通过脉搏指数连续心输出量监测技术观察针刺对急性心力衰竭患者的影响

目的观察针刺对急性心力衰竭（acuteheartfailure，AHF）的影响。方法随机将60例诊断为AHF的患者分为针刺治疗组和西医对照组，每组30例。西医对照组给予增强心肌收缩力、减轻心脏前后负荷、抗感染等对症治疗；针刺治疗组在西医治疗基础上针刺相关经络穴位，每天1次，连续针刺5天。两组患者均通过脉搏指数连续心输出量（pulse—indicatedcontinuouscardiacoutput，PiCCO）监测有创平均动脉压（MAP）、心率（HR）、心脏指数（C1）、每搏输出量指数（SI）、左心做功指数（LCWI），比较治疗前后上述指标的变化，比较两组患者lCU住院时间、再次住院率及28天病死率。结果两组治疗5天后，CI、Sl、LCWI较治疗前明显升高（P〈0．01），HR、MAP较治疗前下降（P〈0．05），其中，针刺治疗组CI、SI、LCWI升高更为明显（P〈0．05），而两组HIR、MAP改善差异无统计学意义（P〉0．05）。与本组入院第1天相比较，针刺治疗组Cl、Sl、LCWl从第2天开始出现明显升高，HR从第4天出现下降，MAP从第5天出现下降，差异均有统计学意义（P〈0．05）；而西医对照组中CJ、SI、LCWJ从第3天开始升高，HIR、MAP均从第5天出现下降，差异均有统计学意义（P〈0．05）。与西医对照组比较，针刺治疗组ICU住院时间明显缩短（P〈0．05），再次住院率及28天病死率均低于对照组（P〈0．05）。结论西医结合针刺治疗可能增强AHF患者的心功能，提高治疗效果，改善预后。

Effect of Acupuncture on Acute Left Heart Failure by PiCCO Technique

Objective To observe the clinical effect of acupuncture on acute heart failure （AHF） patients. Methods Totally 60 patients who were diagnosed as AHF were assigned to the acupuncture group and the control group, 30 in each group. Those in the control group received inotropic agents, pre- load and afterload reducing therapy, anti-infection and so on. Besides, those in the acupuncture group re- ceived needling at relative points, once daily for 5 consecutive days. The mean arterial pressure （MAP）, heart rate （HR）, cardiac index （CI）, stroke volume index （SI）, left ventricle working index （LCWI） were monitored by thermodilution pulse-indicated continuous cardiac output （PiCCO） technique. Changes of the aforesaid data were compared between before and after treatment. The ICU length of stay, readmission rate,and the 28-day mortality were also compared between the two groups. Results After 5 days of the treatment, CI, SI, and LCWI increased more obviously （P 〈 0.01 ）, HR and MAP decreased significantly （P 〈0.05）. Of them, CI, SI, and LCWl increased more obviously in the acupuncture group （P 〈0.05）. There was no obvious difference in HR or MAP between the two groups （P 〉0.05）. Compared with the first day of admission in the same group, CI, SI, and LCWl obviously increased in the acupuncture group from the sec- ond day （P 〈0.05）. HR started to decrease since the fourth day （P 〈0.05）, and MAP began to decreaseuntil the fifth day （P 〈0.05）. CI, SI, and LCWI started to increase in the control group from the third day （P 〈0.05） ; HR and MAP both began to decrease since the fifth day （P 〈0.05）. Compared with the control group, the ICU length of stay was obviously shortened in the acupuncture group （P 〈0.05）. The readmis- sion rate and the 28-day mortality rate were lower than those of the control group （P 〈0.05）. Conclusion The combination of acupuncture and Western medical therapy might strengthen acute heart failure patients＇ heart functions, elevate the therapeutic effect, and improve the prognosis.