世界中医药

目的:探究通督活血汤联合推拿手法对椎动脉型颈椎病(CSA)疗效和血流动力学影响性,以期提高疗效。方法:选取2017年4月至2018年4月宝鸡市中医医院收治CSA患者88例作为研究对象,按照就诊顺序编号随机分为对照组和观察组,每组44例。对照组采用西医治疗,观察组予通督活血汤联合推拿手法治疗,均同时治疗2周。观察2组患者治疗前、完成治疗后血流动力学变化并比较;观察2组患者治疗前、完成治疗后在X线检查指标变化并比较;观察2组患者治疗前、完成治疗后肿瘤坏死因子-α(TNF-α)、内皮素(ET)、神经元特异性烯醇酶(NSE)水平变化并比较;观察2组患者治疗前、完成治疗后在临床症状量化评分变化并比较。结果:1)完成治疗后2组患者椎动脉、基底动脉的收缩期血流速度、舒张期血流速度、平均血流速度较治疗前均显著升高(P<0.05),完成治疗后观察组以上指标均显著高于对照组(P<0.05)。2)完成治疗后2组患者颈椎屈伸活动范围、颈椎弧度较治疗前均显著升高,椎体水平位移、椎体角度位移较治疗前显著下降(P<0.05),完成治疗后观察组颈椎屈伸活动范围、颈椎弧度显著高于对照组,椎体水平位移、椎体角度位移显著低于对照组(P<0.05)。3)完成治疗后2组患者TNF-α、ET、NSE较治疗前均显著降低(P<0.05),完成治疗后观察组以上指标均显著低于对照组(P<0.05)。4)完成治疗后2组患者头痛眩晕、耳鸣耳聋、视物障碍、猝倒、颈椎不适积分较治疗前均显著下降(P<0.05),完成治疗后观察组以上积分均显著低于对照组(P<0.05)。结论:通督活血汤联合推拿手法能通过改善CSA血液流变学促进血液循环,改善颈椎活动范围,促进神经元恢复,从而改善临床症状。

English Summary:

To explore the effects of Tongdu Huoxue Decoction combined with massage manipulation on cervical spondylosis of vertebral artery type(CSA)and hemodynamics in order to improve the therapeutic effect.Methods:A total of 88 cases of CSA were enrolled in Baoji Hospital of Traditional Chinese Medicine from April 2017 to April 2018.They were randomly divided into a control group(44 cases)and an observation group(44 cases).The control group was treated with western medicine and the observation group was treated with Tongdu Huoxue Decoction combined with massage manipulation for 2 weeks.The changes of hemodynamics before and after treatment in the 2 groups were observed and compared; the changes of X-ray examination indexes before and after treatment in the 2 groups were observed and compared; the changes of the levels of TNF-alpha, ET and NSE before and after treatment in the 2 groups were observed and compared; and the clinical effects before and after treatment in the 2 groups were observed and compared.Quantitative score changes of clinical symptoms were compared.Results:1)After treatment, the systolic blood flow velocity, diastolic blood flow velocity and average blood flow velocity of vertebral artery and basilar artery in the 2 groups were significantly increased than those before treatment(P<0.05), and the above indexes in the observation group were significantly higher than those in the control group(P<0.05).2)After treatment, the range of cervical flexion and extension, the radian of cervical spine in both groups increased significantly, and the horizontal displacement and the angular displacement of vertebral body decreased significantly(P<0.05).After treatment, the range of cervical flexion and extension and the radian of cervical spine in the observation group were significantly higher than those in the control group, and the horizontal displacement and angular displacement of vertebral body were significantly lower than those in the control group(P<0.05).3)After treatment, TNF-a, ET and NSE in the 2 groups were significantly decreased than those before treatment(P<0.05), and the above indexes in the observation group were significantly lower than those in the control group(P<0.05).4)The scores of headache, vertigo, tinnitus, deafness, visual disturbance, sudden collapse and cervical discomfort in the 2 groups after treatment were significantly decreased than those before treatment(P<0.05), and those in the observation group after treatment were significantly lower than those in the control group(P<0.05).Conclusion:Tongdu Huoxue Decoction combined with massage manipulation can promote blood circulation, improve cervical range of motion, promote neuron recovery and improve clinical symptoms by improving CSA hemorheology.

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