刮痧联合中药热熨疗法治疗痰瘀互结证晨峰血压的临床疗效研究

背景　刮痧联合中药热熨疗法，通过医护结合，从整体调节患者气血，促进机体阴阳平衡，或可对控制晨峰血压（MBPS）起到较好的效果。目的　探讨刮痧联合中药热熨疗法治疗痰瘀互结证MBPS的临床疗效。方法　选取2017-06-01至2018-04-01在浙江中医药大学附属第二医院老年病区和脊柱病区住院治疗的MBPS阳性患者90例，采用随机数字法分为试验组和对照组，各45例。对照组每日服用苯磺酸氨氯地平片5 mg；试验组在对照组的基础上每周二、四、六晨起行刮痧，每晚睡前行中药热熨疗法。两组分别于治疗前及治疗1、2、3周后进行动态血压监测，记录晨起2 h收缩压（SBP）和舒张压（DBP）与夜间最低血压的差值，以及中医证候积分。结果　两组晨起2 h SBP、DBP与夜间最低血压的差值比较，差异有统计学意义（P<0.05）；不同时间点比较，差异有统计学意义（P<0.05）；组别和时间在晨起2 h SBP、DBP与夜间最低血压的差值上存在交互作用（P<0.05）。试验组治疗1、2、3周后的MBPS阳性率均低于对照组（P<0.05）。两组中医证候积分比较，差异有统计学意义（P<0.05）；不同时间点比较，差异有统计学意义（P<0.05）；组别和时间在中医证候积分上存在交互作用（P<0.05）。结论　痰瘀互结证MBPS患者在服用苯磺酸左旋氨氯地平片的基础上进行刮痧联合中药热熨疗法，可明显降低MBPS阳性率，改善临床症状。

Curative Effect of Scrapping Combined with Chinese Herbal Hot Compress Therapies on Morning Blood Pressure Surge in Patients with Intermingled Phlegm-blood Stasis Syndrome

Background　Comprehensive regulation of the qi-blood to promote yin-yang balance by a kind of medical intervention of scrapping combined with Chinese herbal hot compress therapies and nursing services，may produce good effect on controlling increased morning blood pressure surge（MBPS）．Objective　To explore the effect of scrapping combined with Chinese herbal hot compress therapies on the difference between peak morning systolic blood pressure（SBP） and nocturnal sleep-time SBP，difference between peak morning diastolic blood pressure（DBP） and nocturnal sleep-time DBP，incidence of increased MBPS and clinical TCM syndrome in patients with intermingled phlegm-blood stasis syndrome.Methods　We enrolled 90 hospitalized patients from Department of Geriatrics and Department of Spine Diseases of the Second Affiliated Hospital of Zhejiang Chinese Medical University from June 1，2017 to April 1，2018.They were equally divided into the control group and experimental group by the random number table，receiving once-daily oral administration of amlodipine besylate tablets 5 mg，once-daily oral administration of amlodipine besylate tablets 5 mg combined with scrapping therapy（on every Tuesday，Thursday and Saturday mornings） and Chinese herbal hot compress therapy before going to bed every day.Ambulatory blood pressure monitoring was performed before treatment and at the end of the 1st，2nd and 3rd weeks of treatment.The difference between peak morning SBP and nocturnal sleep-time SBP，difference between peak morning DBP and nocturnal sleep-time DBP，and clinical TCM syndrome were recorded.Results　The mean difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP differed significantly between two groups（P<0.05）．The difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP between the groups varied significantly by time point（P<0.05）．Treatment regimen and duration had interactive effects on the difference between peak morning SBP and nocturnal sleep-time SBP and that between peak morning DBP and nocturnal sleep-time DBP （P<0.05）．The experimental group showed lower incidence of increased MBPS at the end of the 1st，2nd and 3rd weeks of treatment compared with the control group（P<0.05）．The mean TCM syndrome score varied significantly between the groups（P<0.05）．The TCM syndrome score differed significantly between the groups by time point（P<0.05）．Treatment regimen and duration had interactive effects on the TCM syndrome score（P<0.05）．Conclusion　For patients with intermingled phlegm-blood stasis syndrome and increased MBPS，oral administration of amlodipine besylate tablets in combination with scrapping and Chinese herbal hot compress therapies can significantly reduce the blood pressure，and decrease the incidence of increased MBPS as well as improve the clinical TCM syndrome.