针刺联合西药治疗心血瘀阻型胸痹的疗效观察及对血栓弹力图结果的影响

Observation of the therapeutic effect of acupuncture combined with Western medicine in the treatment of chest bi-impediment of heart vessels stasis pattern and its influence on the results of thrombelastography

目的 观察针刺联合西药治疗心血瘀阻型胸痹的临床疗效及对血栓弹力图结果的影响。方法 选取心血瘀阻型胸痹患者共200例,随机分为对照组和试验组,每组100例。对照组给予常规西药治疗,试验组在对照组基础上针刺内关穴。采用超声心动图检测患者治疗前后的心功能指标,包括左心室射血分数(left ventricular ejection fraction, LVEF)、左室舒张末期内径(left ventricular end diastolic diameter, LVEDD)和左室收缩末期内径(left ventricular end systolic diameter, LVESD);测定6 min步行距离评估运动耐力;采用血栓弹力图仪分析计算出患者治疗前后凝血活酶生成时间(R值)、凝血时间(K值)、凝固角(Angle值)、血栓最大弹力度(MA值),并比较两组临床疗效。结果 试验组总有效率为93.0%,高于对照组的82.0%(P<0.05)。两组治疗后LVEF显著增高,LVEDD和LVESD显著降低,差异有统计学意义(P<0.05);试验组治疗后LVEF高于对照组,LVEDD和LVESD低于对照组,差异有统计学意义(P<0.05)。两组治疗后6 min步行距离增高(P<0.05),试验组治疗后6 min步行距离高于对照组(P<0.05)。两组治疗后R值和K值升高,Angle值和MA值降低,差异有统计学意义(P<0.05);试验组治疗后R值和K值高于对照组,Angle值和MA值低于对照组,差异有统计学意义(P<0.05)。结论 针刺联合西药治疗心血瘀阻型胸痹可以提高疗效,改善患者心功能,提高患者的运动耐力,改善心血瘀阻证胸痹患者血液的高凝状态,降低血栓形成的风险。

Objective To observe the clinical efficacy of acupuncture combined with Western medicine in the treatment of chest bi-impediment of heart vessels stasis pattern and its influence on the results of thrombelastography.Method A total of 200 patients with chest bi-impediment of heart vessels stasis pattern were randomly divided into a control group and a trial group,with 100 cases in each group.The control group was treated with conventional Western medicine,and the trial group was treated with acupuncture at Neiguan(PC6)in addition to the treatment of the control group.Echocardiography was used to detect the indexes of cardiac function before and after treatment,including left ventricular ejection fraction(LVEF),left ventricular end diastolic diameter(LVEDD)and left ventricular end systolic diameter(LVESD);exercise capacity was assessed by 6-minute walking distance.Thromboelastography was used to analyze and calculate the thromboplastin production time(R value),clotting time(K value),coagulation angle(Angle value),and the maximum elastic force of thrombus(MA value)before and after treatment,and the clinical efficacy of the two groups was compared.Result The total effective rate of the trial group was 93.0%,which was higher than 82.0%of the control group(P<0.05).After treatment,LVEF was significantly increased,LVEDD and LVESD were significantly decreased in both groups and the differences were statistically significant(P<0.05).After treatment,LVEF in the trial group was higher than that in the control group,LVEDD and LVESD were lower than those in the control group,and the differences were statistically significant(P<0.05).After treatment,the 6-minute walking distance of the two groups increased(P<0.05).The 6-minute walking distance after treatment in the trial group was higher than that in the control group(P<0.05).After treatment,the R value and K value of the two groups increased,and the Angle value and MA value decreased,and the differences were statistically significant(P<0.05).After treatment,the R value and K value of the trial group were higher than those of the control group,and the Angle value and MA value were lower than those of the control group,and the differences were statistically significant(P<0.05).Conclusion Acupuncture combined with Western medicine in the treatment of chest bi-impediment of heart vessels stasis pattern can improve the therapeutic effect,cardiac function,exercise endurance,hypercoagulable state of blood,and reduce the risk of thrombosis.