针灸治疗不同分期主观性耳鸣的临床疗效及对生活质量的影响  

Clinical Effect of Acupuncture and Moxibustion in Treatment of Different Stages of Subjective Tinnitus and Its Effect on Quality of Life

作　　者：查必祥 张雅婷 叶敏 戎志豪 于雷雨 刘婉婷 杨骏[1] ZHA Bixiang;ZHANG Yating;YE Min;RONG Zhihao;YU Leiyu;LIU Wanting;YANG Jun(The First Affiliated Hospital of Anhui University of Chinese Medicine,Anhui Hefei 230031,China;The First Clinical Medical College of Anhui University of Chinese Medicine,Anhui Hefei 230031,China)

机构地区：[1]安徽中医药大学第一附属医院,安徽合肥230031 [2]安徽中医药大学第一临床医学院,安徽合肥230031

出　　处：《安徽中医药大学学报》2025年第1期52-57,共6页Journal of Anhui University of Chinese Medicine

基　　金：国家中医药管理局全国名中医杨骏传承工作室(皖中医药发展秘〔2022〕19号);安徽省临床医学研究转化专项(202304295107020125);安徽高校自然科学研究项目(2022AH050468)。

摘　　要：目的观察针灸治疗不同分期主观性耳鸣(subjective tinnitus,ST)的临床疗效及对患者生活质量的影响。方法根据不同病程将90例ST患者分为急性期(病程小于3个月)32例、亚急性期(病程3~6个月)27例、慢性期(病程大于6个月)31例。不同分期ST患者均以全国名中医杨骏教授“宁神通窍、通经活络”针灸方法进行治疗,选取听宫、翳风、头窍阴、哑门、百会、大椎、中渚,采用电针深刺听宫等特殊手法。比较不同分期ST患者临床疗效,治疗前后耳鸣评价量表(tinnitus evaluation questionnaire,TEQ)、耳鸣致残量表(tinnitus handicap inventory,THI)、耳鸣视觉模拟量表(visual analogue scale,VAS)、医院焦虑抑郁量表(hospital anxiety and depression scale,HADS)、匹兹堡睡眠质量指数量表(Pittsburgh sleep quality index,PSQI)评分及平均气导听阈值。结果不同分期ST患者临床疗效比较,差异无统计学意义(P>0.05)。治疗后不同分期ST患者TEQ、THI评分较治疗前均显著降低(P<0.05),且与慢性期比较,治疗后急性期ST患者TEQ评分下降程度更显著(P<0.05)。治疗后不同分期ST患者的VAS评分和平均气导听阈值较治疗前均显著降低(P<0.05),且急性期ST患者VAS评分较亚急性期、慢性期下降程度更显著(P<0.05),急性期ST患者平均气导听阈值较慢性期下降程度更显著(P<0.05)。治疗前急性期ST患者PSQI评分显著高于慢性期(P<0.05),HADS评分显著高于亚急性期和慢性期(P<0.05)。不同分期ST患者治疗后PSQI、HADS评分均较治疗前显著降低(P<0.05)。但治疗后不同分期ST患者PSQI、HADS评分比较,差异均无统计学意义(P>0.05)。结论“宁神通窍、通经活络”针灸治疗不同分期ST患者均具有较好的临床疗效,能减轻或消除耳鸣症状(在急性期效果更为明显),改善听力水平、睡眠质量及精神状态,提高患者生活质量,早期疗效更为显著。Objective To investigate the clinical effect of acupuncture and moxibustion in the treatment of different stages of subjective tinnitus(ST)and its effect on quality of life.Methods According to the course of ST,90 patients were divided into acute ST group(32 patients with a disease course of<3 months),subacute ST group(27 patients with a disease course of 3-6 months),and chronic ST group(31 patients with a disease course of>6 months).According to the principles of"tranquilizing the mind,relieving stuffiness,and clearing and activating the channels and collaterals"for acupuncture and moxibustion proposed by National Famous TCM Doctor Yang Jun,the Tinggong,Yifeng,Touqiaoyin,Yamen,Baihui,Dazhui,and Zhongzhu points were selected for all three groups,and the special techniques including deep electroacupuncture at Tinggong were used.The three groups were compared in terms of clinical outcome,the scores of Tinnitus Evaluation Scale(TEQ),Tinnitus Handicap Inventory(THI),Visual Analogue Scale(VAS),Hospital Anxiety and Depression Scale(HADS),and Pittsburgh Sleep Quality Index(PSQI),and mean air-conducted hearing threshold before and after treatment.Results There was no significant difference in clinical outcome between the three groups(P>0.05).After treatment,all three groups had significant reductions in TEQ and THI scores(P<0.05),and compared with the chronic ST group,the subacute ST group had a significantly greater reduction in TEQ score after treatment(P<0.05).After treatment,the patients with different stages of ST had significant reductions in VAS score and mean hearing threshold(P<0.05);compared with the subacute ST group and the chronic ST group,the acute ST group had a significantly greater reduction in VAS score after treatment(P<0.05),and compared with the chronic ST group,the acute ST group had a significantly greater reduction in mean hearing threshold(P<0.05).Before treatment,there were significant differences in PSQI and HADS scores between the patients with different stages of ST(P<0.05),while after treatm

关 键 词：主观性耳鸣 急性期 亚急性期 慢性期 针灸 宁神通窍 通经活络 

分 类 号：R246.81[医药卫生—针灸推拿学]