刮痧联合中药热熨疗法治疗痰瘀互结证晨峰血压的临床疗效研究
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摘要
背景刮痧联合中药热熨疗法,通过医护结合,从整体调节患者气血,促进机体阴阳平衡,或可对控制晨峰血压(MBPS)起到较好的效果。目的探讨刮痧联合中药热熨疗法治疗痰瘀互结证MBPS的临床疗效。方法选取2017-06-01至2018-04-01在浙江中医药大学附属第二医院老年病区和脊柱病区住院治疗的MBPS阳性患者90例,采用随机数字法分为试验组和对照组,各45例。对照组每日服用苯磺酸氨氯地平片5 mg;试验组在对照组的基础上每周二、四、六晨起行刮痧,每晚睡前行中药热熨疗法。两组分别于治疗前及治疗1、2、3周后进行动态血压监测,记录晨起2 h收缩压(SBP)和舒张压(DBP)与夜间最低血压的差值,以及中医证候积分。结果两组晨起2 h SBP、DBP与夜间最低血压的差值比较,差异有统计学意义(P<0.05);不同时间点比较,差异有统计学意义(P Background Comprehensive regulation of the qi-blood to promote yin-yang balance by a kind of medical intervention of scrapping combined with Chinese herbal hot compress therapies and nursing services,may produce good effect on controlling increased morning blood pressure surge(MBPS).Objective To explore the effect of scrapping combined with Chinese herbal hot compress therapies on the difference between peak morning systolic blood pressure(SBP) and nocturnal sleep-time SBP,difference between peak morning diastolic blood pressure(DBP) and nocturnal sleep-time DBP,incidence of increased MBPS and clinical TCM syndrome in patients with intermingled phlegm-blood stasis syndrome.Methods We enrolled 90 hospitalized patients from Department of Geriatrics and Department of Spine Diseases of the Second Affiliated Hospital of Zhejiang Chinese Medical University from June 1,2017 to April 1,2018.They were equally divided into the control group and experimental group by the random number table,receiving once-daily oral administration of amlodipine besylate tablets 5 mg,once-daily oral administration of amlodipine besylate tablets 5 mg combined with scrapping therapy(on every Tuesday,Thursday and Saturday mornings) and Chinese herbal hot compress therapy before going to bed every day.Ambulatory blood pressure monitoring was performed before treatment and at the end of the 1 st,2 nd and 3 rd weeks of treatment.The difference between peak morning SBP and nocturnal sleep-time SBP,difference between peak morning DBP and nocturnal sleep-time DBP,and clinical TCM syndrome were recorded.Results The mean difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP differed significantly between two groups(P<0.05).The difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP between the groups varied significantly by time point(P<0.05).Treatment regimen and duration had interactive effects on the difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP(P<0.05).The experimental group showed lower incidence of increased MBPS at the end of the 1 st,2 nd and 3 rd weeks of treatment compared with the control group(P<0.05).The mean TCM syndrome score varied significantly between the groups(P<0.05).The TCM syndrome score differed significantly between the groups by time point(P<0.05).Treatment regimen and duration had interactive effects on the TCM syndrome score(P<0.05).Conclusion For patients with intermingled phlegm-blood stasis syndrome and increased MBPS,oral administration of amlodipine besylate tablets in combination with scrapping and Chinese herbal hot compress therapies can significantly reduce the blood pressure,and decrease the incidence of increased MBPS as well as improve the clinical TCM syndrome.
引文
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[2]华琦,范利,李静,等.老年人异常血压波动临床诊疗中国专家共识[J].中国心血管杂志,2017,22(1):1-6.DOI:10.3969/j.issn.1007-5410.2017.01.001.HUA Q,FAN L,LI J,et al.Chinese expert consensus on the diagnosis and treatment of abnormal blood pressure fluctuation in the elderly[J].Chinese Journal of Cardiovascular Medicine,2017,22(1):1-6.DOI:10.3969/j.issn.1007-5410.2017.01.001.
[3]RIPLEY T L,BAUMERT M.Controversies among the hypertension guidelines[J].J Pharm Pract,2016,29(1):5-14.DOI:10.1177/0897190015615879.
[4]DAVIS L L.Hypertension guidelines:evidence-based treatments for maintaining blood pressure control[J].Nurse Practitioner,2015,40(6):32-37.DOI:10.1097/01.NPR.0000465116.19783.a7.
[5]XIE J C,YAN H,ZHAO Y X,et al.Prognostic value of morning blood pressure surge in clinical events:a meta-analysis of longitudinal studies[J].J Stroke Cerebrovasc Dis,2015,24(2):362-369.DOI:10.1016/j.jstrokecerebrovasdis.2014.09.001.
[6]王欢,胡元会,杜柏,等.单纯收缩压期高血压痰瘀互结证病人红细胞计数、血脂的分析[J].中西医结合心脑血管病杂志,2017,15(12):1474-1476.DOI:10.3969/j.issn.1672-1349.2017.12.015.WANG H,HU Y H,DU B,et al.Analysis of erythrocyte parameters and bood lipids in patients with isolated systolic hypertension and phlegm and blood stasis syndrome[J].Chinese Journal of Integrative Medicine on Cardio-/Cerebrovascular Disease,2017,15(12):1474-1476.DOI:10.3969/j.issn.1672-1349.2017.12.015.
[7]张国娣,郭巧英,陶晓虹,等.中医护理效果量化管理的实践[J].医院管理论坛,2015,32(10):41-44.ZHANG G D,GUO Q Y,TAO X H,et al.Practice of quantifying TCM nursing effect[J].Hospital Management Forum,2015,32(10):41-44.
[8]FUJIWARA T,TOMITANI N,SATO K,et al.The relationship between a blunted morning surge and reversed nocturnal blood pressure dipping or"riser"pattern[J].J Clin Hypertens(Greenwich),2017,19:1-7.DOI:10.1111/JCH.13087.
[9]PIERDOMENICO S D,PIERDOMENICO A M,COCCINA F,et al.Circadi an blood pressure changes and cardiovascular risk in elderly-treated hypertensive patients[J].Hypertens Res,2016,39(11):805-811.DOI:10.1038/HR.2016.74.
[10]胡文静,刘红霞,王娟,等.老年高血压患者收缩压晨峰与脑白质损害的相关性[J].中华老年心脑血管病杂志,2018,20(3):268-270.HU W J,LIU H X,WANG J,et al.Association between morning surge of systolic blood pr essure and white matter lesions in elderly hypertensive patients[J].Chin J Geriatr Heart Brain Vessel Dis,2018,20(3):268-270.
[11]魏叶红,徐敏,陈旭锋.循经拍打联合中药穴位外敷对晨峰血压的干预研究[J].中国全科医学,2017,20(3):337-341.DOI:10.3969/j.issn.1007-9572.2017.03.014.WEI Y H,XU M,CHEN X F.Intervention study of flappingmeridians combined with Chinese traditional medicine point plaster on morning blood pressure surge[J].Chinese General Practice,2017,20(3):337-341.DOI:10.3969/j.issn.1007-9572.2017.03.014.
[12]刘海华,刘朝,王莹莹,等.刮痧对原发性高血压降压作用的时效规律研究[J].中国针灸,2015,35(7):711-714.DOI:10.13703/j.0255-2930.2015.07.022.LIU H H,LIU C,WANG Y Y,et al.Aging law on anti-hypertensive effect of scrapping therapy on primary hypertension[J].Chinese Acupunctuer,2015,35(7):711-714.DOI:10.13703/j.0255-2930.2015.07.022.