1.24小時動態血壓觀測:要求所有患者生活作息節律一致,均於治療前、治療後4周兩個時間點,採用無創型攜帶式動態血壓監測儀進行監測, 連續紀錄24小時。電腦軟體自動剔除無效資料(所測資料應80%以上有效)。通過電腦分析系統獲得24小時、日間、夜間的平均舒張壓、收縮 壓及血壓負荷。其結果如下1.24-hoursambulatorybloodpressureobservatio n:Allpatientsshouldtakethesamelifestyle,monitorthebloo dpressurebynon-invasiveandportableambulatory24-hourblood pressuremonitoringdevicebothinthepre-treatmentandpost-tre atment.Computersoftwareexcludetheinvaliddataautomatically (80%datashouldbeavailable).ThenwecanhaveaverageDBP,SBP andbloodpressureloadof24-hour,day-timeandnight-timebyco mputeranalysissystem.Theresultsareasfollows:治療前Pre-tre atment治療後Post-treatment收縮壓SBP舒張壓DBP收縮壓SBP舒張壓DBP24小時 24hour139.98±7.5393.54±4.13132.68±13.8484.33±11.63白天Day -time140.60±8.0989.25±7.54135.75±10.0884.66±10.17夜間Night -time138.45±11.2388.18±7.78129.64±16.8879.49±10.38與治療前比 較(P<0.05)Comparedwithpre-treatment(P<0.05)治療前後血壓水準比較Thec omparisonofBPbeforeandaftertreatment治療前Pre-treatment 治療後Post-treatment收縮壓SBP舒張壓DBP收縮壓SBP舒張壓DBP白天Day-time 37.73±26.7931.91±28.7026.58±21.3528.51±27.78夜間Night-time 55.94±34.6846.29±31.0545.35±34.5639.80±31.17與治療前比較(P<0.0 5)Comparedwithpre-treatment(P<0.05)治療前後血壓負荷的變化Thecompari sonofBPloadbeforeandaftertreatment結果顯示,針刺後 ,患者日間、夜間的血壓均得到有效控制,有利於靶器官的保護。其24小時平均收縮壓、舒張壓,日間平均收縮壓、舒張壓,夜間平均收縮壓、舒 張壓與治療前比較均有顯著性降低(P<0.05)。血壓負荷也有較為顯著的改善。 Theresultsshows thatafterfourweeksofacupuncture,thedaytime,night-timeBP areingoodcontrol.Anditisgoodforthetargetorgans.Theav erageSBP,DBPof24-hour,day-time,night-timeandtheloadofS BPandDBParesignificantlylowerthanbefore(P<0.05).2. 血壓變異性觀測:採用國際公認的經典方法,以動態血壓儀監測到的24小時收縮壓、舒張壓標準差作為長時血壓變異性指標。其結果如下: 2.Bloodpressurevariabilityobserved:Byclassicalapproachrec ognizedinternationally,takethe24-hourSBPandDBPstandardde viationasalong-termbloodpressurevariabilityindicators.The resultsareasfollows:治療前Pre-treatment治療後Post-treatment 收縮壓SBP舒張壓DBP收縮壓SBP舒張壓DBP白天Day-time10.69±2.7113.29±4 .699.02±2.6612.44±4.01夜間Night-time10.00±3.2413.04±4.32 8.64±4.0111.78±4.74與治療前比較(P<0.05)Comparedwithpre-trea tment(P<0.05)治療前後血壓變異性的變化ThecomparisonofBPvariabilitybefo reandaftertreatment一定時間內血壓波動的程度稱為血壓變異性,血壓變異性增大,主要是因為動脈壓力反射 敏感性減退以及阻力小動脈結構重塑導致血管的收縮反應性增強。越來越多的臨床研究證實,血壓變異性升高與靶器官損害密切相關,血壓變異性越 高的高血壓患者靶器官損害越嚴重。所以最有效的降壓治療既應降低24小時平均血壓水準,又要改善血壓變異性。