“活血散风针刺法”辅助治疗对老年卒中伴高血压患者清晨血压及血压负荷的影响
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摘要
目的:在醒脑开窍针刺法和常规口服硝苯地平的基础上,观察加用"活血散风针刺法"对80岁以上老年卒中伴高血压患者神经肢体功能、血压负荷及清晨血压的影响。方法:将70例卒中伴高血压患者随机分为观察组和对照组,每组35例。对照组采用常规醒脑开窍针刺法加口服硝苯地平控释片。醒脑开窍针刺法主穴为水沟,配以内关、三阴交穴,留针20 min,患侧上极泉、尺泽、委中穴,不留针。硝苯地平控释片每次口服30 mg,每日1次,共治疗6周。观察组加用"活血散风针刺法",以人迎为主穴,配以曲池、合谷、足三里、太冲穴,采用严格的手法量学针刺,留针20 min。两种针刺方法均每日1次,每周治疗5次后,间隔2 d继续治疗,10次为一疗程,共治疗3个疗程,即6周。测量两组患者治疗前后清晨血压、24 h血压负荷,观察治疗前后美国国立卫生研究院卒中量表(National Institute of Health stroke scale,NIHSS)评分及Barthel指数(Barthel index,BI)分级情况。结果:两组治疗后清晨收缩压和舒张压均明显低于治疗前(均P<0.01),且观察组收缩压和舒张压均低于对照组(均P<0.01);两组收缩压治疗前后差值比较差异无统计学意义(P>0.05),观察组舒张压治疗前后差值大于对照组(P<0.01)。两组治疗后收缩压负荷和舒张压负荷均低于治疗前(均P<0.01),且观察组收缩压和舒张压负荷均低于对照组(均P<0.05),观察组收缩压和舒张压负荷治疗前后差值均高于对照组(均P<0.05)。治疗后两组NIHSS评分均低于治疗前(均P<0.01);治疗后,观察组NIHSS评分低于对照组(P<0.05),观察组NIHSS评分治疗前后差值高于对照组(P<0.01)。治疗后,两组BI分级情况均优于治疗前(均P<0.05),且观察组优于对照组(P<0.05)。结论:在醒脑开窍针刺结合硝苯地平控释片治疗老年卒中伴高血压患者的基础上,"活血散风针刺法"可以进一步改善神经及肢体功能,有效降低老年患者清晨血压水平,特别是舒张压,明显改善收缩压负荷和舒张压负荷。
Objective To observe the effects of "Huoxue Sanfeng acupuncture" auxiliary therapy on neurological function, blood pressure load and morning blood pressure in elderly patients with stroke complicated with hypertension,on the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine. Methods Seventy patients with stroke complicated with hypertension were randomly divided into an observation group and a control group, 35 cases in each group. "Xingnao Kaiqiao acupuncture" and conventional nifedipine controlled release tablets were given in the control group. Regarding regaining consciousness with acupuncture, the main acupoint is Shuigou(GV 26), combined with Neiguan(PC 6) and Sanyinjiao(SP 6), retaining needle for 20 min, additionally, the quick needling technique was applied to Shangjiquan(Extra), Chize(LU 5) and Weizhong(BL 40) of the affected side, nifedipine controlled release tablets were orally administered 30 mg once a day for a total of 6 weeks. The "Huoxue Sanfeng acupuncture" was added on the basis treatment in the observation group, the acupuncture was applied at Renying(ST 9) as the main acupoint, combined with Quchi(LI 11), Hegu(LI 4), Zusanli(ST 36) and Taichong(LR 3). The strict manipulation quantitative acupuncture was used and the needle was retained for 20 min. Both acupuncture methods were performed once a day, 5 times a week, and continued treatment at intervals of 2 days, 10 times for one course, and a total of 3 courses were needed. The morning blood pressure and 24 h blood pressure load were measured before and after treatment. The National Institute of Health stroke scale(NIHSS) score and the Barthel index(BI) classification were observed before and after treatment. Results The systolic and diastolic blood pressures were significantly lower than those before treatment in the two groups(all P<0.01), and the systolic and diastolic blood pressures in the observation group were lower than those in the control group(both P<0.01). There was no significant difference between the difference of systolic blood pressure before and after treatment in the two groups(P>0.05),and the difference of the diastolic blood pressure before and after treatment in the observation group was higher than that in the control group(P<0.01). The systolic and diastolic pressures load in the two groups were lower than those before treatment(all P<0.01), and the systolic and diastolic pressures load in the observation group were lower than those in the control group(both P<0.05), the difference of systolic and diastolic pressure load before and after treatment in the observation group were higher than those in the control group(both P<0.05). After treatment, the NIHSS scores in the two groups were lower than those before treatment(both P<0.01). The NIHSS scores in the observation group were lower than those in the control group(P<0.05). The difference of NIHSS scores before and after treatment in the observation group was higher than that in the control group(P<0.01). After treatment, the BI grading was better than that before treatment in the two groups(both P<0.05), and the BI grading in the observation group was superior to that in the control group(P<0.05).Conclusion On the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine controlled release tablets in the treatment of elderly patients with stroke complicated with hypertension, "Huoxue Sanfeng acupuncture" can further improve the function of nerve and limbs, effectively reduce the morning blood pressure level of elderly patients, especially diastolic blood pressure, and significantly improve systolic blood pressure and diastolic blood pressure load.
