本文關(guān)鍵詞：循經(jīng)取穴治療慢性穩(wěn)定性心絞痛的療效評價及HRV相關(guān)機理研究　出處：《成都中醫(yī)藥大學(xué)》2016年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 針刺 慢性穩(wěn)定性心絞痛 循經(jīng)取穴 隨機對照試驗 心率變異性

【摘要】：目的：評價循經(jīng)取穴治療慢性穩(wěn)定性心絞痛(chronic stable angina pectoris, CSAP)的臨床療效,探索循經(jīng)取穴治療CSAP的心率變異性(heart rate variability, HRV)相關(guān)自主神經(jīng)調(diào)節(jié)作用,為循經(jīng)取穴治療CSAP的臨床運用提供科學(xué)的試驗依據(jù)。方法：1.采用多中心、隨機、對照的研究方法,通過中央隨機系統(tǒng)將符合納入標(biāo)準(zhǔn)的404例CSAP受試者隨機分為循經(jīng)取穴組(A組)、他經(jīng)取穴組(B組)、非經(jīng)非穴組(C組)、等待治療組(D組)。A組針刺手少陰心經(jīng)的通里、手厥陰心包經(jīng)的內(nèi)關(guān)；B組針刺手太陰肺經(jīng)的孔最及太淵；C組針刺兩個非穴點。在研究期間內(nèi)D組不進行針刺干預(yù)。四組均給予基礎(chǔ)治療,選取穴位采取仰臥位,雙側(cè)取穴,隔日針刺1次,每次治療30min,每周3次,共治療4周。分別在入組0周、4周、8周、12周和16周時評價心絞痛情況。以4周內(nèi)心絞痛發(fā)作次數(shù)為主要療效指標(biāo),次要療效指標(biāo)包括心絞痛發(fā)作次數(shù)改善值、視覺模擬評分(visual analogue scale, VAS)、西雅圖心絞痛量表(seattle anginaquestionnaire,SAQ)評分、硝酸甘油用量、Zung抑郁自評量表(self-rating depression scale,SDS)及焦慮自評量表(self-rating anxiety scale,SAS)評分等指標(biāo)。2.受試者干預(yù)措施與上述試驗一致。運用24小時動態(tài)心電圖分析技術(shù),在治療前后(前后間隔4周)檢測受試者HRV的SDNN-24小時、SDNN Index、 SDANN Index、rMSSD、pNN50、頻域功率-24小時、最小頻域功率小時、最大頻域功率小時等指標(biāo),以了解針刺循經(jīng)取穴與非循經(jīng)、非經(jīng)非穴和等待治療對心臟自主神經(jīng)功能的影響。結(jié)果：1.循經(jīng)取穴治療CSAP的臨床療效評價結(jié)果(1)在主要療效指標(biāo)方面,A組(入組4周、8周、12周、16周)、B組(入組4周、8周、12周、16周)、C組(入組4周)三組的心絞痛發(fā)作次數(shù)與D組相應(yīng)時間點比顯著減少(P0.05)。A組(入組8周、12周、16周)心絞痛發(fā)作次數(shù)與B組、C組相應(yīng)時間點比顯著減少(P0.05)。而B組與C組在心絞痛發(fā)作次數(shù)方面的臨床效應(yīng)無差別(P0.05)。(2)在次要療效指標(biāo)方面,A組(入組4周、8周、12周、16周)、B組(入組4周、8周)、C組(單一訪視時間評價點)三組的西雅圖心絞痛量表(SAQ)的二個維度即心絞痛發(fā)作情況(anginal frequency, AF)、治療滿意程度(treatment satisfaction,TS)指標(biāo)均與D組相應(yīng)時間點比顯著改善(P0.05)。A組(入組12周、16周)在心絞痛發(fā)作次數(shù)改善值、VAS評分、西雅圖心絞痛量表(SAQ)的三個維度即心絞痛發(fā)作情況(AF)、心絞痛穩(wěn)定狀態(tài)(anginal stability, AS)、治療滿意程度(TS)和SAQ總分與B組、C組相應(yīng)時間點比顯著改善(P0.05)；而B組與C組臨床效應(yīng)無差別(P0.05)。在SAS評分、SDS評分、硝酸甘油用量方面,四組療效差異無統(tǒng)計學(xué)意義(P0.05),但呈現(xiàn)A組B組C組、D組趨勢。(3)在安全性分析方面, D組1例受試者死于急性心肌梗死,其中死亡病例肯定與針刺無關(guān)。除此之外,整個研究中未出現(xiàn)嚴(yán)重不良事件。各組生命體征治療前后及組間比較均無統(tǒng)計學(xué)意義(P0.05)。2.循經(jīng)取穴治療CSAP的HRV相關(guān)機理研究結(jié)果經(jīng)治療后,A組和B組在SDNN Index指標(biāo)上,分別與D組相比均顯著增高(P0.05)。其余各組間兩兩比較HRV指標(biāo)差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論：1.循經(jīng)取穴、他經(jīng)取穴及非經(jīng)非穴針刺治療CSAP臨床效應(yīng)在減少心絞痛發(fā)作次數(shù)、提高患者治療滿意度方面均優(yōu)于等待治療組。針刺結(jié)合基礎(chǔ)藥物治療CSAP安全、有效。2.循經(jīng)取穴針刺治療CSAP在改善心絞痛癥狀、提高生活質(zhì)量方面明顯優(yōu)于他經(jīng)取穴組及非經(jīng)非穴組,并可改善心絞痛受試者情緒和減少心絞痛發(fā)作時急救藥物用量。循經(jīng)取穴治療效應(yīng)優(yōu)于他經(jīng)取穴及非經(jīng)非穴,具有持續(xù)性特點。3.循經(jīng)取穴與他經(jīng)取穴組的HRV明顯高于等待治療組。針刺經(jīng)穴可能對心臟自主神經(jīng)功能調(diào)節(jié)有益,使CSAP患者預(yù)后趨優(yōu),但仍需要進一步的研究證實。