TheBPchange dinacertainperiodoftimeiscalledBPvariability.Thearter ialbaroreflexsensitivitydecreasedandthevesselcontractiler esponseincreasecausedbysmallresistancearteryremodeling,ca ncausetheBPvariabilityincrease.Moreandmoreclinicalstudi esfindthattheBPvariabilityiscloselyrelatedtothetarget organdamage.Therefore,thebesttherapyistoreducing24-hour averageBPaswellasimprovingtheBPvariability.結果顯示,針刺可明顯 降低高血壓病患者各時段收縮壓和舒張壓的標準差,與治療前相比有顯著性差異,證明本方法能有效的防止靶器官的損害,達到降壓治療的真正目的 。Theresultshowsthatacupuncturecansignificantlyreducethe standarddeviationofSBPandDBP.Ithassignificantdifference betweenpre-treatmentandpro-treatment,whichprovedthatthis methodcanpreventtargetorgandamageeffectively.3.血壓晝夜節律:( 日間血壓均值-夜間血壓均值)/日間血壓均值×100%,當此值大於10%時,為正常晝夜節律的杓型血壓;當此值小於10%時,為非正常晝 夜節律的非杓型血壓。其結果如下:3.Circadianrhythmofbloodpressure:Theremai nderofmeanbloodpressurenumberduringthedayminusthenumbe rofnight-timemeanbloodpressuredividedbythenumberofmean daytimebloodpressure,andtimes100%.Whenitisover10%,it isdipperBPwithnormalcircadianrhythm,whileitislessthan 10%,itisnon-dipperone.Theresultsareasfollows:治療前後血壓晝夜節 律的比較(例數)ThecomparisonofCircadianrhythmofbloodpressurebet weenpre-therapyandpost-therapy(n)倒轉及深勺非勺型勺型r值z值p值收縮壓治療 前3643501160.5882.4510.014收縮壓治療後238287305舒張壓治療前295378 1570.571.9740.048舒張壓治療後161239430結果顯示:收縮壓節律治療前後比較(p=0.014 <0.05),差異有統計學意義,舒張壓節律治療前後比較(p=0.048<0.05),差異有統計學意義,說明通過針刺能夠改善高血壓患 者的晝夜節律。Researchfindingsshow:Systolicbloodpressurecircadi anbeforeandaftertreatment,arestatisticallysignificantdiff erences(p=0.014<0.05),Diastolicpressurecircadianbeforeanda ftertreatmentarestatisticallysignificantdifferences(p=0.048 <0.05),Explainbyacupuncturecanimprovehypertensioncircadian rhythms.血壓晝夜節律是指血壓的晝夜變化規律。正常人24小時血壓曲線呈“雙峰一穀”的“杓 型”,這種血壓晝夜節律變化對適應機體的活動及保護心腦血管正常結構與功能起著重要作用。非杓型高血壓病患者心腦血管系統承受著更高和更長 時間的血壓負荷,因而心腦血管重構更為顯著。而高血壓病血壓晝夜節律紊亂,反映了更為異常的神經內分泌啟動及代謝紊亂。 CircadianrhythmofBPreferstothechangesduringdayan dnight.Normal24-hourBPcurveisashapeof"dipper"consisto f"twopeaksandaValley",andthiscircadianrhythmplaysanim portantpartinadaptingtothebodyactivitiesandprotectingno rmalcardio-cerebralvascularstructureandfunction.Patientwit hnon-dipperhypertensionwhosecardio-cerebralvascularsystems uffersmoreBPload,hassignificantlycardio-cerebralvascularr emodeling.ThedisorderofBPrhythmisrelatedtoabnormalactiv ationofneuroendocrineandmetabolicdisorders. 血壓晝夜節律具有獨立于血壓水準的預後價值,是評估高血壓病靶器官受損害有價值的指標,因而在高血壓病及靶器官損害的防治中,應注意糾正 血壓晝夜節律性的異常。本結果顯示,針刺可以很好的改善高血壓患者晝夜變化節律,使其恢復正常杓型節律,這對於保護心腦血管形態和功能具有 重要的意義。