本文選題：電針 + 內(nèi)關(guān)穴　； 參考：《北京中醫(yī)藥大學(xué)》2014年碩士論文

【摘要】：心肌缺血性疾病,屬于中醫(yī)學(xué)“胸痹”“真心痛”“厥心痛”的范疇。隨著人們生活水平的顯著提高,心肌缺血性疾病已成為全世界發(fā)病率和死亡率均非常高的疾病之一,嚴(yán)重威脅人類的健康和生命。多年來,現(xiàn)代醫(yī)學(xué)在闡明心肌缺血發(fā)病機(jī)制以及尋找有效的預(yù)防和治療手段方面進(jìn)行了大量的研究。迄今,除了經(jīng)典的傳統(tǒng)抗凝擴(kuò)冠藥,和后來發(fā)展的支架搭橋等外科手術(shù)外,其它防治心肌缺血性損傷的辦法還是不多,至今該病的發(fā)病率和死亡率仍然高居不下。針灸作為一種簡(jiǎn)、便、驗(yàn)的預(yù)防和治療手段,早在《黃帝內(nèi)經(jīng)》中就有關(guān)于針灸治療“胸痹”,“心痛”的記載。大量的古代文獻(xiàn)、臨床經(jīng)驗(yàn)以及現(xiàn)代研究均顯示：針刺對(duì)缺血心肌具有較為確切的保護(hù)作用,如緩解冠心病病人心絞痛、胸悶等臨床癥狀,改善ECG-ST-T及左心功能等等。因此,找到關(guān)于針刺如何發(fā)揮改善心肌缺血性損傷作用的途徑,具有重要的臨床意義和價(jià)值,同時(shí)將有助于為針刺改善冠心病心肌缺血性疾病提供科學(xué)基礎(chǔ)。 研究證明,急性心肌缺血時(shí),交感神經(jīng)及心臟-腎上腺素受體過度激活,導(dǎo)致細(xì)胞內(nèi)鈣超載,從而引起心肌缺血性損傷。過去有關(guān)針灸方面的研究顯示：針刺效應(yīng)可通過影響交感神經(jīng)系統(tǒng)的興奮性而來發(fā)揮改善心肌缺血性損傷的作用。眾所周知,交感神經(jīng)的主要靶受體是p-腎上腺素能受體(β-AR),同時(shí),β-AR也是心臟中最重要的受體,故交感神經(jīng)對(duì)心臟的調(diào)節(jié)和控制作用主要是通過p-AR來完成的。由此可知,針刺效應(yīng)的作用極有可能通過影響心臟交感神經(jīng)系統(tǒng),從而進(jìn)一步作用于交感神經(jīng)系統(tǒng)的靶受體p-腎上腺素能受體,最終起到改善缺血性心肌損傷的作用。 實(shí)驗(yàn)?zāi)康模?本研究通過采用結(jié)扎冠狀動(dòng)脈左前降支的大鼠急性心肌缺血模型,以及小鼠游泳疲勞運(yùn)動(dòng)模型,來觀察電針內(nèi)關(guān)穴對(duì)缺血心肌的保護(hù)作用。進(jìn)一步探討p-AR介導(dǎo)電針內(nèi)關(guān)穴改善缺血性心肌損傷的機(jī)制研究,為針刺防治心肌缺血性疾病提供臨床指導(dǎo)意義以及理論基礎(chǔ)。 實(shí)驗(yàn)方法： 1.第一部分實(shí)驗(yàn)：選用雄性成年Wistar大鼠32只,體重235±15g。將大鼠隨機(jī)分為四組：正常組(NC組)、模型組(Model組)、電針組(EA組)和心得安組(EAP組),每組各8只。Model、EA和EAP組于麻醉后行冠脈結(jié)扎術(shù),且全程記錄Ⅱ?qū)?lián)心電圖。NC組僅穿線,不做其他處理。EA組于每次麻醉后電針內(nèi)關(guān)30min(電針參數(shù)：強(qiáng)度3mA,頻率20Hz); EAP組于麻醉后先腹腔注射p-AR阻斷劑——心得安(10mg/kg),15min后再電針“內(nèi)關(guān)"30min,連續(xù)3天。通過觀察大鼠心電圖ST段幅值的變化、心律失常評(píng)分和心肌梗塞面積來明確電針“內(nèi)關(guān)”穴改善缺血性心肌損傷的效應(yīng),并探討p-AR是否參與介導(dǎo)了上述針刺效應(yīng)。 2.第二部分實(shí)驗(yàn)：選用野生型C57BL/6小鼠及與其同品系的β1/β2-AR雙敲小鼠,各24只,雄性,體質(zhì)量18-25g。C57BL/6小鼠隨機(jī)分為三組：對(duì)照組(Control組)、游泳游泳疲勞組(疲勞組,Fatigue組)和電針組(EA組),每組各8只。Control組不給予任何處理；Fatigue組只給予游泳疲勞運(yùn)動(dòng),不做其他處理；EA組將小鼠放入自制的黑色鼠套后電針雙側(cè)“內(nèi)關(guān)”30min(電針參數(shù)：強(qiáng)度0.5mA,頻率2Hz),連續(xù)7天。β1/β2-AR雙敲小鼠的處理方法同上。本實(shí)驗(yàn)部分通過游泳疲勞運(yùn)動(dòng)模型來觀察電針“內(nèi)關(guān)”穴改善游泳疲勞誘發(fā)的心肌缺血效應(yīng),并引用β1/β2-AR敲除小鼠來進(jìn)一步觀察p-AR是否參與介導(dǎo)了電針“內(nèi)關(guān)”穴改善缺血性心肌損傷的針刺效應(yīng)。 實(shí)驗(yàn)結(jié)果： 1.p-腎上腺素能受體介導(dǎo)電針抗大鼠急性心肌缺血的機(jī)制研究 1.1電針“內(nèi)關(guān)”穴對(duì)急性心肌缺血大鼠心電圖ST段幅值的影響 大鼠急性心肌缺血造模前,NC、Model、EA和EAP組ST段幅值均正常,四組之間沒有顯著的統(tǒng)計(jì)學(xué)差異(P0.05)。經(jīng)3天干預(yù)后,除NC組與Baseline比較無明顯變化外,Model組心電圖ST段幅值有明顯的抬高(P0.01),說明造模較成功。EA組在經(jīng)過3天的電針干預(yù)后其心電圖ST段幅值基本接近于正常,與Model組比較有明顯的降低(P0.01),而EAP組在經(jīng)過3天的電針干預(yù)后ST段幅值與Model組比較無統(tǒng)計(jì)學(xué)差異(P0.05),與Baseline和EA組比較均有明顯抬高(P0.01)。 1.2電針“內(nèi)關(guān)”穴對(duì)急性心肌缺血大鼠心律失常評(píng)分的影響 在急性心肌缺血造模前,NC、Model、EA和EAP組各組大鼠心律失常評(píng)分均為O。經(jīng)3天干預(yù)后,除NC組與Baseline比較無變化外,Model組出現(xiàn)了明顯的房性／室性心律失常(P0.01)。而EA組經(jīng)過3天的電針干預(yù)后,心律失常評(píng)分與Model組比較明顯降低(P0.05),而EAP組在經(jīng)過3天的電針干預(yù)后心律失常評(píng)分與Model組比較無統(tǒng)計(jì)學(xué)差異(P0.05),與Baseline和EA組比較均有顯著性差異(P0.05,P0.01)。 1.3電針“內(nèi)關(guān)”穴對(duì)急性心肌缺血大鼠心肌梗塞面積的影響 造模前,各組大鼠心肌梗塞面積均為0。經(jīng)過3天干預(yù)后,與NC組比較,Model組和EAP組心肌梗塞面積均明顯增加(P0.01)。在而經(jīng)過3天電針干預(yù)后,EA組心肌梗塞面積明顯低于與Model和EAP組(P0.01)。 2、β-腎上腺素能受體介導(dǎo)電針抗小鼠游泳疲勞的機(jī)制研究 2.1電針“內(nèi)關(guān)”穴對(duì)游泳疲勞C57BL/6小鼠各項(xiàng)指標(biāo)的影響 Control組在Baseline.干預(yù)第1天至第7天后心電圖ST段幅值、心率和心律失常評(píng)分均未見明顯的改變。游泳疲勞運(yùn)動(dòng)后,Fatigue組和EA組小鼠均出現(xiàn)心電圖ST段幅值抬高、心率減慢和心律失常評(píng)分增加等急性心肌缺血的征象,各項(xiàng)指標(biāo)與相應(yīng)的Baseline比較,均有明顯的統(tǒng)計(jì)學(xué)差異(P0.01),經(jīng)過7天的干預(yù)后,Fatigue組ST段幅值、心率和心律失常評(píng)分均沒有變化,無統(tǒng)計(jì)學(xué)差異(P0.05),而EA組在經(jīng)過7天的電針“內(nèi)關(guān)”穴干預(yù)后,上述指標(biāo)除心率沒有變化外,其他均基本接近于正常水平,與Fatigue組比較有明顯的改善(P0.01)。 