Objective To observe the effects of "Huoxue Sanfeng acupuncture" auxiliary therapy on neurological function, blood pressure load and morning blood pressure in elderly patients with stroke complicated with hypertension,on the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine. Methods Seventy patients with stroke complicated with hypertension were randomly divided into an observation group and a control group, 35 cases in each group. "Xingnao Kaiqiao acupuncture" and conventional nifedipine controlled release tablets were given in the control group. Regarding regaining consciousness with acupuncture, the main acupoint is Shuigou(GV 26), combined with Neiguan(PC 6) and Sanyinjiao(SP 6), retaining needle for 20 min, additionally, the quick needling technique was applied to Shangjiquan(Extra), Chize(LU 5) and Weizhong(BL 40) of the affected side, nifedipine controlled release tablets were orally administered 30 mg once a day for a total of 6 weeks. The "Huoxue Sanfeng acupuncture" was added on the basis treatment in the observation group, the acupuncture was applied at Renying(ST 9) as the main acupoint, combined with Quchi(LI 11), Hegu(LI 4), Zusanli(ST 36) and Taichong(LR 3). The strict manipulation quantitative acupuncture was used and the needle was retained for 20 min. Both acupuncture methods were performed once a day, 5 times a week, and continued treatment at intervals of 2 days, 10 times for one course, and a total of 3 courses were needed. The morning blood pressure and 24 h blood pressure load were measured before and after treatment. The National Institute of Health stroke scale(NIHSS) score and the Barthel index(BI) classification were observed before and after treatment. Results The systolic and diastolic blood pressures were significantly lower than those before treatment in the two groups(all P<0.01), and the systolic and diastolic blood pressures in the observation group were lower than those in the control group(both P<0.01). There was no significant difference between the difference of systolic blood pressure before and after treatment in the two groups(P>0.05),and the difference of the diastolic blood pressure before and after treatment in the observation group was higher than that in the control group(P<0.01). The systolic and diastolic pressures load in the two groups were lower than those before treatment(all P<0.01), and the systolic and diastolic pressures load in the observation group were lower than those in the control group(both P<0.05), the difference of systolic and diastolic pressure load before and after treatment in the observation group were higher than those in the control group(both P<0.05). After treatment, the NIHSS scores in the two groups were lower than those before treatment(both P<0.01). The NIHSS scores in the observation group were lower than those in the control group(P<0.05). The difference of NIHSS scores before and after treatment in the observation group was higher than that in the control group(P<0.01). After treatment, the BI grading was better than that before treatment in the two groups(both P<0.05), and the BI grading in the observation group was superior to that in the control group(P<0.05).Conclusion On the basis of "Xingnao Kaiqiao acupuncture" combined with nifedipine controlled release tablets in the treatment of elderly patients with stroke complicated with hypertension, "Huoxue Sanfeng acupuncture" can further improve the function of nerve and limbs, effectively reduce the morning blood pressure level of elderly patients, especially diastolic blood pressure, and significantly improve systolic blood pressure and diastolic blood pressure load.
引文
[1]周天银,龚霁,周旋.高血压流行病学特点及老年高血压防治效果观察[J].中西医结合心血管病电子杂志,2016,4(31):107-109.
[2]GBD 2015 Mortality and Causes of Death Collaborators.Global,regional,and national life expectancy,all-cause mortality,and cause-specific mortality for 249 causes of death,1980-2015:a systematic analysis for the global burden of disease study 2015[J].Lancet,2016,388(10053):1459-1544.
[3]Paul A.2014 Evidence-based guideline for the management of high blood pressure in adults.report from the panel members appointed to the eighth Joint National Committee(JNC8)[J].JAMA,2014,311(5):507-520.
[4]中华医学会心血管病学分会高血压组.清晨血压临床管理的中国专家指导建议[J].中华心血管病杂志,2014,42(9):721-725.
[5]寇鹏,石学敏.醒脑开窍法针刺治疗中风疗效回顾及NIHSS量表评价分析[J].山西中医,2015,13(5):41-42,55.
[6]李小峰,陈敏.改良Barthel指数评定量表的设计与应用[J].护理研究,2015,29(13):1657-1658.
[7]沈小梅,张巨艳.清晨高血压的发生机制及防治措施的研究进展[J].中西医结合心脑血管病杂志,2015,13(4):446-448.