TheBPrhythmisanindexoftargetorganda mageassessment,soweshouldpayattentiontoregulatingtheBP rhythm.TheresultsshowedacupuncturecanimprovetheBPrhythm, whichisgoodforcardio-cerebralvascularmorphologyandfuncti on.4.停藥減藥情況觀測:當患者血壓水準處於正常範圍,並持續7天后,開始實施減藥並停藥。4.Decreasea nddiscontinuancemedicineobserved:Decreaseanddiscontinuance medicinewillbecomeintooperation,whenpatients’BPbeinnorm alrange,andlast2days.減藥停藥情況Decreaseanddiscontinuanceme dicine用藥例數Casesofusingmedicine830(100%)停藥例數Casesof191(2 3.01%)減藥例數Casesof429(51.69%)未停減藥者Casesof210(25.30%)停減藥率 Rateofdecreaseanddiscontinuancemedicine620(74.70%)針刺降壓優 勢的初步總結Thepreliminarysummaryoftheadvantagesoftheacupunctu retreatment針灸治療高血壓,是根據傳統中醫理論對於高血壓病的認識,從病人的整體情況出發,針對病因病機和症狀表現, 標本兼顧,綜合治療。與藥物治療相比,針灸治療高血壓具有如下特點:Acupuncturetreatmentofhypert ensionisbasedonthetheoryofTCM,takingtheoverallconditio nintoconsideration,basingonpathogenesisandsymptom,maketr eatmentforbothappearanceandsubstance.Comparedwithdrugs,a cupuncturetreatmenthassuchadvantages.1.降壓療效顯著,促進血壓達標; 2.能減輕24小時血壓負荷值,有效降低夜間血壓負荷;3.降低血壓的變異性,減少靶器官損害,減少併發症的發生 ;4.恢復正常的血壓晝夜節律,改善病人的預後;5.規範使用可以減免藥物並代替藥物1.Asignifi cantantihypertensiveeffect,andpromoteBPtobestandard.2.R educe24-hourbloodpressureload,andreducenight-timebloodpr essureloadeffectively.3.Reducethevariabilityofbloodp ressure,andreducetargetorgandamageandtheoccurrenceo fcomplications.4.Restorethenormalcircadianrhythmofblood pressure,improvetheprognosis.5.Usestandarddrugsanddrugc anreplacerelief.目前,針刺治療高血壓病的系列研究還處於初期階段,需要進一步應用循證醫學手段開展深入系統的 臨床試驗,從而獲得高級別的證據。同時開展基礎研究明確針刺降壓的生物學基礎及機制。Atpresent,theseries ofacupuncturetreatmentofhypertensionresearchisstillinthe experimentalstage,needfurtherapplicationofevidence-basedm edicineinthesystemmeansfurtherclinicaltrials,thusobtains seniorotherevidence.Inbasicresearchclearlybiologicalbasi sandacupuncturestep-downmechanism.有关高血压治疗方面的问题,可以说是常谈常新。 目前在抗高血压治疗方面,国际上有一个新的趋势,就是强调高品质降压,其内涵有两个方面:一是降压的品质,二是患者的生活质量。今 天我将提供给各位老师一些有关高品质降压中降压品质和生活质量方面的新资料,供大家在临床工作中参考。針灸治療原發性高血壓病臨床研 究ClinicalStudyonAcupunctureforPrimaryHypertension石學敏SHI Xuemin中國工程院院士天津中醫藥大學第一附屬醫院榮譽院長Academician,ChineseAcademyo fEngineeringHonoraryPresident,TheFirstTeachingHospitalof TianjinUniversityofTraditionalChineseMedicine2010/11年度「傑出 學人系列」講座DistinguishedScholarLectureSeries2010/11研究背景一、 高血壓病流行病學特點目前全世界成人中約有25%~35%為高血壓病患者,其總數已達9.72億;而大於70歲人群中則上升到60%~7 0%。