2.2電針“內(nèi)關(guān)”穴對(duì)游泳疲勞β1/β2-AR敲除小鼠各項(xiàng)指標(biāo)的影響 Control組在Baseline、第1天至第7天后心電圖ST段、心率和心律失常評(píng)分均未見明顯的改變。游泳疲勞運(yùn)動(dòng)后,Fatigue組和EA組小鼠均出現(xiàn)心電圖ST段幅值抬高、心率減慢和心律失常評(píng)分增加,與Baseline比較,均有明顯的統(tǒng)計(jì)學(xué)差異(P0.01),經(jīng)過7天的干預(yù)后,EA組與Fatigue組比較,ST段幅值、心率和心律失常評(píng)分均沒有變化,無統(tǒng)計(jì)學(xué)差異(P0.05)。 實(shí)驗(yàn)結(jié)論： 電針“內(nèi)關(guān)”穴可以有效地改善急性心肌缺血大鼠引起的心電圖ST段幅值的抬高、心律失常評(píng)分增加和心肌梗塞面積的擴(kuò)大；另一方面,電針“內(nèi)關(guān)”穴亦可以改善由游泳疲勞小鼠誘發(fā)的心電圖ST段幅值的異常抬高以及心律失常的發(fā)生。而電針干預(yù)前應(yīng)用β-AR阻斷劑或敲除β-AR后,電針干預(yù)改善心肌缺血的效應(yīng)亦被阻斷。以上結(jié)果表明：電針“內(nèi)關(guān)”穴可以有效地改善心肌缺血征象,且β-AR參與介導(dǎo)了上述針刺效應(yīng)。
[Abstract]:Myocardial ischemic disease, which belongs to the category of "chest pain", "heartpain" and "syncope" in traditional Chinese medicine. With the remarkable improvement of people's living standard, myocardial ischemic disease has become one of the diseases with high morbidity and mortality all over the world. It is a serious threat to human health and life. In addition to the classical traditional anticoagulant crowns, and the subsequent development of the scaffolding, there are still few other methods to prevent and cure myocardial ischemia, and the incidence and mortality of the disease still remain high. For a simple, simple, effective means of prevention and treatment, there is a record of "chest Bi" and "heart pain" in acupuncture treatment of "chest Bi" and "heart pain". A large number of ancient literature, clinical experience and modern research all show that acupuncture has a more precise protective effect on ischemic myocardium, such as relieving angina pectoris and chest tightness in patients with coronary heart disease. It can improve the function of ECG-ST-T and left heart and so on. Therefore, it is of important clinical significance and value to find the way to improve the effect of acupuncture on ischemic injury of myocardium. It will also help to provide a scientific basis for the improvement of coronary heart disease of coronary heart disease.
Studies have shown that the excessive activation of sympathetic and cardiac adrenergic receptors in acute myocardial ischemia leads to intracellular calcium overload and leads to myocardial ischemic injury. Previous studies on acupuncture and moxibustion have shown that the effect of acupuncture can improve the myocardial ischemia injury by affecting the excitability of the sympathetic nervous system. It is well known that the main target receptor of the sympathetic nerve is the p- adrenergic receptor (beta -AR), and that beta -AR is also the most important receptor in the heart. The regulation and control of the sympathetic nerve to the heart is accomplished mainly through p-AR. Thus, the effect of the acupuncture effect is very likely to be further affected by the cardiac sympathetic nervous system. The target receptor p- adrenergic receptor acting on the sympathetic nervous system eventually plays an important role in improving ischemic myocardial damage.
Objective:
In this study, a rat model of acute myocardial ischemia with a left anterior descending coronary artery and a swimming fatigue model in mice were used to observe the protective effect of electroacupuncture Neiguan on the ischemic myocardium, and further explore the mechanism of p-AR mediated the improvement of ischemic myocardium by Electroacupuncture at Neiguan point. For clinical guidance and theoretical basis.
