针刺及被动直腿抬高对血液净化早期低血压的疗效及机制探讨  

Effect and Mechanism of Acupuncture and Passive Leg Raising on Hypotension in Beginning of Blood Purification

作　　者：易亮[1] 杨志旭[1] 李洁[1] 付妍 Yi Liang;Yang Zhixu;Li Jie;Fu Yan(Xiyuan Hospital of China Academy of Traditional Chinese Medicine,Beijing 100091,China)

机构地区：[1]中国中医科学院西苑医院,北京100091

出　　处：《中国中医急症》2020年第5期876-879,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：中国中医科学院自由探索项目(ZZ0908040)。

摘　　要：目的研究针刺及被动直腿抬高对血液净化治疗患者早期低血压的疗效及机理探讨。方法采用前瞻性随机对照研究,观察对象为2015年12月至2018年11月入住中国中医科学院西苑医院ICU行血液净化治疗的患者共171例,根据纳入和排除标准将所有患者随机分为试验(1)组57例、试验(2)组59例与对照组55例。所有受试者血液净化治疗均采用连续静脉-静脉血液净化模式。对照组常规血液净化治疗,试验(1)组在血液净化开始时抬高双腿30°,持续30 min;试验(2)组在试验(1)组的基础上给予针刺合谷(双侧)、足三里(双侧),施以"烧山火"手法后留针,留针30 min。血液净化开始前及开始30 min后行无创心功能监测,持续时间30 min。观察3组血液净化治疗前和治疗后1 h内平均动脉压,发生低血压次数、血压下降幅度及无创心功能监测各参数变化。结果 3组平均动脉压治疗后与治疗前比较均差异有统计学意义(P <0.05);治疗1 h后,试验(1)组平均动脉压、低血压次数与对照组比较有明显差异(P <0.05);试验(2)组平均动脉压、低血压次数、血压降幅与对照组比较差异显著(P <0.01),低血压次数、血压降幅与试验(1)组比较差异有统计学意义(P <0.05)。无创心功能监测方面,对照组搏出量、收缩时间比例、心室收缩加速度与治疗前比,差异均有统计学意义(P <0.05);试验(1)组和试验(2)组各参数与治疗前比较,无明显差异(P> 0.05)。结论血液净化患者治疗早期均出现不同程度的血压下降,直腿抬高能有效改善低血压状态,配合针刺疗法,疗效更佳,可能是通过增加心输出量,增强心脏做功达到改善血压的目的。Objective:To study the efficacy and mechanism of acupuncture and passive straight leg raising on hypotension in the beginning of blood purification. Methods:A prospective randomized controlled study was conducted,and the subjects were 171 patients admitted to ICU of Xiyuan Hospital of China Academy of Traditional Chinese Medicine from December 2015 to November 2018. According to the inclusion and exclusion criteria,all patients were randomly divided into the experimental group 1 of 57 cases,the experimental group 2 of 59 cases and the control group of 55 cases. All patients were take CVVH mode. The control group received routine blood purification treatment,while group 1 raised both legs for 30 minutes at the beginning of blood purification. On this basis,group 2 was given needling at Hegu and Zusanli,and applying the "burning mountain fire" technique,and the needle was retained for 30 minutes. The mean arterial pressure,the frequency of hypotension,the decrease of blood pressure and the changes of parameters of noninvasive cardiac output were observed before and within 1 hour after treatment. Results:The mean arterial pressure of the 3 groups before and after treatment had statistical significance(P < 0.05). After 1 hour′s treatment,the mean arterial pressure and the frequency of hypotension in group 1 were significantly different from those in the control group(P < 0.05). The mean arterial pressure,the times of hypotension and the decreasing range of blood pressure in group 2 were significantly different from those in the control group(P < 0.01);the times of hypotension and the decrease of blood pressure were significantly different from group 1(P < 0.05). As for non-invasive cardiac output,compared with before treatment,there were significant differences in stroke volume,systolic time ratio and ventricular systolic acceleration in the control group(P < 0.05). There was no statistical difference in the parameters of group 1 and group 2 before and after treatment.Conclusion:In the early stage of blood purifica

关 键 词：血液净化治疗 低血压 针刺 被动直腿抬高 

分 类 号：R544.2[医药卫生—心血管疾病]