40歲以上人群的死亡原因中,腦血管病和心臟病分別列為第一位和第三位,而總死亡的第一危險因素是高血壓。 Atpresent,about25%~35%oftheadultsthroughouttheworldsu fferfromhypertension.Thetotalnumberreaches972million.Whi letherateriseupto60%~70%inthegroupof70-year-oldpopula tion.Inthereasonsthatcausepeopleover40-year-oldtodeath, cerebrovasculardiseasetakesthefirstplaceandheartdisease takesthethirdplace.Andhypertensioncomestobethefirstris kfactor.研究背景50%的心血管疾病是由高血壓引起的,77%的初發腦卒中都與高血壓病有關。200 0年全球疾病負擔調查結果顯示,高血壓在全球疾病負擔中占4.5%。由於社會經濟的發展和人們生活方式的改變,高血壓患病率呈持續增長趨勢 ,並己成為世界重要的公共衛生問題之一。Theresultofglobaldiseaseburde n(GDB)surveyin2000showedthat50%ofpatientswithcerebrova sculardiseasewerecausedbyhypertension,77%ofstrokeisrela tedtohypertension,andhighbloodpressureintheGDBaccounted for4.5%.Asthedevelopmentofsocio-economicandpeople’slife styles,theprevalencerateofhypertensioncontinuetoshowanu pwardtendencyandhasbecomeoneoftheimportantpublichealth problemsintheworld.二、高血压病治疗概况HypertensionTrea tmentOverview1.藥物治療療效不穩定Unstableeffectiveness我国人群原发性高 血压病的控制率,城市为6.1%,农村仅为0.9%。Theprimaryhypertensioncontrolratei nourcitywas6.1%,whileitwasonly0.9%inruralareas.2.藥 物治療依從性差Poorcompliance我国人群原发性高血压病的治疗率,城市为17.4%,农村仅为5.4%。Thepr imaryhypertensioncurerateinourcitywas17.4%,whileitwas only5.4%inruralareas.3.副作用大Manysideeffects 由於聯合用藥、長期用藥,降壓藥物對患者造成一定的肝腎損害,另外電解質紊亂、消化道及呼吸道反應也給患者帶來許多不必要的負擔Th ecombinationandlong-termusesofantihypertensivedrugsmayca useimpairmentofliverandkidney,adversereactionsinalimenta ryandrespiratorytractandelectrolytedisorders,whichbringa lotofunnecessaryproblemstopatients.目前高血壓病的主要治療手段為藥物,但是藥物治 療高血壓病,在我國乃至全球範圍內又存在著以下幾方面的弊病:Nowthemaintreatmentofhypertens ionismedicine,butithassomedisadvantagesasfollows,noton lyinourcountrybutworldwidescope.長期高血壓可引起心、腦、腎等靶器官的嚴重損害,是 腦卒中,冠心病的主要危險因素。近年來許多循證醫學研究證實,抗高血壓藥物的主導作用是控制高血壓本身,而對降低心腦事件的發生率及死亡率 作用不大。Thelong-termhighBPcancausetargetorgandamagesuchas heart,brain,kidneyandsoon,whichalsoisthemajorriskfac torsofstokeandcoronaryheartdisease.Inrecentyears,manyE BMresearchsaidthatthemaineffectoftheantihypertensivedru gsistocontrolBPbuthaslittleeffectonreducingincidencer ateandmortalityofcardiovascularandcerebrovascularevents. 4.藥物作用局限LimitationsofDrugs以往的高血壓治療只強調降壓是抗高血壓治療的唯一目標,但有效控 制血壓後,其併發症的罹患與死亡率仍是普通人群的2~6倍。所以尋求一種既能控制血壓,又能改善預後的降壓新途徑十分重要。Weal wayspayattentiontoloweringtheBP,butwhentheBPiscontrol ledthecomplicationsandmortalityoccurred2to6timesthanth enormalhuman.SoanewtherapythatcancontrolBPaswellasi mprovetheprognosisisnecessary.