【摘要】 目的观察循经叩刺、温针灸足三里、悬钟联合稳心颗粒治疗急性脑血管疾病所致脑源性心律失常的疗效及作用机制探讨。方法将126例急性脑血管疾病所致脑源性心律失常患者随机分为观察组64例及对照组62例,对照组给予西医常规治疗,观察组在对照组治疗基础上给予循经叩刺、温针灸足三里、悬钟联合稳心颗粒治疗,疗程为14 d;记录2组治疗期间不同时期心电图异常率的变化,观察2组治疗前后心律失常发生种类和发生率、相关生化指标、神经缺损评分的变化,随访3个月时预后情况。结果 2组治疗3 d、5 d、7 d、14 d后的心电图异常率均显著降低(P均<0.05),观察组以上时间点的异常率均显著低于对照组(P均<0.05);2组治疗14 d后窦性心动过速、房性期前收缩、室性期前收缩、ST-T段改变、房室传导阻滞、阵发性室上速、室性心动过速发生率均较治疗前显著降低(P均<0.05),且观察组治疗14 d后窦性心动过速、房性期前收缩、室性期前收缩、ST-T段改变发生率均显著低于对照组(P均<0.05)。2组治疗后肌酸激酶(CK)、肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)、天门冬氨酸氨基转移酶(AST)、肌红蛋白(MYO)、肌钙蛋白I(cTnI)、内皮素-1(ET-1)、去甲肾上腺素(NA)、肾上腺素(E)水平均较治疗前显著降低(P均<0.05),观察组治疗后以上指标水平均低于对照组(P均<0.05)。2组治疗后NO水平均较治疗前显著升高(P均<0.05),且观察组显著高于对照组(P<0.05)。2组治疗14 d后NIHSS评分均较治疗前显著降低(P均<0.05),且观察组显著低于对照组(P<0.05)。治疗后随访3个月,观察组mRS评分分级、预后良好率均显著优于对照组(P均<0.05)。结论循经叩刺、温针灸足三里、悬钟联合稳心颗粒可降低急性脑血管疾病所致脑源性心律失常的发生率,具有心血管与神经系统双重保护效应,其作用机制可能与改善血管内皮功能、抑制应激反应有关。更多还原

【Abstract】 Objective It is to observe the therapeutic effect and mechanism of tapping along the meridians, warm acupuncture-moxibustion on Zusanli and Xuanzhong combined with Wenxin granula on cerebral arrhythmia caused by acute cerebrovascular disease. Methods A total of 126 patients with brain-induced arrhythmia caused by acute cerebrovascular disease were randomly divided into observation group(n=64) and control group(n=62). The control group was treated with routine western medicine. The observation group was treated with tapping along the meridians, warm acupuncture-moxibustion on Zusanli and Xuanzhong combined with Wenxin granula on the basis of the control group. Both groups were treated for 14 days. The changes of ECG abnormal rate in different periods during the treatment were recorded. The types and incidence of arrhythmia, changes of biochemical parameters and neurological deficit scores were observed before and after treatment. The prognosis after treatment for 3 months was followed-up. Results The abnormal rate of electrocardiogram was significantly decreased after 3 days, 5 days, 7 days and 14 days of treatment in the two groups(P<0.05), the abnormal rate of the above time points in the observation group was significantly lower than that in the control group(P<0.05). After 14 days, the occurrence rates of sinus tachycardia, atrial premature contraction, ventricular premature contraction, ST-T segmental changes, atrioventricular block, paroxysmal supraventricular tachycardia, ventricular tachycardia were significantly decreased in the two groups(P<0.05), and the incidence of sinus tachycardia, atrial premature contraction, ventricular premature contraction, and ST-T segment change was significantly lower in the observation group than that in the control group(P<0.05). The levels of Creatine kinase(CK), creatine kinase isoenzyme(CK-MB), lactate dehydrogenase(LDH), aspartate aminotransferase(AST), myoglobin(MYO), muscle of cadherin I(cTnI), endothelin-1(ET-1), norepinephrine(NA) and epinephrine(E) after treatment were significantly lower while the levels of NO were significantly higher than those before treatment(P<0.05), the indexes in the observation group were lower or higher than those in the control group(P<0.05). The NIHSS scores of the two groups were significantly decreased after 14 days of treatment in the two groups(P<0.05), and the scores in the observation group were significantly lower than those in the control group(P<0.05). After 3 months of following-up, the good rates of classification of mRS scores and prognosis of the observation group were significantly better than those in the control group(P<0.05). Conclusion Tapping along the meridians, warm acupuncture-moxibustion on Zusanli and Xuanzhong combined with Wenxin granula can reduce the incidence of brain-derived arrhythmia caused by acute cerebrovascular disease. It has dual protective effects of cardiovascular and nervous system, and the mechanism may be related to improving the vascular endothelium function and inhibiting of stress response.更多还原