發(fā)布時間：2018-10-21 17:43

【摘要】：目的:通過針刺急性期腦梗死患者的左側太溪穴,記錄針刺過程中不同時間段患者心率變異性的各項指標(BPM、SDNN、RMSSD、TP、LF、HF、HF%、LF%、logLF/HF)的相應變化,觀察其對患者心率變異性的影響,探討針刺左側太溪穴對腦梗死急性期患者自主神經(jīng)功能的影響,為臨床運用針刺治療腦梗死后自主神經(jīng)功能失調提供依據(jù)。方法:隨機選取45-80歲之間腦梗死急性期患者30名(男患18名,女患12名),平均年齡63.8±7.6歲,平均病程10.33±2.71天。針刺受試者的左側太溪穴,使用medilog(?)AR12動態(tài)心電記錄儀監(jiān)測心率變異性指標,記錄針刺太溪穴前5 min、針刺得氣時、行針時(針刺10 min)、出針時(針刺20 min)、出針后5分鐘5個時間點的心率變異性定量指標BPM、SDNN、RMSSD、TP、LF、HF、HF%、LF%、log LF/HF。將所得數(shù)據(jù)采用SPSS17.0軟件進行統(tǒng)計學分析,計量資料采用均數(shù)土標準差(X±S)表示,對針刺前、進針時、行針時、出針時及出針后5min五個時間點觀察HRV的變化并進行統(tǒng)計分析,其中符合正態(tài)分布的數(shù)據(jù)統(tǒng)計方法采取重復測量數(shù)據(jù)方差分析,不符合正態(tài)分布的需經(jīng)過數(shù)學轉換,轉換符合正態(tài)分布后的數(shù)據(jù)再采取重復測量數(shù)據(jù)方差分析。首先進行Mauchly' s球形檢驗,若P0.05,則采用一般線性模型下的重復測量數(shù)據(jù)單因素方差分析,若P0.05,不滿足球對稱條件,對自由度進行校正,采用Greenhouse-Geisser校正系數(shù)。各時間點HRV各指標間的比較應用Bonferroni法,以P0.05為有統(tǒng)計學意義。結果:1.針刺腦梗死急性期患者左側太溪穴對HRV平均心率的影響:在進針時、行針時、出針時、出針后5min與針刺前比較數(shù)值變化不明顯(P0.05)。2.針刺腦梗死急性期患者左側太溪穴對HRV時域指標的影響:RMSSD、SDNN在進針時、行針時、出針時、出針后5min與針刺前比較數(shù)值變化不明顯(P0.05)。3.針刺腦梗死急性期患者左側太溪穴對HRV頻域指標的影響:(1)TP在出針后5mmin與針刺前比較變化顯著(P0.01),而在進針時、行針時、出針時與針刺前相比無顯著變化(P0.05);(2)HF在進針時、行針時、出針時、出針后5mmin與針刺前相比顯著降低(P0.01);(3)LF在進針時、行針時、出針時、出針后5min與針刺前比較數(shù)值下降明顯(P0.01);(4)HF%在進針時、行針時、出針時、出針后5min與針刺前比較顯著降低(P0.01);(5)LF%在進針時、行針時、出針后5min與針刺前比較無顯著變化(P0.05),而出針時與針刺前比較有顯著變化(P0.05);(6)LogLF/HF在進針時、行針時、出針時、出針后5min與針刺前比較顯著升高(P0.01)。結論:1.針刺左側太溪穴對腦梗死急性期患者總的心率變異性影響不顯著。2.針刺左側太溪穴對腦梗死急性期患者的迷走神經(jīng)活性有抑制作用,對交感神經(jīng)活性有興奮作用。
[Abstract]:Objective: to observe the effect of acupuncture on heart rate variability (BPM,SDNN,RMSSD,TP,LF,HF,HF%,LF%,logLF/HF) in patients with acute cerebral infarction by recording the changes of heart rate variability (BPM,SDNN,RMSSD,TP,LF,HF,HF%,LF%,logLF/HF) in different periods of acupuncture. To explore the effect of acupuncture at left Taixi point on autonomic nervous function in patients with acute cerebral infarction, and to provide evidence for clinical treatment of autonomic nervous dysfunction after cerebral infarction. Methods: 30 patients (18 males and 12 females) with mean age of 63.8 鹵7.6 years and average course of disease of 10.33 鹵2.71 days were randomly selected from 45 to 80 years old patients in acute stage of cerebral infarction (18 males and 12 females). At the left side of Taixi point, the heart rate variability was monitored by medilog (?) AR12 dynamic ECG recorder, and the QI was recorded 5 min, before acupuncture at Taixi point. Heart rate variability quantitative Index BPM,SDNN,RMSSD,TP,LF,HF,HF%,LF%,log LF/HF. at 5 minutes 5 minutes after Acupuncture for 10 min), (20 min), after Acupuncture) The data were analyzed statistically by SPSS17.0 software, and the measured data were expressed by the mean soil standard deviation (X 鹵S). The changes of HRV were observed and analyzed at five time points: before acupuncture, when needle entry, when needle was carried out, when needle was out and after injection, the changes of HRV were observed and analyzed statistically. The statistical method of data in accordance