隨著醫學的發展和時代的進步,對高血壓的治療也提出了更高 的要求,其治療目的已不再是僅僅降低升高的血壓,而防治靶器官損害、提高患者生活品質,有效減免心腦事件的發生已成為高血壓治療的最終目的 。Withthedevelopmentofmedicine,thepurposeofthehypertensio ntreatmentarenotonlyoncontrollingtheBPbutprotectingtar getorgan,improvingqualityoflifeandreducetheheartandcer ebrovascularevents.5.降壓新理念NewIdeaofLoweringBP因此,如何 在有效控制血壓的同時,減少靶器官的損害及併發症的發生,成為高血壓病防治工作中的重點,尋求一種既能控制血壓,又能改善預後的降壓新途徑 十分重要。SoanewtherapythatcancontrolBPaswellasimproveth eprognosisisnecessary.三、針刺治療原發性高血壓病的概況Acupunctur etreatmentofprimaryhypertension早在 上個世紀70年代,我院就開展了針刺治療高血壓病的系列研究,形成了成熟的治療模式,有著嚴格固定的選穴處方、量化規範的操作體系及明確的 針刺量效關係。Earlyin1970s,wehadcarriedoutseriesofresearches oftreatinghypertensionbyacupunctureandformeditsowntreatm entmodel,whichhasfixedprescription,standardizedmanipulatin gmethodandcleardose-effectrelationship.
臨床研究已經證明,該技術治療高血壓可在保護靶器官的基礎上整體調節血壓 節律,能夠有效的促進血壓達標,提高患者生活品質,具有雙向性和特異性的特點。Theclinicalresearcheshad showedthatthistreatmentcanregulatebloodpressurerhythmba sedonthetargetorganprotection,andregulateBPtothenormal level.Itcanimprovethequalityoflife,whileithastwo-way regulationandspecificityeffectiveness.
针法介绍AcupunctureMethod研究組在深入研究古醫籍基 礎上,結合現代醫學理論,根據大量臨床觀察,對中醫“氣海”以及“無虛不作眩,無痰不作眩,無風不作眩”等理論進行了深刻的探索和思辨, 確立了以“活血散風,調和肝脾”為主的治法,創立了以人迎穴為主穴的,有明確規範手法量學標準和量效關係的針刺方法。Accordin gtoabundanceofclinicalresearchesandstudyofclassicalmedi calChineseworks,combinedwithmodernmedicaltheory,wemadea profoundexplorationandcritical-thinkingabouttheoryof“Ener gySea”and“dizzinessmustbeduetodeficiency,phlegmandwind ”,anddevelopedatheoryof“activatebloodcirculationanddisp elthewind,calmingtheliveranddescendingtheadverseflowof qi”,alsoestablishedanacupuncturetreatmentwithstandardized manipulatingmethodandcleardose-effectrelationshipandthem ainpointisRenying(ST9).治療原則:活血散風,調和肝脾取穴:人迎、合穀、太沖、曲池、足三里 療程:每日針刺1~2次,90天為1療程Therapeuticprinciples:Activatebloodcircul ationanddispelthewind,calmingtheliveranddescendingthea dverseflowofqiAcupoints:Renying(ST9),Hegu(LI4),Taichong(LR 3),Quchi(LI11),Zusanli(ST36)Courseoftreatment:1~2times dailyacupunctureandtreating90days直刺1~1.5寸,見針體隨動脈搏動而擺動,施用撚 轉補法第二定義1分鐘;留針30分鐘Perpendicularpuncturefor1~1.5cun,withne edlewavingwiththearterialpulse.Manipulatefor1minutewith theseconddefinitiontwirlingreinforcingmethod.Retainfor30 minutes.