基于无线体温监测技术探讨慢性心力衰竭不同证型穴位温度变化情况及中药治疗效果

Discussion on the acupoint temperature change in patients with different syndrome types of chronic heart failure based on wireless temperature monitoring technology

目的通过对慢性心力衰竭患者进行辨证分型,采用无线体温监测技术监测近心端的膻中穴及远心端的双侧跗阳穴24 h温度变化,同时运用中药进行治疗,观察治疗前后穴位温度变化及心功能改善情况,探讨慢性心力衰竭穴位温度变化规律及中药治疗的疗效。方法96例慢性心力衰竭患者,按照中医证型不同分为气虚血瘀证组(31例)、气阴两虚血瘀证组(33例)、阳气亏虚血瘀证组(32例)。三组均采用基本西药治疗,在此基础上,根据专家共识气虚血瘀证组采用保元汤合血府逐瘀汤治疗,气阴两虚血瘀证组采用生脉散合血府逐瘀汤治疗,阳气亏虚血瘀证组采用真武汤合血府逐瘀汤治疗。比较三组治疗前后膻中穴和跗阳穴的24 h平均温度、脑利钠肽(BNP)水平、左心室舒张末期内径(LVEDd)、左室射血分数(LVEF),观察三组治疗前膻中穴与跗阳穴的24 h温度变化情况。结果治疗前,气阴两虚血瘀证组膻中穴、跗阳穴的24 h平均温度分别为(36.50±0.57)、(35.90±0.60)℃,均高于气虚血瘀证组的(36.10±0.65)、(35.50±0.65)℃和阳气亏虚血瘀证组的(36.10±0.80)、(35.20±0.55)℃,差异具有统计学意义(P<0.05);气虚血瘀证组、阳气亏虚血瘀证组膻中穴、跗阳穴的24 h平均温度比较差异无统计学意义(P>0.05)。治疗后,气虚血瘀证组和阳气亏虚血瘀证组膻中穴、跗阳穴的24 h平均温度均高于本组治疗前,差异具有统计学意义(P<0.05);气阴两虚血瘀证组膻中穴、跗阳穴的24 h平均温度治疗前后比较差异无统计学意义(P>0.05)。治疗后,三组膻中穴、跗阳穴的24 h平均温度比较差异无统计学意义(P>0.05)。治疗后,三组BNP水平均较本组治疗前降低,且气阴两虚血瘀证组BNP(558.40±265.60)ng/L低于气虚血瘀证组的(762.20±244.47)ng/L、阳气亏虚血瘀证组的(883.00±286.80)ng/L,差异具有统计学意义(P<0.05);气虚血瘀证组、阳气亏虚血瘀证组BNP水平比较差异无统计学意义(P>0.05)。治疗后,三组LVEDd短于本组治疗前,LVEF高于本组治疗前,且气阴两虚血瘀证组LVEDd(54.70±5.35)mm短于气虚血瘀证组的(57.60±5.10)mm、阳气亏虚血瘀证组的(57.60±5.15)mm,LVEF(56.40±6.80)%高于气虚血瘀证组的(52.20±6.40)%、阳气亏虚血瘀证组的(51.20±6.30)%,差异具有统计学意义(P<0.05);气虚血瘀证组、阳气亏虚血瘀证组LVEDd、LVEF比较差异无统计学意义(P>0.05)。结论慢性心力衰竭证型不同,近心端及远心端的穴位温度也不同,经过中药治疗可改善心功能,同时部分证型穴位温度有变化。

