针刺经穴对慢性稳定性心绞痛患者心率变异性的影响

Effects of acupuncture at acupoits on heart rate variability in patients with chronic stable angina pectoris

目的:观察针刺经穴对慢性稳定性心绞痛(CSAP)患者心率变异性(HRV)的影响,探索针刺经穴对心脏自主神经功能的调整效应。方法:采用多中心、随机、对照的方法,选取符合纳入标准的148例患者,包括循经取穴组(A组)37例、他经取穴组(B组)37例、非经非穴组(C组)38例和等待治疗组(D组)36例。4组均给予基础治疗。其中循经取穴组取双侧内关、通里;他经取穴组取双侧孔最、太渊;非经非穴组取双侧非穴1、非穴2;各组均为隔日针刺1次,每周3次,共治疗4周。D组无针刺干预。采用24h动态心电图评价受试者治疗前后HRV(SDNN-24小时、SDNN Index、SDANN Index、rMSSD、pNN50、频域功率-24小时、最小频域功率小时、最大频域功率小时)值的变化。结果:与治疗前比较,针刺经穴(包括A组和B组)HRV时域及频域参数值普遍呈增高趋势,但是治疗前后HRV时域及频域参数值,差异无统计学意义。与D组比较,经穴组(包括A组和B组)在SDNN Index、频域功率-24小时及最小频域功率小时指标上有显著差异(P<0.05)。而C组在HRV时域及频域指标方面与D组相比差异无统计学意义。结论:与针刺前比较,针刺经穴组患者HRV增高,提示针刺后CSAP预后趋优。针刺经穴结合基础治疗,优于单纯基础治疗,可以使CSAP患者HRV增高,具有显著改善心脏自主神经系统张力作用,提示这可能会减少CSAP患者的急性心脏事件和心源性猝死的发生。

Objective:To explore the effects of acupuncture at acupoits on heart rate variability(HRV) in patients with chronic stable angina pectoris(CSAP).Methods:By multi-center,randomized and controlled method,148 patients with CSAP who are meeting the inclusion criteria were divided into 4 groups by the central stochastic system:point selection along meridians group(37 cases,group A),point selection on other meridians group(37 cases,group B),non-acupoint group(38 cases,group C) and waiting list group(36 cases,group D).In group A,patients were received acupuncture on bilateral Neiguan(PC6) and Tongli(HT5).In group B,patients were received acupuncture on bilateral Kongzui(LU6) and Taiyuan(LU9).In group C,patients were received acupuncture on bilateral non-acupoint 1 and non-acupoint 2.In group D,there was no intervention.The same basic treatments were given to each group.Treatment time and frequency was 30 min and 3 times a week at intervals of one day respectively and the treatment lasts for 4 weeks.24-hour Holter monitoring was observed before and after treatment.The autonomic nervous function was investigated by power spectral analysis of heart rate variability(HRV).Results:After the treatment,time domain and frequency domain values of acupuncture at acupoits(combination of group A and B) on HRV generally showed a trend of increase,but there were no significant changes between before and after treatment.In combination of group A and B,SDNN index and frequency-domain power-24-hour were significantly higher than those in group D(P<0.05).There was no significant difference between group C and group D in time domain and frequency domain of HRV.Conclusion:After the treatment,the increased HRV in the patients with acupuncture acupoits in group A and B suggested the potential good prognosis on CSAP after acupuncture at acupoits.The foundation treatment in combination with acupuncture at acupoits was better than that of pure foundation treatment,which could make HRV in patients with CSAP increase and significantly improve the tension of cardiac autonomic nervous system.Acupuncture at acupoits may reduce the incidence of acute cardiac events and sudden cardiac death in patients with CSAP.