宣肺健脾益肾针刺法对不同程度支气管哮喘患者心率变异性与肺功能的影响

目的:探讨宣肺健脾益肾针刺法治疗支气管哮喘(简称哮喘)作用机理。方法:71例慢性持续期、缓解期哮喘患者,按照哮喘病情严重程度采用分层随机法将观察对象分为治疗组和对照组。对照组31例,平均年龄(45.2±14.6)岁;治疗组40例,平均年龄(47.1±13.1)岁。所有观察对象均继续应用抗哮喘药物,治疗组同时取宣肺健脾益肾穴位:曲池、列缺、鱼际、内关、足三里、三阴交、太溪,以平补平泻法,针刺10次为1疗程,观察不同病情程度哮喘患者针刺治疗前后心率变异性(Heartratevariability,HRV)频域指标与肺功能变化。结果:针刺治疗后间歇状态、轻度与中度、重度哮喘患者肺功能均出现增高,HRV测定表明评价整个自主神经对心率调控作用的总功率(TP)、HRV三角指数(HRVtriangularindex)出现提高,包括低频功率(LF)、规一化的低频功率(LFnorm)等在内的反映交感神经功能的指标均出现增高,反映副交感神经功能状态的高频功率(HF)、相邻NN间期限的差值超过50ms的心搏数占NN间期的总心搏数百分比[PNN50(%)]也出现升高。结论:针刺治疗可提高不同病情程度哮喘患者的肺功能,其作用机理可能与自主神经调节功能的改善有关。

Effects of Acupuncture on the Pulmonary Function and Heart Rate Variability in Different State of Bronchial Asthma

Objective:To observe the underlying mechanism of acupuncture technique for ventilating the lung,invigorating the spleen and tonifying the kidney in the treatment of bronchial asthma(or asthma for short).Methods:According to the severity of the disease during the persistent stage and paracmasis,71 outpatients and inpatients were randomized into treatment group(n=40)and control group(n=31).Patients of treatment group were treated with acupuncture of Quchi(LI 11),Lieque(LU 7),Yuji(LU 10),Neiguan(PC 6),Zusanli(ST 36),Sanyinjiao(SP 6),Taixi(KI 3),etc.,once daily and those of control group treated with anti-asthma drugs as Cromolyn sodium,Albuterol,fenoterol,etc.Before and after 12 days of the treatment,heart rate variability(HRV)and pulmonary function were detected respectively.Results:In paracmasis and mild type asthma patients,self-comparison indicated that after the treatment,total power(TP),very low frequency(VLF),triangular index(TI)and the percentage of the adjacent R-R intervals(PNN50)of HRV,and forced expiratory volume in the first second(FEV1)(%PRED),forced expiratory flow(FEF)0.2-1.2(L/s),FEF75%-85%(L/s),peak expiratory flow(PEF)(%PRED),FEF25%(%PRED)in treatment group increased significantly(P<0.05,0.01),while no significant changes of various components of both HRV and pulmonary function were found in control group(P>0.05).Comparison between two groups showed that after the treatment,the values of TP,VLF,TI and PNN50 of HRV,and FVC(%PRED),FEV1(%PRED),FEV1/FVC(%PRED),FEF0.2-1.2,FEF25%-75%,PEF(%PRED)and FEF25%(%PRED)in treatment group were significantly higher than those in control group(P<0.05).In moderate and severe type asthma patients,self-comparison showed that after the treatment,TP,LF,LFnorm,VLF,LF/HF,VLF/HF,(LF VLF)/HF,TI and PNN50 of HRV,and FVC(%PRED),FEV1(%PRED),FEV1/FVC(%PRED),FEF0.2-1.2,FEF25%-75%(%PRED),FEF75%-85%,PEF(%PRED),FEF25%(%PRED),FEF50%(%PRED and FEF75%(%PRED)of the pulmonary function all increased remarkably(P<0.05,0.01,0.001);while in comparison with control group,LF,LFnorm,VLF,(LF VLF)/HF and TI of HRV,and all the parameters of the pulmonary function except FEV1/FVC were significantly higher than those in control group(P<0.05,0.01,0.001).No significant changes of various components of both HRV and pulmonary function were found in control group(P>0.05).Conclusion:Acupuncture is significantly superior to medication in improving the pulmonary function of asthma patients with different state of disease,which is related to its function in regulating activities of the autonomic nervous system.