针灸对气血亏虚型颈性眩晕患者椎动脉血流状态的影响

方金 张国妍 焦志宏 勾明会 田伟 张玉辉

摘要  目的：探討针灸对气血亏虚型颈性眩晕患者椎动脉血流状态的影响。方法：选取2016年1月至2019年5月北京市丰台中西医结合医院收治的气血亏虚型颈性眩晕患者66例作为研究对象，按照随机数字表法分为对照组和观察组，每组33例。对照组采用益气聪明汤治疗，观察组在对照组基础上增加针灸疗法，2组均连续治疗1个月。比较2组患者治疗前后眩晕程度、中医证候改善情况及椎-基底动脉血流动力学变化。结果：与治疗前比较，治疗后2组眩晕发作频率均降低，每次持续时间均缩短，且观察组低于/短于对照组，差异有统计学意义（ P <0.05）;治疗后2组头晕目眩、心悸少寐、面色淡白等中医证候积分降低，且观察组低于对照组，差异有统计学意义（ P <0.05）;与治疗前比较，治疗后观察组基底动脉平均血流速度（Vm）增加，PI减小，且观察组基底动脉Vm大于对照组，差异有统计学意义（ P <0.05）;与治疗前比较，治疗后2组左、右椎动脉Vm均增加，且观察组大于对照组，差异有统计学意义（ P <0.05）。结论：针灸可改善气血亏虚型颈性眩晕患者椎-基底动脉血流动力学，减轻患者眩晕程度，效果明显优于单用益气聪明汤。

关键词  气血亏虚型;颈性眩晕;针灸;益气聪明汤;血流动力学;平均血流速度;阻力指数;搏动指数

Effects of Acupuncture on the Blood Flow Status of Vertebral Artery in Patients with Deficiency of Qi and Blood Type Cervical Vertigo

FANG Jin1， ZHANG Guoyan1， JIAO Zhihong1， GOU Minghui1， TIAN Wei2， ZHANG Yuhui3

（1 Center for Treating Diseases Before It Arises， Beijing Fengtai Integrated Traditional Chinese and Western Medicine Hospital， Beijing 100072， China; 2 Department of Rehabilitation， Beijing Hospital of Traditional Chinese Medicine， Capital Medical University， Beijing 100010， China; 3 Institute of Basic Theory for Traditional Chinese Medicine， China Academy of Chinese Medical Sciences， Beijing 100700， China）

Abstract Objective： To explore the effects of acupuncture on the blood flow status of vertebral artery in patients with deficiency of qi and blood type cervical vertigo.  Methods： A total of 66 cases patients with deficiency of qi and blood type cervical vertigo admitted to Beijing Fengtai Hospital of Integrated Traditional and Western Medicine from January 2016 to May 2019 were selected as the study objects and were divided into an observation group and a control group， 33 cases in each group， according to random number table. The control group was given Yiqi Congming Decoction， and the observation group was added with acupuncture on the basis of the control group. The 2 groups were treated continuously for 1 month. The degree of vertigo， the improvement of traditional Chinese medicine symptoms， and the hemodynamic changes of vertebrobasilar artery before and after treatment in the 2 groups were compared.  Results： Compared with those before treatment， the frequency of vertigo attacks after treatment in the 2 groups decreased， each duration shortened， and the observation group was less/shorter than the control group（ P <0.05）; after treatment， the scores of traditional Chinese medicine symptoms such as dizziness， palpitation， less sleep， complexion paleness in the 2 groups reduced， and the observation group was lower than the control group（ P <0.01）. Compared with those before treatment， the average blood flow velocity（Vm）of the basilar artery in the observation group increased， the PI decreased， and the Vm of the basilar artery in the observation group was greater than that in the control group（ P <0.05）. Compared with that before treatment， the Vm of left and right vertebral arteries after treatment in the 2 groups increased， and the observation group was greater than the control group（ P <0.05）.  Conclusion： Acupuncture can improve the hemodynamics of vertebrobasilar artery in patients with deficiency of qi and blood type cervical vertigo， reduce the degree of vertigo. The efficacy is significantly better than Yiqi Congming Decoction alone， and it is worthy of application and promotion in clinic.

Keywords  Deficiency of qi and blood type; Cervical vertigo; Acupuncture; Yiqi Congming Decoction; Hemodynamics; Average blood flow velocity; Resistance index; Pulsatility index

中图分类号：R245 文献标识码：A  doi： 10.3969/j.issn.1673-7202.2020.14.029

颈性眩晕是由外伤或颈椎退行性病变等原因引起椎-基底动脉供血不全，临床主要表现为眩晕的一类综合征，具体发病机制尚不完全清楚。中医认为其与身体虚弱、气血不足相关，多表现为气血亏虚型[1]。临床多以非手术疗法如针灸、推拿及药物等治疗为主[2-3]。益气聪明汤有益气升阳、补血填精、活血止眩之功，可助患者耳聪目明。针灸可改善脑组织局部血液循环，增加脑部血供，是眩晕常用的治疗手段[4]。本研究旨在探讨针灸联合益气聪明汤对气血亏虚型颈性眩晕患者眩晕程度及椎动脉血流状态的影响。现报道如下。

1 资料与方法

1.1 一般资料

选取2016年1月至2019年5月北京市丰台中西医结合医院收治的气血亏虚型颈性眩晕患者66例作为研究对象，按照随机数字表法分为对照组和观察组，每组33例。……