不同针刺方法治疗稳定型心绞痛的临床观察

Clinical observation on the treatment of stable angina pectoris by different acupuncture methods

目的:比较揿针和电针治疗稳定型心绞痛(SAP)的疗效、生活质量差异。方法:将90例SAP患者随机分为对照组、电针组及揿针组,每组30例,对照组予阿司匹林肠溶片100 mg(不耐受者替换为硫酸氢氯吡格雷片75 mg)、美托洛尔缓释片47.5 mg、阿托伐他汀钙片20 mg口服,每日1次;电针组在对照组基础上予电针(双侧内关、通里)治疗;揿针组在对照组基础上予揿针(单侧内关、通里及同侧耳穴心、交感、神门、皮质下)治疗;两针刺组隔日1次,3次/周,共治疗4周。评价临床疗效、心电图疗效,比较治疗前及治疗后第0、4、8周VAS、SAQ评分。结果:与对照组比较,电针组和揿针组在临床疗效、心电图疗效方面有效率均显著升高(P<0.05)。与本组治疗前比较,3组治疗后第0、4、8周VAS评分均显著降低(P<0.01),SAQ总分均显著升高(P<0.01,P<0.05);与本组治疗后第0周比较,电针组治疗后第4、8周SAQ总分显著降低(P<0.05,P<0.01),揿针组治疗后第8周SAQ总分显著降低(P<0.01);与对照组同期比较,电针组和揿针组治疗后第0、4、8周VAS评分均显著降低(P<0.05);治疗后第8周,揿针组SAQ总分显著高于电针组(P<0.01)。结论:在西药治疗基础上加用揿针或电针治疗能明显提高疗效和SAP患者生活质量;揿针与电针在临床疗效、心电图疗效、VAS评分上效果相当。

Objective:To compare the curative effect and quality of life of patients with Stable Angina Pectoris(SAP)treated by press-needle and electroacupuncture.Methods:A total of 90 cases of SAP patients were randomly divided into control group,electroacupuncture group and press-needle group,30 cases in each group.Control group were given aspirin enteric-coated tablet 100 mg(patients with intolerance were given Clopidogrel Bisulfate Tablet 75 mg);Metoprolol Sustained-release Tablets 47.5 mg;Atorvastatin 20 mg.On the basis of the control group,electroacupuncture[bilateral Neiguan(PC 6),Tongli(HT 5)]was added for treatment in electroacupuncture group;On the basis of the control group,press-needle[unilateral Neiguan(PC 6),Tongli(HT 5)and ipsilateral auricular acupoint heart,sympathetic,shenmen,subcortical]was added in press-needle group.The two acupuncture groups were treated 3 times/week,once every other day for 4 weeks.Clinical efficacy,electrocardiogram efficacy were evaluated,and VAS and SAQ scores were evaluated before and at 0,4 and 8 weeks after treatment.Results:Compared with the control group,the clinical efficacy and electrocardiogram efficacy of the press-needle group and electroacupuncture group were significantly increased(P<0.05).Compared with before treatment,VAS scores in 3 groups were significantly decreased at 0,4 and 8 weeks after treatment(P<0.01),and total SAQ scores were significantly increased(P<0.01,P<0.05).Compared with week 0 after treatment,the total score of SAQ in the electroacupuncture group was significantly decreased at week 4 and 8 after treatment(P<0.05,P<0.01),and the total score of SAQ in the acupuncture group was significantly decreased at week 8 after treatment(P<0.01).Compared with control group in the same period,VAS score in the electroacupuncture group and press-needle group were significantly decreased at 0,4 and 8 weeks after treatment(P<0.05).At the 8th week after treatment,the total score of SAQ in the press-needle group was significantly higher than that in the electroacupuncture group(P<0.01).Conclusion:On the basis of western medicine treatment,the addition of press-needle or electroacupuncture can significantly improve the curative effect and quality of life of SAP patients;The clinical efficacy,electrocardiogram efficacy and VAS scores of press-needle were similar to those of electroacupuncture.