Experimental methods:
1. the first part of the experiment: 32 male adult Wistar rats and 235 + 15g. rats were randomly divided into four groups: normal group (group NC), model group (group Model), electroacupuncture group (group EA) and propranolol group (group EAP), each group of 8.Model, EA and EAP group underwent coronary artery ligation after anesthesia, and the whole course record of lead electrocardiogram in.NC group was not done. The other treatment of.EA group was 30min (Electroacupuncture Parameters: 3mA, frequency 20Hz) after each anaesthesia. Group EAP was injected with p-AR blocker, 10mg/kg, 15min and Electroacupuncture of "Neiguan" for 3 days after anesthesia. The amplitude of ST segment, arrhythmia score and myocardial infarction area were observed. To clarify the effect of electroacupuncture at "Neiguan" on improving ischemic myocardial injury, and to explore whether p-AR participates in the above-mentioned acupuncture effect.
2. the second part of the experiment: the wild type C57BL/6 mice and the same strain of beta 1/ beta 2-AR double knockout mice, each 24, male, body mass 18-25g.C57BL/6 mice were randomly divided into three groups: the control group (Control group), swimming and swimming fatigue group (fatigue group, Fatigue group) and Electroacupuncture group (EA group), each group of 8.Control groups did not give any treatment; Fatig In group UE, only swimming fatigue was given and no other treatment was done. In group EA, the mice were put into the self-made black rat sleeve after the Electroacupuncture of the bilateral "Neiguan" 30min (Electroacupuncture Parameters: intensity 0.5mA, frequency 2Hz) for 7 days. The treatment method of beta 1/ beta 2-AR double knockout mice was the same. The effect of myocardial ischemia induced by good swimming fatigue, and using beta 1/ beta 2-AR knockout mice to further observe whether p-AR is involved in mediating the acupuncture effect of electroacupuncture "Neiguan" on the improvement of ischemic myocardial injury.
Experimental results:
Mechanism of 1.p- adrenergic receptor mediated Electroacupuncture against acute myocardial ischemia in rats
1.1 effect of electroacupuncture at "Neiguan" point on ST segment amplitude of electrocardiogram in rats with acute myocardial ischemia
Before the model of acute myocardial ischemia in rats, the amplitude of ST segment in NC, Model, EA and EAP groups were all normal. There was no significant difference between the four groups (P0.05). After 3 days of dry prognosis, the amplitude of ST segment in the Model group was obviously elevated (P0.01) except the NC group and Baseline, which showed that the prognosis of the model was more successful after 3 days of electroacupuncture. The amplitude of the ST segment of the electrocardiogram was basically close to the normal, compared with the Model group (P0.01), while the ST segment amplitude in the EAP group after 3 days of electroacupuncture was not significantly different from that in the Model group (P0.05), and there was a significant elevation compared with the Baseline and the EA group (P0.01).
1.2 effect of electroacupuncture at "Neiguan" point on arrhythmia score in rats with acute myocardial ischemia