Objective Through syndrome differentiation and classification of patients with chronic heart failure,wireless temperature monitoring technology is used to monitor the 24-h temperature changes of proximal Tanzhong point and distal bilateral Fuyang points.At the same time,traditional Chinese medicine is used in the treatment.The change of acupoint temperature and the improvement of cardiac function before and after treatment are observed,so as to investigate the rule of acupoint temperature change in patients with chronic heart failure and the therapeutic effect of treatment with traditional Chinese medicine.Methods 96 patients with chronic heart failure were divided into a Qi deficiency and blood stasis syndrome group(31 cases),a Qi Yin deficiency and blood stasis syndrome group(33 cases)and a Yang Qi deficiency and blood stasis syndrome group(32 cases)according to different TCM syndrome types.Patients of the three groups were treated with basic Western medicine.In addition,according to the consensus of experts,patients of the Qi deficiency and blood stasis syndrome group received Baoyuan Decoction and Xuefu Zhuyu Decoction,patients of the Qi Yin deficiency and blood stasis syndrome group were treated with Shengmai San and Xuefu Zhuyu Decoction,and patients of the Yang Qi deficiency and blood stasis syndrome group were treated with Zhenwu Decoction and Xuefu Zhuyu Decoction.The 24-h average temperature of Tanzhong point and Fuyang point,the level of brain natriuretic peptide(BNP),the left ventricular end diastolic diameter(LVEDd)and left ventricular ejection fraction(LVEF)before and after treatment were compared among the three groups.The 24-h temperature changes of Tanzhong point and Fuyang point before and after treatment were observed.Results Before treatment,the 24-h average temperature of Tanzhong point and Fuyang point in patients of the Qi Yin deficiency and blood stasis syndrome group were(36.50±0.57)and(35.90±0.60)℃,respectively,which were higher than(36.10±0.65)and(35.50±0.65)℃of the Qi deficiency and blood stasis syndrome group and(36.10±0.80)and(35.20±0.55)℃of the Yang Qi deficiency and blood stasis syndrome group,respectively;and the differences were statistically significant(P<0.05).The difference in 24-h average temperatures of Tanzhong point and Fuyang point in patients between the Qi deficiency and blood stasis syndrome group and the Yang Qi deficiency and blood stasis syndrome group were not statistically significant(P>0.05).After treatment,the 24-h average temperatures of Tanzhong point and Fuyang point in patients of the Qi deficiency and blood stasis syndrome group and the Yang Qi deficiency and blood stasis syndrome group were higher than their own 24-h average temperatures of Tanzhong point and Fuyang point before treatment,respectively;and the differences were statistically significant(P<0.05).The differences in 24-h average temperatures of Tanzhong point and Fuyang point in patients of the Qi Yin deficiency and blood stasis syndrome group before and after treatment were not statistically significant(P>0.05).After treatment,the differences in 24-h average temperatures of Tanzhong point and Fuyang point in patients among the three groups were not statistically significant(P>0.05).After treatment,the levels of BNP in patients of the three groups were lower than their own levels of BNP before treatment;and BNP level in patients of the Qi Yin deficiency and blood stasis syndrome group was(558.40±265.60)ng/L,which was lower than(762.20±244.47)ng/L of the Qi deficiency and blood stasis syndrome group and(883.00±286.80)ng/L of the Yang Qi deficiency and blood stasis syndrome group,and the differences were statistically significant(P<0.05);the difference in BNP level between the Qi deficiency and blood stasis syndrome group and the Yang Qi deficiency and blood stasis syndrome group was not statistically significant(P>0.05).LVEDd of the three groups after treatment were shorter than their own LVEDd before treatment.LVEF of the three groups after treatment were higher than their own LVEF before treatment.After treatment,LVEDd of the Qi Yin deficiency and blood stasis syndrome group was(54.70±5.35)mm,which was shorter than(57.60±5.10)mm of the Qi deficiency and blood stasis syndrome group;LVEF of the Yang Qi deficiency and blood stasis syndrome group was(56.40±6.80)%,which was higher than(52.20±6.40)%of the Qi deficiency and blood stasis syndrome group and(51.20±6.30)%of the Yang Qi deficiency and blood stasis syndrome group,respectively;and the the differences were statistically significant(P<0.05).The differences in LVEDd and LVEF between the Qi deficiency and blood stasis syndrome group and the Yang Qi deficiency and blood stasis syndrome group were not statistically significant(P>0.05).Conclusion The temperatures at the proximal and the distal points in patients with different types of chronic heart failure are different.After receiving the traditional Chinese medicine treatment,their heart function can be improved with changes in acupoint temperature in patients in some syndrome types.