[Abstract]:Objective: To evaluate the acupoint treatment of chronic stable angina (chronic stable angina pectoris, CSAP) the clinical curative effect, explore the meridian acupoints in the treatment of heart rate variability of CSAP (heart rate variability, HRV) Regulation of autonomic nerve, for meridian acupoints in the treatment of clinical application of CSAP provide scientific experimental basis. Methods: 1. multicenter, randomized, controlled study method, through the central randomization system will meet the inclusion criteria of 404 cases of CSAP were randomly divided into acupoint group (A group), he acupoint group (B group), non acupoint group (C group), waiting for treatment group (group D).A group of acupuncture on heart meridian, pericardium meridian point; acupuncture group B lung meridian hole and Taiyuan; group C two acupuncture non acupoint. During the study period D group without acupuncture intervention. The four groups were given basic treatment. Select the point take supine position, double Side acupoints, acupuncture every other day for 1 times, each time for 30min, 3 times a week, a total of 4 weeks of treatment respectively. In 0 weeks, 4 weeks, 8 weeks, 12 cases of angina pectoris and 16 weeks to 4 weeks. The evaluation of angina within a number of indicators of efficacy, the secondary efficacy parameters including angina pectoris improve the attack frequency value, visual analogue scale (visual analogue scale, VAS) and Seattle Angina Questionnaire (Seattle anginaquestionnaire SAQ) score, dosage of nitroglycerin, Zung self rating Depression Scale (self-rating depression scale, SDS) and self rating Anxiety Scale (self-rating anxiety scale, SAS) score index.2. the subjects of intervention measures with the test. By using 24 hour ambulatory electrocardiogram analysis, before and after treatment (before and after an interval of 4 weeks) were determined by HRV SDNN-24 SDNN Index, SDANN h, Index, rMSSD, pNN50, power frequency -24 hours minimum frequency power hour, maximum frequency 鍩熷姛鐜囧皬鏃剁瓑鎸囨爣,浠ヤ簡瑙ｉ拡鍒哄驚緇忓彇絀翠笌闈炲驚緇，

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