Objective: To observe the clinical therapeutic effect of Tongdu Tiaoshen acupuncture combined with carotid endarterectomy (CEA) and simple CEA on carotid artery stenosis (CAS).
Methods: A total of 60 patients with CAS were randomized into an observation group (30 cases, 2 cases dropped off) and a control group (30 cases, 3 cases dropped off). Both groups were treated with eversion CEA (eCEA). The conventional treatment of internal medicine and antiplatelet drugs i.e. aspirin enteric-coated tablet and clopidogrel hydrogen sulfate tablet were given in the control group for 4 weeks. On the basis of the treatment in the control group, Tongdu Tiaoshen acupuncture was applied at Baihui (GV 20), Fengfu (GV 16), Yamen (GV 15), cervical Jiaji (EX-B 2), Dazhui (GV 14), etc. in the observation group, once a day, 1-day rest was taken after 6-day treatment, 2 weeks were as one course and totally 2 courses were required. The carotid intima-media thickness (IMT) before and after treatment was detected by ultrasonic diagnostic apparatus, the TCM symptom score was compared before and after treatment and in the follow-up of 6 months after treatment, the clinical efficacy was evaluated in the two groups. The occurrence of endpoints within 1 year was recorded.
Results: After treatment, the carotid IMT and TCM symptom scores were decreased compared before treatment in the both groups (P<0.05), and the changes in the observation group were greater than the control group (P<0.05). In the follow-up, the TCM symptom scores were decreased compared before treatment in the both groups (P<0.05). The total effective rate was 96.4% (27/28) in the observation group, which was superior to 88.9% (24/27) in the control group (P<0.05). There were 1 case of stoke in the observation group and 2 cases of stroke in the control group within 1-year follow-up, and there was no significant difference in the number of endpoints between the two groups within 1 year (P>0.05).
Conclusion: Tongdu Tiaoshen acupuncture combined with CEA can effectively reduce the IMT in patients with CAS, improve the TCM symptom score, the efficacy is superior to simple CEA treatment.
目的：观察“通督调神”法针刺联合颈动脉内膜剥脱术（CEA）与单纯CEA治疗颈动脉狭窄（CAS）的临床疗效。方法：将60例CAS患者随机分为观察组（30例，脱落2例）和对照组（30例，脱落3例）。两组患者均采用外翻式颈动脉内膜剥脱术（eCEA）治疗。对照组患者予内科常规及抗血小板聚集药物（阿司匹林肠溶片或硫酸氢氯吡格雷片）治疗4周，观察组在对照组的基础上采用“通督调神”法针刺治疗，穴取百会、风府、哑门、颈夹脊、大椎等，每日1次，治疗6 d后休息1 d，2周为一疗程，共治疗2个疗程。采用超声诊断仪检测两组患者治疗前后颈动脉内膜中层厚度（IMT），比较两组患者治疗前后及治疗结束后6个月随访时的中医症状积分，评定两组患者临床疗效，并记录1年内终点事件发生情况。结果：治疗后，两组患者颈动脉IMT、中医症状积分均较治疗前降低（P<0.05），且观察组降低幅度大于对照组（P<0.05）。随访时，两组患者中医症状积分均较治疗前降低（P<0.05）。观察组总有效率为96.4%（27/28），高于对照组的88.9%（24/27，P<0.05）。1年内随访，观察组发生脑卒中1例；对照组发生脑卒中2例，两组患者1年内终点事件发生例数比较差异无统计学意义（P>0.05）。结论：“通督调神”法针刺联合CEA能有效降低CAS患者IMT，改善患者中医症状积分，疗效优于单纯CEA治疗。.
Keywords: Tongdu Tiaoshen; acupuncture; carotid artery stenosis; carotid endarterectomy; randomized controlled trial (RCT).