with the normal distribution adopts the analysis of variance of the repeated measurement data, and the data that does not conform to the normal distribution need to go through the mathematical transformation, and the data after the conversion accords with the normal distribution and then adopts the analysis of variance of the repeated measurement data. First, Mauchly' s spherical test is carried out. If P0.05, the single factor ANOVA of repeated measurement data under general linear model is used. If P0.05 is not satisfied with soccer symmetry condition, the degree of freedom is corrected and the Greenhouse-Geisser correction coefficient is adopted. Bonferroni method was used to compare the indexes of HRV at each time point, with P0.05 as the statistical significance. The result is 1: 1. Effect of Acupuncture at left Taixi Point on mean Heart rate of HRV in patients with Acute Cerebral Infarction: there was no significant change in 5min after acupuncture and acupuncture before acupuncture (P0.05). Effect of Acupuncture on the time Domain Indexes of HRV in patients with Acute Cerebral Infarction: the changes of 5min after acupuncture were not significant (P0.05). The effect of acupuncture on the frequency domain of HRV in patients with acute cerebral infarction: (1) the changes of 5mmin in TP after acupuncture were significant compared with those before acupuncture (P0.01), while in acupuncture, there was no significant change between acupuncture and acupuncture (P0.05); (2). When the needle was out, the 5mmin was significantly lower (P0.01); (3) LF after the acupuncture than before the acupuncture. When the needle was in, the value of the 5min after the acupuncture was significantly decreased (P0.01); (4) HF% when the needle was in, when the needle was running, and when the needle was out, when the needle was in, and when the needle was out, there was a significant decrease in the value of (P0.01); (4) HF% when the needle was taken out. 5min after acupuncture was significantly lower than that before acupuncture (P0. 01); (5) LF% was not significantly changed after needle injection (P0. 01); (5), 5min after acupuncture had no significant change compared with that before acupuncture (P0.05), but there were significant changes (P0.05); (6) when LogLF/HF was in needle, when needle was used and when needle was out when out of needle, there was no significant difference between 5min and acupuncture before acupuncture (P0. 01); (6). The 5min after acupuncture was significantly higher than that before acupuncture (P0.01). Conclusion: 1. Acupuncture at left side of Taixi point had no significant effect on total heart rate variability in patients with acute cerebral infarction. 2. Acupuncture at left side of Taixi point can inhibit vagus nerve activity and stimulate sympathetic nerve activity in patients with acute cerebral infarction.
【學位授予單位】：黑龍江中醫(yī)藥大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R246.6

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本文編號：2285872