Before the model of acute myocardial ischemia, the arrhythmia scores of NC, Model, EA and EAP groups were all O. after 3 days of dry prognosis. Except the NC group and Baseline, the Model group had obvious atrial / ventricular arrhythmia (P0.01). While the EA group after 3 days of electroacupuncture, the arrhythmia score was significantly lower than the Model group (P0.05). There was no significant difference in arrhythmia score between group EAP and Model group after 3 days of electroacupuncture intervention (P0.05), and there was significant difference compared with group Baseline and EA (P0.05, P0.01).
1.3 effect of electroacupuncture at "Neiguan" point on myocardial infarction area in rats with acute myocardial ischemia
The infarct area of all rats in each group was 0. after 3 days of dry prognosis. Compared with the NC group, the area of myocardial infarction in group Model and EAP increased significantly (P0.01). After 3 days of electrical acupuncture, the area of myocardial infarction in group EA was significantly lower than that in group Model and EAP (P0.01).
Mechanism of 2, beta adrenergic receptor mediated Electroacupuncture against swimming fatigue in mice
2.1 effect of electroacupuncture at Neiguan on various indexes of swimming fatigue C57BL/6 mice
In group Control, the amplitude of ST segment of electrocardiogram, heart rate and arrhythmia score were not significantly changed after Baseline. intervention first days to seventh days. After swimming fatigue, all Fatigue and EA group mice had the signs of acute myocardial ischemia, such as ST segment elevation, heart rate slowing and arrhythmia score, and the corresponding Ba Compared with Seline, there were significant statistical differences (P0.01). After 7 days of prognosis, the amplitude of ST segment, heart rate and arrhythmia score of group Fatigue did not change, and there was no statistical difference (P0.05), but in group EA, after 7 days of electroacupuncture "Neiguan" point, the above indexes were basically close to the normal level except the heart rate, and the other were almost the same as Fa. There was a significant improvement in group tigue (P0.01).
2.2 effects of electroacupuncture at Neiguan on the indexes of swimming fatigue 1/ 2-AR mice
Control group had no significant changes in heart rate and arrhythmia score at Baseline, first days to seventh days, heart rate and arrhythmia score. After swimming fatigue, the ST segment elevation, heart rate slowing and arrhythmia score increased in both Fatigue and EA groups. There were significant statistical differences (P0.01) after 7 days, compared with the Baseline ratio (P0.01). After intervention, there was no significant difference in the amplitude of ST segment, heart rate and arrhythmia score between group EA and group Fatigue (P0.05).
Experimental conclusions:
Electroacupuncture of "Neiguan" point can effectively improve the elevation of the amplitude of ST segment of ECG induced by acute myocardial ischemia in rats, increase the score of arrhythmia and enlarge the area of myocardial infarction. On the other hand, the electroacupuncture "Neiguan" point can also improve the abnormal elevation of the amplitude of the ST segment of electrocardiogram induced by the swimming fatigue mice and the arrhythmia. The effect of electroacupuncture intervention to improve myocardial ischemia was also blocked before using the beta -AR blocker or knockout beta -AR before electroacupuncture intervention. The results showed that the electroacupuncture "Neiguan" point could effectively improve the myocardial ischemia signs, and the beta -AR was involved in mediating the above acupuncture effect.
【學(xué)位授予單位】：北京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R245

