颈性眩晕的中医证型与脑血流动力学的相关性研究  

Research on the Relationship between Cervical Vertigo and Cerebral Hemodynamics

作　　者：叶洁[1,2] 顾小华[3] 许金海[1] 莫文[1,4,2] 施杞[1,4,2] 

机构地区：[1]上海中医药大学附属龙华医院骨伤科,上海200032 [2]上海中医药大学施杞名中医工作室 [3]上海市第七人民医院 [4]上海中医药大学脊柱病研究所

出　　处：《中国中医骨伤科杂志》2014年第3期7-10,共4页Chinese Journal of Traditional Medical Traumatology & Orthopedics

基　　金：上海市卫生系统优秀学科带头人计划(XBR2013104);上海市教育委员会预算内科研项目(2010JW42);国家十二五重大新药创制专项项目-中药新药临床评价技术平台课题的建设(2011ZX09302-006-04);国家中医药管理局国家中医临床研究基地业务建设科研专项(JDZX2012120);上海市科委科技支撑项目(12401902104);上海市卫生系统优秀人才项目(XBR2013104)

摘　　要：目的:探讨转颈试验经颅多普勒(TCD)在颈性眩晕诊断的应用价值,并观察颈性眩晕的中医辨证分型与脑血流动力学的关系。方法:对对照组30例健康受试者以及罹患组120例颈性眩晕患者辨证分型后进行中立位和转颈试验后经颅多普勒超声检测。结果:①罹患组常规中立位检测血流速度异常者91例,阳性率为75.8%;行转颈试验后,TCD检查血流速度异常者为107例,异常率提高到89.2%。②各型颈性眩晕的脑血流动力学改变有各自的特点。痰湿阻络组血流速度增快,呈低阻力波型;肝阳上亢组血流速度明显增快,但呈高阻力波型。肝肾阴虚组血流速度减慢,呈高阻力波型;气血亏虚组呈血流速度减慢;结论:①转颈试验TCD检查对颈性眩晕的诊断有其特殊价值;②椎动脉痉挛与狭窄、脑动脉弹性减退或硬化、椎-基底动脉下游小动脉闭塞可能是颈性眩晕发病病因之一,各中医证型患者的TCD表现各具特点。Objective：To explore the value of neck torsion test combined with transcranial Doppler （TCD） in the diagnosis of cervical vertigo and observe the relationship between cervical vertigo and cerebral hemodynamics. Methods：The treatment group （120 cases） and the control group （30 cases） underwent TCD after syndrome differentiation in neutral position and also after neck torsion test. Results：l. Ninety-one cases （75.8 %） in the treatment group showed abnormal blood flow velocity in neutral position. After neck torsion test, the number increased to 107 cases （89.2%）. 2. There were corresponding features of cerebral hemodynamics in different syndrome types of cervical vertigo. The speed of blood flow was increased in the syndrome of phlegm-dampness blocking collaterals with low resistance spectra on TCD. In the syndrome of hyperactivity of liver-yang, the blood flow was also increased but with high resistance spectra. The blood flow was slowed in the syndrome of yin deficiency of liver and kidney with high resistance spectra. In the syndrome of qi and blood deficien- cy, the blood flow was remarkably slow. Conclusion.. 1. Neck torsion test combining TCD has special value for diagnosing cervical vertigo. 2. Vertebral artery spasm or stenosis, declined cerebral arterial elasticity or hardening and occlusion of downstream small artery of vertebral basilar artery are possible reasons for vertical vertigo. There are different manifestations in different syndrome types of traditional Chinese medicine.

关 键 词：颈性眩晕 中医证型 脑血流速度 转颈试验 

分 类 号：R274.39[医药卫生—中医骨伤科学]