眼针带针运动对经皮冠状动脉介入术治疗患者术后心率变异性及预后的影响研究  

Effect of Ocular Acupuncture and Exercise Combination Therapy on Postoperative Heart Rate Variability and Prognosis of Patients Treated with Percutaneous Coronary Intervention

作　　者：张迪 李鸿鹏 马江 聂谦[4] 孙剑峰[1] 吴志鹏[1] 张宏才[4] 赵珏[4] ZHANG Di;LI Hongpeng;MA Jiang;NIE Qian;SUN Jianfeng;WU Zhipeng;ZHANG Hongcai;ZHAO Jue(Department of Rehabilitation,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China;School of Medicine and Life Science,Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China;Rehabilitation Department,Southwest Hospital of Army Medical University,Chongqing 400038,China;Department of Cardiology,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610072,China)

机构地区：[1]成都中医药大学附属医院康复科,四川省成都市610072 [2]成都中医药大学医学与生命科学院,四川省成都市610075 [3]陆军军医大学西南医院康复科,重庆市400038 [4]成都中医药大学附属医院心血管二科,四川省成都市610072

出　　处：《中国全科医学》2023年第36期4535-4544,共10页Chinese General Practice

基　　金：四川省中医药管理局项目(2020LC0081);成都中医药大学“杏林学者”项目(MPRC2021044);成都中医药大学附属医院科研项目(20ZL02)。

摘　　要：背景已知心率变异性(HRV)是评价心脏自主神经功能的非侵入性指标,常用于评估冠状动脉病变短期预后。经皮冠状动脉介入治疗(PCI)是一种常用的冠状动脉病变手术方式,但术后常见恶性心律失常、复发性心肌梗死等主要不良心血管事件(MACE),双联抗血小板治疗(DAPT)虽可在一定程度上减少MACE发生,但易合并消化道出血,不能持续有效地改善PCI预后。而眼针可有效减少胸痛持续时间和频率,运动疗法可增强心脏和血管功能,二者相结合的眼针带针运动在PCI术后的应用有待探索。目的探讨眼针带针运动对冠心病(CHD)患者PCI后HRV及预后的影响。方法选取2021年9月—2022年8月在成都中医药大学附属医院就诊的32例PCI后中、低危的CHD患者为研究对象。按1∶1的分配比例随机分为眼针带针运动组或药物治疗组。眼针带针运动组在双联抗血小板治疗的基础上加以眼针带针运动,药物治疗组仅接受双联抗血小板治疗,两组受试者均完成了2周干预。收集患者以下资料:(1)基线指标:包括性别、年龄、身高、体质量、血压、呼吸频率、介入治疗的时间间隔、教育水平、职业、冠状动脉病变严重程度、患基础疾病数量。(2)主要指标:采用24 h动态心电图评价PCI后24 h内和2周干预结束当天HRV。记录全部正常窦性心搏RR间期的标准差(SDNN)、24 h内每5 min RR间期平均值的标准差(SDANN)、24 h内每5 min内RR间期标准差的平均值(SDNN index)、相邻RR间期差值均方的平方根(rMSSD)、相邻RR间期相差>50 ms的个数占总心跳次数的百分比(PNN50)、高频(HF)、低频(LF)、低频/高频比值(LF/HF)。采用MACE评估干预后2、4、8周的预后。通过电话和门诊会诊记录心源性或全因死亡、恶性心律失常如室性心动过速和心室颤动、重度心力衰竭、复发性心肌梗死、再次PCI、胸痛等情况。(3)次要指标:C反应蛋白(CRP)、N末端脑钠肽�Background Heart rate variability(HRV)is commonly used to evaluate the short-term prognosis of coronary artery diseaseas a well-known non-invasive indicator of cardiac autonomic function.Percutaneous coronary intervention(PCI)is a commonly usedsuigical treatment of coronary artery disease,however,major adverse cardiac event(MACE)such as malignant arrhythmias and recurrent myocardial infarction are common after suigical treatment.Although dual antiplatelet therapy(DAPT)can reduce the occurrence of MACE to a certain extent,it is prone to be complicated with gastrointestinal bleeding,and unable to consistently improve the prognosis of PCI.Ocular acupuncture can effectively reduce the duration and frequency of chest pain,and exercise therapy can enhance the function of heart and blood vessels.The application of ocular acupuncture and exercise combination therapy(OAECT)after PCI remains to be explored.Objective To investigate the effect of OAECT on postoperative heart rate variability and prognosis of patients treated with PCI.Methods A total of 32 CHD patients after PCI with moderate and low risk attending Hospital of Chengdu University of Traditional Chinese Medicine were selected and randomly divided into the OAECT group and drug treatment group in a 1∶1 allocation ratio.Patients in the OAECT group received OAECT in addition to DAPT,patients in the drug treatment group received DAPT alone,patients in both 2 groups completed the 2-week intervention.The data of patients was collectedas follows:(1)Baseline indicators:gender,age,height,weight,blood pressure,respiratory rate,interval between onset and intervention,education level,occupation,severity of coronary artery disease,and number of underlying diseases.(2)Main indicators:HRV within 24 h after PCI and on the day of the end of 2-week intervention,including the standard deviation of all normal to normal RR intervals(SDNN),standard deviation of all 5-minute RR intervals(SDANN),mean of the standard deviation of all NN intervals for all 5-min segment of 24 hours(SDNN

关 键 词：冠心病 经皮冠状动脉介入治疗 眼针疗法 眼针带针运动 心率变异性 主要不良心血管事件 随机对照试验 

分 类 号：R541.4[医药卫生—心血管疾病]