弱激光对老年冠心病患者血流动力学参数的影响(英文)

Effect of low-power laser irradiation on hemodynamics of patients with geriatric coronary heart disease

背景:有报道针刺内关穴对心血管系统有特异的生理效应。采用氦氖激光束替代针刺在内关穴进行照射改善老年冠心病患者的心脏功能。目的:观察氦氖激光内关穴照射对老年冠心病患者循环系统的影响。设计:自身前后对照观察。单位:武警河南省总队医院。对象:2000/2001武警河南省总队医院康复疗养的老年冠心病患者40例。男28例,女12例;年龄66～85岁,平均70岁;病程2～20年;合并原发性高血压15例,高脂血症7例。方法:采用氦氖激光照射内关穴,波长为632.8nm,功率为5mW,15min/穴,1次/d,20次为1个疗程。治疗前、首次治疗后即刻和第1疗程结束后检测血流动力学指标。主要观察指标:①老年冠心病患者氦氖激光照射前后心脏功率参数中心脏总功率、左心室有效功率及左心排指数的变化。②心肌收缩力参数中左室总泵力、左室喷血压、左室有效泵力及射流压力的变化。③冠状动脉循环参数中心肌耗氧量、冠状动脉缺血阈值及心肌柔顺性参数的变化。④心肌弹性模量的变化.结果:纳入老年冠心病患者40例,全部进入结果分析,无脱落者。①首次治疗后与治疗前比较:心脏功率参数(心脏总功率、左心排指数、左室有效功率参数)均降低[(534.086±90.923),(616.587±137.426)J/min;(4.821±0.622),(5.469±1.144)L/min·m2;(116.528±22.476),(136.603±30.796)J/min,P<0.05或P<0.01],冠状动脉循环参数中的心肌耗氧量降低,冠状动脉缺血阈值参数升高[(22.783±4.174),(25.255±6.125)mL/min,(180.108±31.210),(157.031±35.056)g/cm4s2,P<0.01]。②第1疗程结束后与治疗前比较:心脏功率参数心脏总功率降低[(489.291±118.434),(616.587±137.426)J/min,P<0.05],冠状动脉循环参数中心肌耗氧量降低,冠状动脉缺血阈值升高[(22.472±6.011),(25.255±6.125)mL/min,(193.757±51.704),(157.031±35.056)g/cm4s2,P<0.01]。结论:采用氦氖激光照射器将氦氖激光束替代针刺在内关穴进行照射治疗老年冠心病,能发生热效应、生物学效应和电磁场的场效应等,激发“经络”的生理功能,达到改善心脏负荷率和心肌的耗氧量,提高组织的供氧量和利用率,改善冠状动脉舒缩功能,使冠状动脉供血和循环改善。

BACKGROUND: It is reported that there is special physiological effect of Neiguan (Luo-connecting point, P6) acupuncture on the cardiovascular system. Instead of acupuncture, irradiation of the Neiguan point with He-Ne laser can improve the cardiac function of senile patients with coronary heart disease (CHD). OBJECTIVE: To study the effect of irradiation of Neiguan acupoint with He-Ne laser on the circulatory system of senile patients with coronary heart disease. DESIGN: Auto-control study. SETTING: Henan Provincial General Hospital of the Chinese People's Armed Police Force. PARTICIPANTS: Forty senile patients with coronary heart disease hospitalized in the General Hospital of Henan People's Armed Police Force for rehabilitation from 2000 to 2001 were selected. There were 28 males and 12 females, aged from 66 to 85 with the average age of 70. The course of their disease was from 2 years to 20 years. Among the patients, 15 were complicated with essential hypertension and 7 were with hyperlipemia. METHODS: He-Ne laser, with wavelength of 632.8 nm and power of 5 mw, was used to irradiate directly the Neiguan acupoint once a day, 15 minutes in each time and 20 times as a whole course. Indexes of hemodynamics were detected before the treatment, just after the first treatment and after the first course of treatment. MAIN OUTCOME MEASURES: ① Cardiac work total (CWT), left heart work effective (LWE) and left cardiac index (LCI); ② Left heart total pumping force (LTPF), left heart jetting pressure (JP), left heart effective pumping force (LEPF) and pressure of efflux (EPE); ③ Consumption myocardium oxygen (CMO) and coronary compliance (CMR); ④ Modulus of elasticity of the cardiac muscle (VE). RESULTS: All 40 senile patients with coronary heart disease entered the final analysis without any loss. ① Comparison between the first time of post-treatment and the pre-treatment: The data of CWT, LCI, and LWE were decreased [(534.086±90.923), (616.587±137.426) J/minute; (4.821±0.622), (5.469±1.144) L/minute.m2; (116.528±22.476), (136.603 ±30.796) J/minute, P < 0.05 or P < 0.01]. Parameter of CMO was decreased but parameter of CMR was increased [(22.783±4.174), (25.255±6.125) mL/minute, (180.108±31.210), (157.031±35.056) g/cm4s2, P < 0.01]. ② Comparison between post-first course and pretreatment: Parameters of CWT were decreased [(489.291±118.434), (616.587±137.426) J/minute, P < 0.05], those of CMO were also decreased but th ose of CMR were increased [(22.472±6.011), (25.255±6.125) mL/minute, (193.757±51.704), (157.031±35.056) g/cm4s2, P < 0.01]. CONCLUSION: The treatment of coronary heart disease with He-Ne laser beam instead of needling may induce heating effect, biological effect and electromagnetic field, which can excitated the physiological function of meridian in order to improve cardiac load and myocardial oxygen consumption, to increase the oxygen supply and the utilization rate of tissue, improve relaxation-contraction function of coronary artery and promote the blood supply and circulation of coronary artery.