人迎ST9均直刺0.8~1寸,施用撚轉瀉法第一定義1分鐘,留針30分鐘Perpendicularpu ncturefor0.8~1cun.Manipulatefor1minutewiththefirstdefi nitiontwirlingreducingmethod.Retainfor30minutes.合谷LI4太冲 LR3直刺1寸,施用撚轉補法第一定義1分鐘,留針30分鐘Perpendicularpuncturefor1cun. Manipulatefor1minutewiththeseconddefinitiontwirlingrein forcingmethod.Retainfor30minutes.曲池足三里LI11ST36臨床研究 ClinicalResearch“針刺治療原發性高血壓病”已經成為天津中醫藥大學第一附屬醫院針灸學科固定、持續的重要研 究方向之一,為此我院特設了高血壓門診,同時也開闢了相應的病房,並購置了研究設備和觀察儀器。"Acupuncture treatmentofprimaryhypertension"hasbecomeoneoftheimporta ntresearchdirectionsoftheAcupunctureDepartmentoftheFirst TeachingHospitalofTianjinUniversityofTraditionalChineseM edicine.AndWehavefoundahypertensionclinicandhypertension ward,andalsohaveboughttheresearchfacilitiesandscopes. 該課題已在WHO國際臨床試驗註冊平臺及中國臨床試驗註冊中心註冊,註冊號為:ChiCTR-TRC-00000455,並通過註冊臨 床試驗倫理審查委員會審查,批准號:ChiECRCT-200900004。Thisstudyhasreg isteredintheWHOInternationalClinicalTrialsRegistryPlatfor mandtheChineseClinicalTrialRegistrationCenter,thecodeis :ChiCTR-TRC-00000455.Andithassignedupethicalreviewofcli nicaltrialsCommissionandthenumberis:ChiECRCT-200900004. 一、針刺治療亞急性原發性高血壓病的臨床觀察 Clinicalobservationofacupuncturetreat mentofsubacuteprimaryhypertension採用隨機、對照、單盲臨床試驗的設計方法。將在 2009年8月~2010年6月之間我院針灸科病房及急症科的原發性高血壓病亞急症患者188例分為三組,其中針刺組128例,對照組30 例,藥物組30例。Authorperformedarandom,contrastingandsingle -blinddesignmethodology.FromAug2009toJan2010,authorhas collected188casesofprimaryhypertensiveurgenciespatientsth atallcamefromacupuncturedepartmentandemergencydepartment intheAffiliatedHospitalofTianjinUniversityofTCM,meanwhil edividedthemtothreegroups:acupuncturegroup128cases,cont rolgroup30,medicinegroup30.針刺組:採用撚轉補法第二定義針刺雙側人迎穴,行手法1分鐘, 留針30分鐘;對照組:舌下含服硝苯地平10mg;觀察組:採用直刺雙側人迎穴1~1.5寸,見 針體隨動脈搏動而擺動, 不作手法,留針30分鐘。Patientsintheacupuncturegroupw eregiventwisting-twirlingtonifyingtechniqueofAcademicianSh ionthebilateralRenying(ST9)foroneminute,30minutesforre tentionoftheneedleinthebody;patientsinthemedicinegroup weregiventotakemedicine“nifedipine”insublingual10mgonc e;patientsinthecontrolgroupweregivenperpendicularneedlin gonthebilateralRenying(ST9)for1~1.5cun,withtheneedlebody swayingtopulsationofcarotidarteryandwithoutanytechnique ,30minutesforretentionoftheneedleinthebody.