穴位注射孔最穴治疗咯血的机理研究及临床观察

【作者】 刘海静；

【导师】 王伟；

【作者基本信息】 浙江中医学院 ， 针灸学， 2001， 硕士

【摘要】 目的：前期临床及实验研究已证明，水针孔最穴对咯血（主要研究对象为支气管扩张咯血者）确有很好的疗效，并对肺部血管有收缩作用。本文通过实验研究及对临床疗效的观察对其收缩肺血管的机理及其他可能的止血机理做进一步探讨。方法：将日本大耳白兔随机分为臀部非穴组（非穴组）、足三里组和孔最组，分别在相应部位进行穴位注射。测定其出血时间（BT）（玻片法）、凝血时间（CT）和优球蛋白溶解时间（ELT）及血小板聚集功能（肉眼观察法），同时采用高压液相色谱——电化学分析法测定各组兔肺组织内的去甲肾上腺素（NE）、肾上腺素（E）及多巴胺（DA）的含量，用放射免疫法测定兔肺组织内的血栓素B₂（TXB₂）、6—酮—前列腺素F_1α(6-Keto-PGF_1α)的含量。 临床对20例接受穴位注射孔最穴疗法的咯血患者进行了疗效观察，并对患者针刺前后凝血酶原时间（PT）和活化部分凝血酶原时间（APTT）进行测定。结果：动物实验孔最组兔肺组织中去甲肾上腺素（NE）和血栓素B₂（TXB₂）含量均明显高于非穴组和足三里组（p＜0.01），而在非穴组和足三里组之间则无差异；与其它两组相比，孔最组凝血时间（CT）和出血时间（BT）明显缩短（p＜0.05），但优球蛋白溶解时间（ELT），血小板聚集功能及兔肺组织肾上腺素①)，多巴胺（DA和 6－酮－前列．腺素 F；。“－KetoPGF1；）的含量均无明显差异。 临床观察结果总有效率达100％，“痊愈14例，显效4例，有效二例。但治疗前后患者 PT和 APTT却无明显差异o＞0．05人结论：水针孔最穴确有较好的治疗咯血作用。它主要是通过兴奋肺部交感神经，促进其末梢释放NE，增加肺组织TXA。的含量来收缩肺部血管，及可能的促凝血作用而达止血目的的。更多还原

【Abstract】 OBJECTIVES:To observe the effect of Kongzui Point Injection (KPI) against hemoptysis in clinical pactice and inguire the mechanism of contracting pulmonary vessels caused by KPI (a phenomenon found on the former experiment) and other hemostatic mechanism of KPJ by experiments.METHOD:Thirty Jepanese rabbits were devided into 3 groups at random as group Nonpoint, group ZuSanLi and group KongZui, and adopted injection of sterile water for injection in correspoinding area, two times a day. After 3 days, we observed their bleeding time (BT) and coagulation time (CT) firstly , and then took their venous blood to test the euglobulinolysis time (ELT) and do platelet agglutination test (PAgT) and also pulmonaiy tissues to test the content of noradrenaline(NE),adrenaline(E),dopaminc(DA),thromboxine B2(TXB2) and prostaglandin F1 a(PGF1 ~).On the clinical researeh, we tested the change of the TXB2 and 6-keto-PGF1 content of 20 patients?venous blood before and after seven days treatment by KPI.RESULTS:The content of NE and TXB2 in pulmonary tissues of group KongZui was significantly higher than in the other two groups (P<O.0 1), there was also a statisticallyobvious difference of BT and CT between group KongZui ond group Nonpount , and group KongZui and group ZuSanLi (P<0.05), CT and BT in group KongZui were obriouslY shorter than in the Other two groups .But there was no statistically obvious difference between the other two groups (P>O.05). There were no statistically significant .difference of E, DA and 6-keto-PGF1 in pulmonary tissues, ELT, and the agglutinant function of platelet among three groups (P>.0. 05).After seven days of treatment ,14 cases cured , 4 case got marked effect ,2 cases got moderate effect . But there were no statistically obvious difference of PT and APTT after the treatment compared with them before the treatment(P>0. 05)CONCLUSION: KPI has good effect on hemeptysis by exciting pulmonary sympathetic nerve to increase the level of NE , increasing the level of TXA~ in pulmonary tissues and by its probable function of improving blood coagulation also.更多还原