[8]肖世南,杨燕云,张海成,等.动态血压负荷对原发性高血压患者左室收缩功能不全的预测价值[J].西北国防医学杂志,2014,35(6):520-523.
[9]贾国栋,宫桂花,孟萍,等.老年高血压患者危险因素分析及其对靶器官损害的影响[J].中华老年心脑血管病杂志,2012,14(1):22-25.
[10]杜宇征.高血压与“活血散风、疏肝健脾”针刺法[J].中华针灸电子杂志,2017,6(3):89-92.
[11]张海,赵红.醒脑开窍针刺法治疗高血压合并中风临床观察[J].上海针灸杂志,2012,31(8):550-552.
[12]康明明,石学敏.针刺治疗原发性高血压病40例疗效观察[J].中华中医药杂志,2013,28(5):1406-1409.
[13]乔波,张春红,石学敏.针刺人迎穴治疗高血压病的近代研究概况[J].吉林中医药,2011,31(6):599-600.
[14]杜宇征,蔡婓.石学敏院士针刺治疗高血压临证经验[J].中国针灸,2013,33(11):1000-1003.
[15]郭琳,赵静,张国栋,等.针刺治疗中风合并高血压疗效观察[J].上海针灸杂志,2011,30(9):624.
[16]袁建,梁庭栋.中医治疗高血压病机理初探[J].中医临床研究,2015,7(34):59-61.
[17]张一颖,杜宇征.中医治疗干预血压变异性的研究进展[J].浙江中医药大学学报,2013,37(7):940-942.
[18]陈宥伊,杜宇征,张春红.人迎穴干预原发性高血压病的研究进展[J].吉林中医药,2016,36(8):856-858.
[19]申鹏飞,石学敏.针刺治疗原发性高血压病的临床疗效观察[J].辽宁中医杂志,2010,37(9):1802-1803.
[2]GBD 2015 Mortality and Causes of Death Collaborators.Global,regional,and national life expectancy,all-cause mortality,and cause-specific mortality for 249 causes of death,1980-2015:a systematic analysis for the global burden of disease study 2015[J].Lancet,2016,388(10053):1459-1544.
[3]Paul A.2014 Evidence-based guideline for the management of high blood pressure in adults.report from the panel members appointed to the eighth Joint National Committee(JNC8)[J].JAMA,2014,311(5):507-520.
[4]中华医学会心血管病学分会高血压组.清晨血压临床管理的中国专家指导建议[J].中华心血管病杂志,2014,42(9):721-725.
[5]寇鹏,石学敏.醒脑开窍法针刺治疗中风疗效回顾及NIHSS量表评价分析[J].山西中医,2015,13(5):41-42,55.
[6]李小峰,陈敏.改良Barthel指数评定量表的设计与应用[J].护理研究,2015,29(13):1657-1658.
[7]沈小梅,张巨艳.清晨高血压的发生机制及防治措施的研究进展[J].中西医结合心脑血管病杂志,2015,13(4):446-448.
[8]肖世南,杨燕云,张海成,等.动态血压负荷对原发性高血压患者左室收缩功能不全的预测价值[J].西北国防医学杂志,2014,35(6):520-523.
[9]贾国栋,宫桂花,孟萍,等.老年高血压患者危险因素分析及其对靶器官损害的影响[J].中华老年心脑血管病杂志,2012,14(1):22-25.
[10]杜宇征.高血压与“活血散风、疏肝健脾”针刺法[J].中华针灸电子杂志,2017,6(3):89-92.
[11]张海,赵红.醒脑开窍针刺法治疗高血压合并中风临床观察[J].上海针灸杂志,2012,31(8):550-552.
[12]康明明,石学敏.针刺治疗原发性高血压病40例疗效观察[J].中华中医药杂志,2013,28(5):1406-1409.
[13]乔波,张春红,石学敏.针刺人迎穴治疗高血压病的近代研究概况[J].吉林中医药,2011,31(6):599-600.
[14]杜宇征,蔡婓.石学敏院士针刺治疗高血压临证经验[J].中国针灸,2013,33(11):1000-1003.
[15]郭琳,赵静,张国栋,等.针刺治疗中风合并高血压疗效观察[J].上海针灸杂志,2011,30(9):624.
[16]袁建,梁庭栋.中医治疗高血压病机理初探[J].中医临床研究,2015,7(34):59-61.
[17]张一颖,杜宇征.中医治疗干预血压变异性的研究进展[J].浙江中医药大学学报,2013,37(7):940-942.
[18]陈宥伊,杜宇征,张春红.人迎穴干预原发性高血压病的研究进展[J].吉林中医药,2016,36(8):856-858.
[19]申鹏飞,石学敏.针刺治疗原发性高血压病的临床疗效观察[J].辽宁中医杂志,2010,37(9):1802-1803.