三组患者一般情况 比较如下Thegeneralinformationofthethreegroups組別Group例數Cas es男性/女性Male/Female平均年齡(歲)Age(Year)病程(年)Pathogenesis(Year)針 刺組Acupuncture1281.2557.60±18.854.73±1.28對照組ControlGroup 301.4353.13±16.314.67±1.24藥物組MedicineGroup301.3154.27±1 7.114.58±1.19P值>0.05>0.05>0.05三組患者在男女比例、平均年齡、病程等方面比較,無顯著差別, 說明基線一致,具有可比性Themale-to-femaleratio,averageage,pathogenesi sbetweenthethreegroupshasnosignificantdifference,thatis ,thebaselineisconsistentanditiscomparable.組別針刺前3分鐘1 5分鐘30分鐘60分鐘2小時4小時6小時針刺組209.37±13.18④190.13±15.03①145. 35±10.33②③147.51±11.47②③144.32±10.38②③145.17±12.80② ③143.42±13.19②③168.24±15.52①③對照組207.23±16.57191.09 ±17.18①184.32±15.27①189.64±13.22①209.88±13.36⑤203.43± 15.27⑤207.27±15.93⑤206.03±16.25⑤藥物組204.87±19.12199.30 ±15.38⑤191.49±13.47①188.32±14.30①174.92±14.34①③163.8 6±14.23①③185.33±14.39①③198.73±15.64⑤三組患者治療前後收縮壓比較T hecomparisonofSBPbetweenpre-treatmentandpost-treatmentof thethreegroups①與治療前比較P<0.05,②與治療前P<0.01,③與對照組比較P<0.05,④與對照組 比較P>0.05,⑤與治療前比較P>0.05①Comparedwithpre-treatment(P<0.05),② Comparedwithpre-treatment(P<0.01),③Comparedwithcontrolgr oup(P<0.05),④Comparedwithcontrolgroup(P>0.05),⑤Compared withpre-treatment(P>0.05).组别針刺前3分鐘15分鐘30分鐘60分鐘2小時4小 時6小時針刺組121.93±10.21④103.80±9.11①145.35±10.33②③147.51± 11.47②③144.32±10.38②③145.17±12.80②③143.42±13.19②③ 168.24±15.52①③對照組207.23±16.57191.09±17.18①184.32±15. 27①189.64±13.22①209.88±13.36⑤203.43±15.27⑤207.27±15.9 3⑤206.03±16.25⑤藥物組204.87±19.12199.30±15.38⑤191.49±13. 47①188.32±14.30①174.92±14.34①③163.86±14.23①③185.33± 14.39①③198.73±15.64⑤三組患者治療前後收縮壓比較ThecomparisonofSBP betweenpre-treatmentandpost-treatmentofthethreegroups①與治 療前比較P<0.05,②與治療前P<0.01,③與對照組比較P<0.05,④與對照組比較P>0.05,⑤與治療前比較P>0.0 5①Comparedwithpre-treatment(P<0.05),②Comparedwithpre-tr eatment(P<0.01),③Comparedwithcontrolgroup(P<0.05),④Compa redwithcontrolgroup(P>0.05),⑤Comparedwithpre-treatment(P >0.05).组别針刺前3分鐘15分鐘30分鐘60分鐘2小時4小時6小時針刺組121.93±10.21 ④103.80±9.11①94.25±7.03①92.81±8.14①③90.75±8.08①③ 91.29±7.12①③88.30±6.09①③93.02±5.52①③對照組120.35±10.4 4110.13±10.52①107.18±10.03①110.12±11.33①123.15±9.87⑤ 120.21±9.03⑤120.52±10.24⑤124.37±11.10⑤藥物組124.77±10.10 119.53±10.06⑤104.07±9.93①108.71±10.303①98.56±9.14①③9 3.36±8.50①③105.36±10.84①③128.85±11.04⑤三組患者治療前後舒張壓比較Th ecomparisonofDBPbetweenpre-treatmentandpost-treatmentoft hetwogroups①與治療前比較P<0.05,②與治療前P<0.01,③與對照組比較P<0.05,④與對照組比較P> 0.05,⑤與治療前比較P>0.05①Comparedwithpre-treatment(P<0.05),②Com paredwithpre-treatment(P<0.01),③Comparedwithcontrolgroup (P<0.05),④Comparedwithcontrolgroup(P>0.05),⑤Comparedwith pre-treatment(P>0.05).