超激光照射星状神经节对冠心病患者心电图和血压及心率的影响

Influences of super laser irradiation at stellate Ganglion on the electrocardiogram, blood pressure and heart rate of patients with coronary heart disease

目的:对比观察冠心病患者和健康者经超激光照射星状神经节治疗后脉搏、血压和心电图多项指标的变化,评估超激光照射星状神经节对冠心病患者的治疗效果。方法:①选择2004-12/2005-04在深圳市第二人民医院体检及在心内科门诊就诊的冠心病患者18例,男7例,女11例。患者均知情同意。随机将患者分为2组:照射左侧星状神经节治疗组(n=8)及口服药物治疗组(n=10)。同期选择本院医务人员18人作为对照组,均无基础心脏病,且知情同意。随机分为2组:照射左侧星状神经节对照组(n=9)和照射右侧星状神经节对照组(n=9)。②采用超激光疼痛治疗仪行超激光照射星状神经节,输出功率80%,照射周期为2s,停2s,照射10min,至感到头部有温热舒适感,或出现霍纳氏征。口服药物组患者仰卧休息10min后,口服硝酸异山梨醇5mg。③所有受试者分别在超激光照射星状神经节和口服药物前,以及超激光照射星状神经节和口服硝酸异山梨醇后10和30min测量并记录心率、血压,计算心率收缩压乘积;由专业人员用心电图机描记12导联心电图,测量并分析QT间期的变化。测得的QT值按Bazett公式,用R-R间期的平方数除实测的QT值,即得校正的QT间期,并以最大QT与最小QT之差计算QT离散度。④计量资料差异性测定采用t检验。结果:冠心病患者18例和健康者18人均进入结果分析。①心电图各项指标变化:左侧星状神经节治疗组在干预后10和30minQT离散度较治疗前明显减少犤(31±10),(30±12),(40±6)ms,P<0.05犦。左侧星状神经节治疗组和口服药物治疗组干预后30min校正的QT间期明显低于干预前犤(397±10),(391±29)ms;(401±10),(402±41)ms,P<0.05犦。其他组的QT离散度在治疗后也有减少,但差异不明显(P>0.05)。②干预后30min左侧星状神经节治疗组、左侧星状神经节对照组和右侧星状神经节对照组的心率明显比治疗前减慢犤(75±8),(76±6),(76±5)次/min;(82±4),(82±4),(84±4)次/min,P<0.05犦。干预后10min右侧星状神经节对照组心率明显比治疗前减慢犤(76±5),(84±4)次/min,P<0.05犦。干预后10和30min各组平均动脉压和心率收缩压乘积与治疗前接近(P>0.05)。结论:使用超激光照射左侧星状神经节可以减少心肌的QT离散度,改善冠心病患者的心肌缺血。

AIM： To compare and observe changes of pulse, blood pressure andelectrocardiogram in patients with coronary heart disease and healthy people after super laser irradiation at stellate ganglion, and evaluate the therapeutic effect of super laser irradiation at stellate ganglion on coronary heart disease. METHODS： ① Eighteen physical examinees and patients with coronary heart disease （7 males and 11 females） in the Department of Cardiology, Shenzhen Second People＇s Hospital between December 2004 and April 2005 participated in the study voluntarily, they were randomly divided into irradiation at left stellate ganglion treated group （n=8） and oral medication treated group （n=10）. Eighteen medical staff without basic heart disease in the hospital at the same period were taken as the control group voluntarily, and they were randomly divided into irradiation at left stellate ganglion control group （n=9） and irradiation at right stellate ganglion control group （n=9）. ② The super laser ache therapeutic equipment was used for super laser irradiation at stellate ganglion, the output power was 80%, the irradiation cycle was 2 s with an interval of 2 s for l0 minutes until head felt warm and heat comfortable feeling or Homer＇s syndrome occurred. The patients in the oral medication group took 5 mg isosorbide dinitrate orally after a 10-minute rest laying on the back. ③ The heart rate and blood pressure were measured in all the subjects before and 10 and 30 minutes after the irradiation and oral medication respectively, the multiplication of heart rate and systolic pressure was calculated. The changes of QT interval was measured and analyzed with cardiofax tracing 12-leadel ectrocardiagram by professional staff. The corrected QT interval was calculated with the formula of Bazett： （R-R interval）2/QT value; The QT dispersion was calculated with the difference value between the maximal QT value and minimal QT value. ④ The difference of the measured data was analyzed with the t test. RESULTS： All the 18 patients with coronary heart disease and 18 healthy controls were involved in the analysis of results. ① The changes of electrocardiographic indexes： In the irradiation at left stellate ganglion treated group, the QT dispersions at 10 and 30 minutes after intervention were obviously decreased as compared with that before intervention [（31 ± 10）,（30±12）, （40±6） ms, P 〈 0.05]. The corrected QT intervals at 30 minutes after intervention in the irradiation at left stellate ganglion treated group and oral medication group were obviously lower than those before intervention [（397±10）, （391±29） ms; （401±10）, （402±41） ms, P 〈 0.05]. The QT dispersions in the other groups were insignificantly decreased after intervention （P 〉 0.05）. ② The heart rates at 30 minutes after interventionin the irradiation at left stellate ganglion treated group and irradiation at left and right stellate ganglion control groups were obviously slower than those before intervention [（75±8）, （76±6）, （76±5） beats per minute; （82±4）, （82±4）, （84±4） beats per minute, P 〈 0.05]. The heart rate in the irradiation at right stellate ganglion control group at 10 minutes afterintervention was obviously lower than that before intervention [（76±5）, （84±4）beats per minute, P 〈 0.05]. At 10 and 30 minutes after intervention, the mean arterial blood pressure and the multiplication of heart rate and systolic pressure were close to those before treatment （P 〉 0.05）. CONCLUSION： Super laser irradiation at left stellate ganglion can reduce the myocardial QT dispersion, and ameliorate the myocardial ischemia of patients with coronary heart disease.