“通督调神”法针刺治疗主观性耳鸣:随机对照试验  

Tongdu Tiaoshen acupuncture for subjective tinnitus:a randomized controlled trial

作　　者：李成龙 茅伟 张利达 张鑫 吴海洋[4] 张国庆[4] 张君宇[5] 王颖[4,6] 韩为 LI Chenglong;MAO Wei;ZHANG Lida;ZHANG Xin;WU Haiyang;ZHANG Guoqing;ZHANG Junyu;WANG Ying;HAN Wei(First Clinical Medical College,Anhui University of CM,Hefei 230012,China;Department of TCM,Affiliated Brain Hospital of Guangzhou Medical University;Department of Acupuncture and Moxibustion,Nanjing Gaochun District Hospital of TCM;Department of Encephalopathy,Second Affiliated Hospital of Anhui University of CM,Hefei 230001,China;Department of Geriatrics,Second Affiliated Hospital of Anhui University of CM,Hefei 230001,China;Anhui Famous TCM Studio of WANG Ying,Hefei 230001,China)

机构地区：[1]安徽中医药大学第一临床医学院,合肥230012 [2]广州医科大学附属脑科医院中医科 [3]南京市高淳区中医院针灸科 [4]安徽中医药大学第二附属医院脑病科,合肥230001 [5]安徽中医药大学第二附属医院老年病科,合肥230001 [6]安徽省名中医王颖工作室,合肥230001

出　　处：《中国针灸》2024年第6期648-652,共5页Chinese Acupuncture & Moxibustion

基　　金：国家自然科学基金面上项目:81973933;安徽省第十三批115产业创新团队“针药结合防治脑病创新团队”项目:皖人才办[2020]4号;安徽省针灸临床医学研究中心项目:2021zjzx02;安徽省名中医王颖工作室建设项目:中发展[2022]5号。

摘　　要：目的:观察“通督调神”法针刺治疗主观性耳鸣的临床疗效,并探讨其可能的作用机制。方法:将92例主观性耳鸣患者随机分为针刺组(46例,脱落5例)和药物组(46例,脱落2例)。针刺组予“通督调神”法针刺治疗,穴取水沟、印堂、神庭、百会、风府、大椎和患侧中渚、听会、翳风,每次30 min,隔日1次,每周3次;药物组予口服银杏叶片(40mg/次)、甲钴胺片(0.5mg/次),均每日3次。两组均连续治疗4周。观察两组患者治疗前后耳鸣严重程度评分、耳鸣响度视觉模拟量表(VAS)评分和情绪自评量表(DASS-21)评分,检测治疗前后两组患者血清脑源性神经营养因子(BDNF)含量,并评定临床疗效。结果:治疗后,两组患者耳鸣严重程度评分、耳鸣响度VAS评分和DASS-21评分均较治疗前降低(P<0.01),且针刺组均低于药物组(P<0.05)。治疗后,两组患者血清BDNF含量均较治疗前降低(P<0.01),且针刺组低于药物组(P<0.05)。针刺组总有效率为82.9%(34/41),高于药物组的70.5%(31/44,P<0.05)。结论:“通督调神”法针刺可改善主观性耳鸣患者的耳鸣严重程度、耳鸣响度和不良情绪,其机制可能与调节血清BDNF含量、影响听觉中枢可塑性有关。Objective To observe the clinical effect of Tongdu Tiaoshen acupuncture(acupuncture for promoting the circulation of the governor vessel and regulating the spirit)for subjective tinnitus,and explore its potential mechanism.Methods A total of 92 patients with subjective tinnitus were randomly divided into an acupuncture group(46 cases,5 cases dropped out)and a medication group(46 cases,2 cases dropped out).The acupuncture group received Tongdu Tiaoshen acupuncture at Shuigou(GV 26),Yintang(GV 24+),Shenting(GV 24),Baihui(GV 20),Fengfu(GV 16),Dazhui(GV 14)and Zhongzhu(TE 3),Tinghui(GB 2),Yifeng(TE 17)on the affected side,30 min each time,once every other day,3 times a week.The medication group was orally administered ginkgo biloba leaves tablets(40 mg each time)and mecobalamin tablets(0.5 mg each time),3 times a day.Both groups were treated for 4 weeks.The scores of tinnitus severity,tinnitus loudness visual analogue scale(VAS)and depression anxiety stress scale-21(DASS-21)before and after treatment were observed in the two groups,serum level of brain-derived neurotrophic factor(BDNF)before and after treatment in the two groups was detected,and the clinical effect was evaluated in the two groups.Results After treatment,the scores of tinnitus severity,tinnitus loudness VAS and DASS-21 were decreased compared with those before treatment in the two groups(P<0.01),and the scores in the acupuncture group were lower than those in the medication group(P<0.05).After treatment,the serum level of BDNF was decreased compared with that before treatment in the two groups(P<0.01),and the serum level of BDNF in the acupuncture group was lower than that in the medication group(P<0.05).The total effective rate of the acupuncture group was 82.9%(34/41),which was higher than 70.5%(31/44)in the medication group(P<0.05).Conclusion Tongdu Tiaoshen acupuncture could improve the severity of tinnitus,tinnitus loudness and negative emotion in patients with subjective tinnitus.Its mechanism may be related to the regulation of serum level of B

关 键 词：主观性耳鸣 针刺 通督调神 视觉模拟量表评分 脑源性神经营养因子 随机对照试验 

分 类 号：R246.81[医药卫生—针灸推拿学]