辰时针刺辅助治疗非杓型原发性高血压疗效观察

Therapeutic effect of adjuvant treatment of acupuncture in a period of day from 7:00 am to 9:00 am on non-dipper essential hypertension

目的:比较辰时针刺配合西药与单纯西药治疗对非杓型原发性高血压患者血压昼夜节律的影响。方法:将70例非杓型原发性高血压患者随机分为针药组(35例,脱落2例)和西药组(35例)。西药组晨起口服马来酸左旋氨氯地平片,每次2.5 mg,每日1次;针药组在西药组治疗基础上予辰时(7:00-9:00)针刺治疗,穴取风池、中脘、天枢、合谷、曲池、足三里等,每日1次,每周5次,两组均治疗4周。观察两组治疗前后的诊室血压、24 h动态血压、血清褪黑素(MT)和5-羟色胺(5-HT)含量。结果:针药组降压总有效率为75.8%(25/33),优于西药组的54.3%(19/35,P<0.05)。两组患者治疗后均能降低患者24 h平均收缩压(24 h ASBP)、白天平均收缩压(DASBP)、白天平均舒张压(DADBP)、夜间平均收缩压(NASBP)(P<0.05),针药组降低以上4项的效果更明显(P<0.05)。两组患者治疗后血清MT升高、5-HT降低(P<0.05),且针药组血清MT高于西药组、5-HT低于西药组(P<0.05)。结论:辰时针刺配合西药治疗能有效降低非杓型原发性高血压患者的血压,调节血清MT与5-HT水平从而维持血压昼夜节律,疗效优于单纯西药治疗。

Objective To compare the infuences on circadian rhythm of blood pressure in the patients with non-dipper essential hypertension between the combined treatment of time acupuncture and western medication and the simple western medication. Methods A total of 70 patients with non-dipper essential hypertension were randomized into an acupuncture plus western medication group(35 cases, 2 cases dropped out) and a western medication group(35 cases). In the western medication group, levamlodipine maleate tablets were taken orally, 2.5 mg each time, once daily. In the acupuncture plus western medication group, on the base of the treatment as the western medication group, acupuncture was applied specially in the period of the day from 7:00 am to 9:00 am. The acupoints included Fengchi(GB 20), Zhongwan(CV 12), Tianshu(ST 25), Hegu(LI 4), Quchi(LI 11), Zusanli(ST 36), etc. Acupuncture was given once daily, 5 treatments a week. The duration of treatment in the two groups was 4 weeks. The clinic blood pressure before and after treatment, 24 h ambulatory blood pressure and the levels of serum melatonin(MT) and 5-serotonin(5-HT) were observed in the two groups. Results The total effective rate of anti-hypertension was 75.8%(25/33) in the acupuncture plus western medication group, better than 54.3%(19/35) in the western medication group(P<0.05). The 24 h average systolic blood pressure, the daytime average systolic blood pressure, the daytime average diastolic pressure, and the nighttime average systolic blood pressure were all reduced after treatment in the two groups(P<0.05). The reduction effect of the aforementioned 4 indexes in the acupuncture plus western medication group was much more obvious as compared with the western medication group(P<0.05). After treatment, the serum level of MT was increased and 5-HT decreased in the patients of two groups(P<0.05). The serum level of MT in the acupuncture plus western medication group was higher than that in the western medication group and the level of 5-HT was lower than the western medication group(P<0.05). Conclusion Time acupuncture therapy in the period of the day from 7:00 am to 9:00 am, combined with western medication effectively reduce blood pressure and regulate the levels of serum MT and 5-HT so as to maintain the circadian rhythm of blood pressure in patients with non-dipper essential hypertension. The therapeutic effect of this combined treatment is superior to simple western medication.