针刺左侧太溪穴对脑梗死急性期患者心率变异性的影响

发布时间：2018-10-21 17:43

【摘要】：目的:通过针刺急性期脑梗死患者的左侧太溪穴,记录针刺过程中不同时间段患者心率变异性的各项指标(BPM、SDNN、RMSSD、TP、LF、HF、HF%、LF%、logLF/HF)的相应变化,观察其对患者心率变异性的影响,探讨针刺左侧太溪穴对脑梗死急性期患者自主神经功能的影响,为临床运用针刺治疗脑梗死后自主神经功能失调提供依据。方法:随机选取45-80岁之间脑梗死急性期患者30名(男患18名,女患12名),平均年龄63.8±7.6岁,平均病程10.33±2.71天。针刺受试者的左侧太溪穴,使用medilog(?)AR12动态心电记录仪监测心率变异性指标,记录针刺太溪穴前5 min、针刺得气时、行针时(针刺10 min)、出针时(针刺20 min)、出针后5分钟5个时间点的心率变异性定量指标BPM、SDNN、RMSSD、TP、LF、HF、HF%、LF%、log LF/HF。将所得数据采用SPSS17.0软件进行统计学分析,计量资料采用均数土标准差(X±S)表示,对针刺前、进针时、行针时、出针时及出针后5min五个时间点观察HRV的变化并进行统计分析,其中符合正态分布的数据统计方法采取重复测量数据方差分析,不符合正态分布的需经过数学转换,转换符合正态分布后的数据再采取重复测量数据方差分析。首先进行Mauchly' s球形检验,若P0.05,则采用一般线性模型下的重复测量数据单因素方差分析,若P0.05,不满足球对称条件,对自由度进行校正,采用Greenhouse-Geisser校正系数。各时间点HRV各指标间的比较应用Bonferroni法,以P0.05为有统计学意义。结果:1.针刺脑梗死急性期患者左侧太溪穴对HRV平均心率的影响:在进针时、行针时、出针时、出针后5min与针刺前比较数值变化不明显(P0.05)。2.针刺脑梗死急性期患者左侧太溪穴对HRV时域指标的影响:RMSSD、SDNN在进针时、行针时、出针时、出针后5min与针刺前比较数值变化不明显(P0.05)。3.针刺脑梗死急性期患者左侧太溪穴对HRV频域指标的影响:(1)TP在出针后5mmin与针刺前比较变化显著(P0.01),而在进针时、行针时、出针时与针刺前相比无显著变化(P0.05);(2)HF在进针时、行针时、出针时、出针后5mmin与针刺前相比显著降低(P0.01);(3)LF在进针时、行针时、出针时、出针后5min与针刺前比较数值下降明显(P0.01);(4)HF%在进针时、行针时、出针时、出针后5min与针刺前比较显著降低(P0.01);(5)LF%在进针时、行针时、出针后5min与针刺前比较无显著变化(P0.05),而出针时与针刺前比较有显著变化(P0.05);(6)LogLF/HF在进针时、行针时、出针时、出针后5min与针刺前比较显著升高(P0.01)。结论:1.针刺左侧太溪穴对脑梗死急性期患者总的心率变异性影响不显著。2.针刺左侧太溪穴对脑梗死急性期患者的迷走神经活性有抑制作用,对交感神经活性有兴奋作用。
[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 卤7.6 years and average course of disease of 10.33 卤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 卤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.
【学位授予单位】：黑龙江中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.6

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