针刺耳胰胆穴对慢性炎性胆囊运动影响的观察及时效规律初探
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摘要
目的：本研究以胆囊形态彩色多普勒超声影像检测结果为客观指标,观察耳针对慢性胆囊炎患者胆囊运动的影响并探讨其时效关系,观察留针时间长短与针刺效应的关系。本课题不仅为临床选择最佳留针时间提供依据,同时为针刺作用的时效关系研究奠定基础。方法：本研究观察对象是22例慢性胆囊炎患者,采用计算机随机分组法,将符合纳入标准的患者随机分为2组,分别为留针30分钟组和留针60分钟组,分别记录针刺前5分钟、针后10分钟、针后20分钟、针后30分钟、针后40分钟、针后50分钟和针后60分钟时胆囊容积的大小,进行统计分析。结果：每组内针后不同时点的胆囊容积大小、胆囊收缩率均有明显差异(P<0.05)；组别与时点的交互作用对胆囊容积大小和胆囊收缩率均无明显影响(P>0.05)；两组间胆囊容积及胆囊收缩率的差别均无统计学意义(P>0.05)。留针30分钟组,胆囊容积在针后20分钟时最小且与针前5分钟比较有明显差别(P<0.05),其它时点胆囊容积和胆囊收缩率与针前5分钟比较均无统计学差异(P>0.05)；留针60分钟组,胆囊容积在针后40分钟时最小,并且针后20分钟、针后40分钟、针后50分钟时胆囊容积大小及胆囊收缩率与针前5分钟比较均有明显差别(P<0.05)。留针30分钟组的最佳诱导期是在针后20分钟,半衰期约在针后40分钟；留针60分钟组的最佳诱导期在针后40分钟,半衰期在针后60分钟以后；两组半衰期长短均为20分钟左右。针刺后的前10分钟内,针刺后1分钟、3分钟、5分钟、7分钟、10分钟时的胆囊容积大小与针前5分钟相比,均无显著性差别(P>0.05)。结论：1.针刺耳廓胰胆穴能够明显促进慢性炎性胆囊的张力性舒缩运动。2.留针30分钟和留针60分钟对胆囊的收缩程度或收缩幅度影响不大。3.针刺耳廓胰胆穴治疗慢性胆囊炎或胆石症的最佳诱导期为40分钟,留针40分钟内胆囊发生2次明显的张力性舒缩运动,因此留针时间以40分钟为宜。4.留针30分钟组和留针60分钟组对胆囊动力学影响的半衰期较短,均为20分钟左右。提示每天可以针刺或按压2-4次。5.针刺耳胰胆穴对胆囊运动具有双向良性调节作用,针刺是促进胆囊的收缩还是胆囊的扩张取决于胆囊的张力状态。
Objective:This study used the test result of color Doppler ultrasound gallbladder as an objective index to observe the influence of auricular acupuncture to chronic inflammation of the gallbladder and the time-effect relationship, and compared the relationship between the length of needle retaining time and acupuncture effect. The issue not only choosed the best needle retaining time to provide the basis for clinical, at the same time laid the foundation for time-effect relationship for the role of acupuncture.
Methods:This study used computer random grouping method, observed 22 chronic cholecystitis patients, who met the inclusion criteria and were randomly divided into 2 groups, which were 30 minutes retained needles and the 60 minutes group. we recorded index about gallbladder volume 5mins before needling;after needling, index was recorded every 10mins, from 10mins to 60mins. Results:Within each group at different time points, the size of the gallbladder volume and gallbladder contraction rates were significantly different after needle (P<0.05); the interaction between group and time had no significant effect on gallbladder volume and gallbladder contraction rates (P>0.05); the gallbladder volume and gallbladder contraction rates had no significant differences between the two groups (P>0.05). In the group of retained needles for 30 minutes, the gallbladder volume in 20 minutes after the needle was smallest and significant different from the gallbladder volume in 5 minutes before needle (P<0.05), gallbladder volume and gallbladder contraction rate had no statistical difference between in the other time points and in 5 minutes before the needle (P>0.05); In the group with needle retention for 60 minutes, the gallbladder volume in 40 minutes after the needle was smallest, and the gallbladder volume and gallbladder contraction rate in 20 minutes after the needle,40 minutes after the needle,50 minutes after the needle compared with the needle 5 minutes ago were significantly different (P<0.05). The best induction period in 30 minutes of needle retention group was period of needles for 20 minutes, the half-life of was about 40 minutes after the needle; The best induction period in 60 minutes of needle retention group was period of needles for 40 minutes, the half-life of was about 40 minutes after the needle; The half-life lengthes of two groups were about 20 minutes. In the first 10 minutes after acupuncture, gallbladder volume of the point at 1 minute,3 minutes,5 minutes,7 minutes,10 minutes, were no significantly different, compared to 5 minutes before needle, (P > 0.05). Conclusion:1. Needling Yidan point can obviously promote the gallbladder movement of chronic cholecystitis patients.2. There are no obvious influence to gallbladder movement between 30min group and 60min group. 3. The half time of the 2 groups are short, about 20mins, which suggests that 2～4 times needling or pressing were necessary.4. In the two groups, the best induction period is 40mins, which suggests that 40mins needling was the best time.5. Needling have a double cation, optimum, regulating effect, but the dilatation or shrinking depended on the situation of the, gallbladder's tension situation.
