电针对稳定期慢性阻塞性肺疾病患者小气道功能的影响

Effect of electroacupuncture on small airway function in patients with stable chronic obstructive pulmonary disease

目的:观察电针对稳定期慢性阻塞性肺疾病(COPD)患者小气道功能及运动耐量的调节作用。方法:将62例稳定期COPD患者随机分为观察组(31例,脱落1例)和对照组(31例,脱落5例)。两组均在规范用药及有氧运动基础上采用电针治疗,穴取膻中、乳根、关元、中脘、天枢、膺窗。观察组用毫针,直刺3 mm;对照组用安慰针,不刺入皮下,均连接低频电子脉冲治疗仪,连续波,频率2 Hz,每次30 min,隔日1次,每周3次,共治疗14次。比较两组患者治疗前后肺功能指标[第1秒用力呼气容积(FEV1)、用力肺活量(FVC)、第1秒用力呼气容积占用力肺活量的比值(FEV1/FVC)、最大自主通气量(MVV)、余25%肺活量的最大呼气流速(MEF25)、余50%肺活量的最大呼气流速(MEF50)、余75%肺活量的最大呼气流速(MEF75)占预计值百分比]、运动心肺功能指标[代谢当量(METs)、公斤摄氧量(VO2/kg)、每分钟通气量(VE)、氧脉搏(VO2/HR)占预计值百分比及每分钟最大通气量(VEmax)、氧通气当量(VE/VO2)、二氧化碳通气当量(VE/VCO2)]、6分钟步行距离(6MWD)、慢性阻塞性肺疾病评估测试(CAT)总分、改良英国医学研究学会呼吸困难(mMRC)评分及COPD综合分级的变化。结果:观察组治疗后FVC%、MVV%、MEF75%、MEF50%、VO2/kg%、METs%、VEmax、VO2/HR%、6MWD、CAT总分较治疗前改善(P<0.05,P<0.01);对照组治疗后MEF75%、CAT总分较治疗前降低(P<0.05)。治疗后观察组MVV%、MEF50%、VO2/kg%、METs%、VEmax、6MWD优于对照组(P<0.05,P<0.01)。结论:电针可通过改善小气道阻塞、通气量提升COPD患者的呼吸功能及运动耐量。

Objective To observe the regulatory effect of electroacupuncture(EA) on small airway function and exercise tolerance in patients with stable chronic obstructive pulmonary disease(COPD). Methods A total of 62 patients with stable COPD were randomized into an observation group(31 cases, 1 case dropped off) and a control group(31 cases, 5 cases dropped off). On the base of routine medication and aerobic exercise, the patients of the two groups all received EA at Danzhong(CV 17), Rugen(ST 18), Guanyuan(CV 4), Zhongwan(CV 12), Tianshu(ST 25) and Yingchuang(ST 16). In the observation group, filiform needles were used and inserted perpendicularly, 3 mm in depth. In the control group, the placebo needling method was performed, in which the needle was not inserted through skin at each point. In both groups, electric stimulation with low-frequency electronic pulse instrument was exerted, with continuous wave, 2 Hz in frequency, lasting 30 min each time in the two groups. The treatment was given once every other day, 3 times a week, for 14 treatments totally. Before and after treatment, the following indexes were compared in patients between the two groups, i.e. the lung function indexes(forced expiratory volume in first second [FEV1], forced vital capacity [FVC], the ratio of FEV1 to FVC [FEV1/FVC], maximal voluntary ventilation [MVV], the percentage of maximal expiratory flow [MEF] at 25% of FVC exhaled [MEF25], MEF50 and MEF75 in predicted value), cardiopulmonary exercise test indexs(metabolic equivalent [METS], oxygen uptake per kg body weight [VO2/kg], minute ventilation [VE], the percentage of oxygen pulse [VO2/HR] in predictd value, maximal minute ventilation [VEmax], ventilatory equivalent for oxygen [VE/VO2], ventilatory equivalent for carbon dioxide [VE/VCO2]), 6-minute walk distance(6 MWD), the total score of COPD assessment test(CAT), the modified British Medical Research Council(mMRC) score and COPD comprehensive grade. Results After treatment, FVC%, MVV%, MEF75%, MEF50%, VO2/kg%, METs%, VEmax, VO2/HR%, 6 MW and the total CAT score were all improved as compared with those before treatment in the observation group(P<0.05, P<0.01). After treatment, MEF75% and the total CAT score were reduced as compared with those before treatment in the control group(P<0.05). After treatment, MVV%, MEF50%, VO2/kg%, METs%, VEmax and 6 MWD in the observation group were all better than those in the control group(P<0.05, P<0.01). Conclusion Electroacupuncture can improve the respiratory function and exercise tolerance in COPD patients through removing small airway obstruction and increasing ventilation.