rate in the treatment group(9.4%,3/32)was lower than that(32.3%,10/31)in the control group(χ^(2)=5.035,P<0.05).Conclusion:The combination of Tianma Goutengyin and acupuncture can remarkably alleviate the clinical symptoms of adult tic disorder patients with ascendant hyperactivity of liver yang,reduce TBA,TG and PaCO_(2),and increase the concentration of Na^(+)and PaO_(2).Patients treated with the combination show small adverse reactions and low recurrence rate.