Objective:This study used the test result of color Doppler ultrasound gallbladder as an objective index to observe the influence of auricular acupuncture to chronic inflammation of the gallbladder and the time-effect relationship, and compared the relationship between the length of needle retaining time and acupuncture effect. The issue not only choosed the best needle retaining time to provide the basis for clinical, at the same time laid the foundation for time-effect relationship for the role of acupuncture.
Methods:This study used computer random grouping method, observed 22 chronic cholecystitis patients, who met the inclusion criteria and were randomly divided into 2 groups, which were 30 minutes retained needles and the 60 minutes group. we recorded index about gallbladder volume 5mins before needling;after needling, index was recorded every 10mins, from 10mins to 60mins. Results:Within each group at different time points, the size of the gallbladder volume and gallbladder contraction rates were significantly different after needle (P<0.05); the interaction between group and time had no significant effect on gallbladder volume and gallbladder contraction rates (P>0.05); the gallbladder volume and gallbladder contraction rates had no significant differences between the two groups (P>0.05). In the group of retained needles for 30 minutes, the gallbladder volume in 20 minutes after the needle was smallest and significant different from the gallbladder volume in 5 minutes before needle (P<0.05), gallbladder volume and gallbladder contraction rate had no statistical difference between in the other time points and in 5 minutes before the needle (P>0.05); In the group with needle retention for 60 minutes, the gallbladder volume in 40 minutes after the needle was smallest, and the gallbladder volume and gallbladder contraction rate in 20 minutes after the needle,40 minutes after the needle,50 minutes after the needle compared with the needle 5 minutes ago were significantly different (P<0.05). The best induction period in 30 minutes of needle retention group was period of needles for 20 minutes, the half-life of was about 40 minutes after the needle; The best induction period in 60 minutes of needle retention group was period of needles for 40 minutes, the half-life of was about 40 minutes after the needle; The half-life lengthes of two groups were about 20 minutes. In the first 10 minutes after acupuncture, gallbladder volume of the point at 1 minute,3 minutes,5 minutes,7 minutes,10 minutes, were no significantly different, compared to 5 minutes before needle, (P > 0.05). Conclusion:1. Needling Yidan point can obviously promote the gallbladder movement of chronic cholecystitis patients.2. There are no obvious influence to gallbladder movement between 30min group and 60min group. 3. The half time of the 2 groups are short, about 20mins, which suggests that 2～4 times needling or pressing were necessary.4. In the two groups, the best induction period is 40mins, which suggests that 40mins needling was the best time.5. Needling have a double cation, optimum, regulating effect, but the dilatation or shrinking depended on the situation of the, gallbladder's tension situation.
引文
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[17]王敏飞,吴硕东.胃动素在胆石症患者血浆和胆囊组织中的含量及意义[J].中国实用医药,2008；3(18)：12.
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[20]Frindhandler TM, Davison JS, Shaffer EA, et al. Defective gallbladder contractility in the ground squired and prairie dog during the early stages of cholesterol gallstone formation [J]. Gastrotenterol,1983; 85(4):830-836.
[21]龚传美,绍荣世,朱元根,等.体针耳针并用对胆囊运动功能调整的临床研究[J].中国针灸,1996；(1)：1.
[22]张林昌,陈英红.B超直视下观察针刺耳穴贴压治疗胆囊炎疗效[J].中国针灸,2003；23(8)：455.
[23]贲卉,朱元根,龚传美.耳-体穴电针对大鼠胆汁分泌的影响及其体液调节机制的研究[J].中国针灸,1997；(1).
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[26]马庆久,石景森,要秀,等.耳穴脉冲刺激对Oddi括约肌张力及肌电活动的影响[J].第四军医大学学报,2002；23(21)：1926.
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[1]梁晓强,方邦江,张静.胰岛素抵抗和胆石病相关性的研究综述[J]..中西医结合学报,2007：5(2)：208.
[2]陈少宗.关于全息穴位系统和传统经络穴位系统关系的再讨论[J].医学与哲学,1995；16(5)：250.
[3]陈少宗.全息生物医学理论与临床应用[M].黄河出版社,1991：39,147.
[4]陈少宗.全息耳针疗法[M].华夏出版社,1995：49.
[5]陈少宗.现代针灸学迫切需要解决的两大问题[J].医学与哲学,2007；28(12)：62.
[6]陈少宗.关于修订“耳穴国标”的意见[J].医学与哲学,2008；29(2)
[7]赖杰.中药加旋磁仪治疗胆石症35例[J].广西中医药,1996：19(1)：12.