結果顯示針刺組於治療後3分鐘血壓開始下降,在針刺後15分鐘 患者血壓下降到較為理想水準,並一直持續至針刺後4小時,此後血壓略有上升,直至針刺後6小時,第二次針刺前,血壓仍顯著低於針刺前水準。 對照組在前30分鐘內與血壓下降,30分鐘後血壓回到治療前水準。藥物組服藥後15分鐘,患者血壓開始下 降,呈緩慢下降趨勢,於服藥後2小時血壓開始回升,在服藥後6小時呈超過服藥前水準趨勢。Theresultssh owedthat3minafteracupuncturetheBPbegantodropdown,and itcametoanormallevelafter15minlastingfor4h.Thenitwa srisingupuntil6hafteracupuncture.AndtheBPwasstillsign ificantlylowerthanpre-treatmentbeforethesecondtreatment. Inthecontrolgroup,differencealsoexistedbetweenthe former30minandpretherapy.Whileinthecontrolgroup, itbegantofalldownslowly15minaftermedication,anditbega ntoriseup2hafterthemedication,andalmostoverthepre-tre atmentlevelafter6h.二、針刺治療原發性高血壓病門診患者的臨床觀察Clinical observationofacupuncturetreatmentofsubacuteprimaryhyperten sion所有200例病例來源於2009年8月~2010年7月之間我院高血壓門診的就診患者。男性121例,女性79例 。200casesareallfromhypertensionclinic,betweenAug200 9toJan2010.Male121,Famale79.治療前Pre-treatment治療後Post -treatment收縮壓SBP舒張壓DBP收縮壓SBP舒張壓DBP24小時24hour148.73± 17.3292.62±10.54131.56±11.1385.48±8.92白天Day-time151.46±18.6098.42±11.51134.43±12.3787.85±9.02夜間Night-time142.35±14.5389.85±10.59120.72±13.4367.42±7.48血壓負荷BPLoad(%)48.80±21.7048.42±21.8011.30±9.5414.63±10.13與治療前比較(P<0.05)Comparedwithpre-treatment(P<0.05)治療前後血壓水準比較ThecomparisonofBPbeforeandaftertreatment停藥減藥情況觀測:當患者血壓水準處於正常範圍,並持續7天後,開始實施減藥並停藥。Decreaseanddiscontinuancemedicineobserved:Decreaseanddiscontinuancemedicinewillbecomeintooperation,whenpatients’BPbeinnormalrange,andlast2days.減藥停藥情況Decreaseanddiscontinuancemedicine用藥例數Casesofusingmedicine119停藥例數Casesof26(21.85%)減藥例數Casesof43(36.13%)未停減藥者Casesof50(42.02%)停減藥率Rateofdecreaseanddiscontinuancemedicine69(57.98%)三、動態血壓監測評價針刺治療50例高血壓病III期患者的臨床觀察Acupunctureeffectivenessofthe830hypertensioncasesmonitoredbyambulatory24-hourbloodpressuresystem2009年2月-2010年6月間,針灸病房收集病例數986例,將依從性差,病程過短,資料不全156例作為脫落例,共收集830例患者。男性495例,女性335例。平均病程11.49±9.72年。平均年齡61.68±10.15歲。所有患者入院前均服用降壓藥物。986casesareallfromacupunctureward,becauseofbadobedience,shortcourseanddataincomplete,156casesaretakenasecclasis,so830casesarecollected.495casesaremaleand335casesarefemale.Averagecourseis11.49±9.72year.Averageageis61.68±10.15year.Allofthecasestookthedepressurizationmedicine.有关高血压治疗方面的问题,可以说是常谈常新。目前在抗高血压治疗方面,国际上有一个新的趋势,就是强调高品质降压,其内涵有两个方面:一是降压的品质,二是患者的生活质量。今天我将提供给各位老师一些有关高品质降压中降压品质和生活质量方面的新资料,供大家在临床工作中参考。 |
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