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王賢嫻;張磊;;胸痹貼穴位貼敷治療冠心病心絞痛40例療效觀察[J];長(zhǎng)春中醫(yī)藥大學(xué)學(xué)報(bào);2011年01期

2 張慧;;藥物穴位注射對(duì)冠心病ST-T段的即時(shí)影響[J];臨床醫(yī)學(xué);2007年08期

3 林芳;徐珊寧;;溫和灸加淺針治療心肌缺血60例[J];福建中醫(yī)學(xué)院學(xué)報(bào);2008年01期

4 孫忠人;王一茗;張小軍;;針刺預(yù)處理對(duì)心肌缺血大鼠HSP70的影響[J];甘肅中醫(yī);2008年08期

5 童利民;陸小平;代燕;童延華;黃富強(qiáng);;電針配合西藥對(duì)冠心病心絞痛患者血清超氧化物歧化酶與丙二醛含量的影響[J];湖北中醫(yī)雜志;2005年12期

6 李小偉;;中西醫(yī)結(jié)合治療不穩(wěn)定型心絞痛30例總結(jié)[J];中醫(yī)藥導(dǎo)報(bào);2009年02期

7 黃潔,嚴(yán)潔,常小榮,王超,易受鄉(xiāng),林亞平;電針內(nèi)關(guān)穴治療穩(wěn)定型心絞痛40例臨床觀察[J];湖南中醫(yī)學(xué)院學(xué)報(bào);2004年02期

8 吳寶慶;劉磊;;瓜蔞薤白半夏湯加味和溫針灸治療胸痹26例[J];中外醫(yī)療;2007年18期

9 劉強(qiáng),楊琳,李振華,路鋼,孫晉浩;大鼠心臟與內(nèi)關(guān)穴區(qū)神經(jīng)投射同源關(guān)系的非熒光雙標(biāo)記示蹤[J];解剖學(xué)雜志;2002年01期

10 史明儀,孫曉寧,顧吉林;內(nèi)關(guān)穴注射硝酸甘油治療心肌缺血的臨床觀察[J];遼寧中醫(yī)雜志;2002年05期

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