[8]邓素荣.磁场治疗胆结石症100例疗效观察[J].现代康复,2000；4(4)：612.
[9]徐岳远.中药内服配合耳压治疗胆石症经验[J].南京中医药大学学报(自然科学版),1998；(4).
[10]张玉梅,吴会斌.耳穴贴压治疗胆石症临床疗效观察[J].延安大学学报,2(4)：38.
[2]刘红旭.胆石症中医药治疗研究概述[J].中国医药学报,2001；16(6)：55.
[3]中华医学会外科学会胆道外科学组.我国胆石病十年来的变迁[J].中华外科杂志,1995；33(11)：652-658.
[4]陈少宗.关于全息穴位系统和传统经络穴位系统关系的再讨论[J].医学与哲学,1995；16(5)：250.
[5]陈少宗.全息生物医学理论与临床应用[M].黄河出版社,1991：39,147.
[6]陈少宗.全息耳针疗法[M].华夏出版社,1995：49.
[7]陈少宗.针刺作用时效关系研究的临床意义[J].针灸临床杂志,2008；24(6)：14.
[8]熊丽娟,刘悦平.电针阳陵泉致胆囊动力学改变的超声评价[J].中国中西医结合影像学杂志,2006；4(3)：220.
[9]陈雁南,韩霞,邹海珠,等.针刺对急性胆囊炎患者胆囊收缩功能的影响[J].上海针灸杂志,2000；19(4)：12.
[10]段明福.耳穴压豆在胆系疾病的医学影像学评价[J].中国医药学报,1991；6(6)：15.
[11]许国铭.胆汁反流相关性疾病[M].上海科学技术出版社,2002.
[12]Weisbrodt NW. Motility of the biliary tree. Textbook of Gastroenterology. In:YamadaT ed.3rd edition, Philadephia, Lippincott Williams & Wilkins,1999.
[13]Smout A Akkarmans L. Normal and disturbed motility of the gastrointestinal tract. Petersfield:Wrightson Biomedical Publishing Ltd,1992.
[14]赵雪生,林少宾.胆囊运动功能的调节、检查方法和影响因素[J].沈阳部队医药,2004；17(4)：313.
[15]Lanzini A. Jazrawi RP. Northfield TC, Stimulaneous quamitative measurement of absolute gallbladder storage and emptying during fasting and eating in humans. Gastroenterology,1997;92:852.
[16]Rindh P, Paolo pgzzi,M Letizis, et al. Postprandial gallbladder motor function:Refulling and turnovre of bile in health and in cholelithiasis.Gastroenterology,1995; 109(2):582.
[17]王敏飞,吴硕东.胃动素在胆石症患者血浆和胆囊组织中的含量及意义[J].中国实用医药,2008；3(18)：12.
[18]傅华群,蒋筱强,熊本京,等.胆囊结石形成时胆汁淤滞与体内胃肠激素的研究[J].中国普通外科杂志,1998；7(6)：321-324.
[19]Azzaroli F, Mazzella G,Mazzeo C, et al.Sluggish small bowel motility involved in determining increased biliary deoxycholicacid in cholesterol gallstone patients[J].Am J Gastroenterol,1999; 94(9):2453-2459.
[20]Frindhandler TM, Davison JS, Shaffer EA, et al. Defective gallbladder contractility in the ground squired and prairie dog during the early stages of cholesterol gallstone formation [J]. Gastrotenterol,1983; 85(4):830-836.
[21]龚传美,绍荣世,朱元根,等.体针耳针并用对胆囊运动功能调整的临床研究[J].中国针灸,1996；(1)：1.
[22]张林昌,陈英红.B超直视下观察针刺耳穴贴压治疗胆囊炎疗效[J].中国针灸,2003；23(8)：455.
[23]贲卉,朱元根,龚传美.耳-体穴电针对大鼠胆汁分泌的影响及其体液调节机制的研究[J].中国针灸,1997；(1).
[24]徐虹,王茵萍.针刺耳迷根穴对胆囊收缩功能的影响中医药研究[J].1997；13(2)：22.
[25]王茵萍,龚传美.针刺不同耳穴对胆囊收缩功能的影响[J].上海针灸杂志,1995；14(5)：199.
[26]马庆久,石景森,要秀,等.耳穴脉冲刺激对Oddi括约肌张力及肌电活动的影响[J].第四军医大学学报,2002；23(21)：1926.
[27]许玉玲,叶燕燕,朱元根.耳-体穴电针对实验性胆囊炎家兔胆囊运动功能的影响[J].针刺研究,2000；25(1)：27.
[28]宋开源,赵纪岚,扈立荣,等.耳穴压丸法对胆结石患者血清胆囊收缩肽含量的影 响[J].中国医药学报,1992；7(2)：13.
[29]刘金龙,周晓娜,刘华清,等.针刺耳廓胆胰穴对人体奥狄氏括约肌电活动的影响[J].泸州医学院学报,1991；14(3)：189.
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