【作者】 张艳丽；

【导师】 庄桂英；

【作者基本信息】 山东大学 ， 康复医学与理疗学， 2008， 硕士

【摘要】 目的:探讨体外超声、低强度激光血管外照射综合治疗冠心病的临床疗效,揭示其机理。方法:共观察冠心病患者72例,全部病人均符合1979年WHO关于冠心病的诊断标准,平均年龄58±10岁,男40例,女32例,有心绞痛反复发作,心电图有缺血性ST-T改变或动态心电图有缺血性改变者61例,无症状者11例,其中合并高血压34例,2型糖尿病12例,高脂血症46例。将病人随机分为超声激光治疗组和对照组两组各36例。两组病人的年龄、病程和临床症状等项目进行组间比较,无显著差异,具有临床可比性。对照组患者均给予他汀类、硝酸酯类药物和阿司匹林等常规的药物治疗,当心绞痛发作时给予口含化硝酸甘油,治疗组在药物治疗的同时采用心脑血管治疗仪,频率800KHz,声强0.75～1.25W/cm~2。四个超声探头分别置于病人的胸骨左、右缘第四肋间、心尖部、心尖与胸左三肋间连线的中点处。同时用低强度氦氖激光外周静脉血管体表照射,输出功率为4.5mW,波长为632.8nm。治疗时间20～30分钟,每日一次,10次为一疗程,治疗3个疗程。观察期间,两组患者每天询问并记录心绞痛发作次数,硝酸甘油的用量,疗程前后进行24小时动态心电图以及血心肌酶学、血脂、血液流变学检查和生活质量评定。应用SPSS13.0统计软件进行统计分析,初步探讨体外超声、低强度激光血管外照射综合治疗冠心病的临床疗效,揭示其机理。结果:①治疗后治疗组显效9例,有效20例,无效7例,有效率为80.6%。对照组显效5例,有效16例,无效15例,有效率为58.3%。两组疗效经统计学处理,有显著性差异(P＜0.05),体外超声、低强度激光血管外照射综合治疗对冠心病症状作用明显。②治疗组治疗后全血粘度、血浆粘度、红细胞压积均比治疗前显著降低(P＜0.01)。治疗组与对照组间差异有显著性(P＜0.05)。③治疗组治疗后血甘油三酯、胆固醇、低密度脂蛋白均比治疗前降低显著(P＜0.05),高密度脂蛋白治疗后与治疗前相比则升高显著(P＜0.05),治疗组与对照组间差异有显著性(P＜0.05)。④治疗组在躯体功能、心理健康、角色心理、活力/精力、身体疼痛和综合健康等领域评分治疗前后组内比较有明显改善(P＜0.05),治疗组与对照组两组组间比较躯体功能、心理健康、角色心理、活力/精力、身体疼痛和综合健康等领域评分差异有统计学意义(P＜0.05)。结论:1、体外超声治疗冠心病的作用包括增强心肌收缩力、促进侧枝循环的建立及损伤心肌的修复,减少瘢痕灶、降血压减低心脏后负荷,降血脂软化血管、超声溶栓,再通血管等;且适当的声强对心肌无任何损害,是一种简单安全,效果良好的治疗方法。2、低强度激光血管外照射治疗冠心病可使血小板聚集功能降低,提高纤溶活性及内源性肝素水平,能促使高粘性血粘度下降,改善血流变及部分血脂指标,达到改善冠心病临床症状的目的。3、在常规药物治疗冠心病的同时使用体外超声、激光血管外体表照射,两者有机结合,具有协同作用,综合疗法疗效优于常规药物治疗。更多还原

【Abstract】 Objective:To observe the effects of the external ultrasound and extravascular low-power laser irradiation therapy in treating coronary heart disease;To reveal its mechanism.Methods:72 patients with coronary heart disease were chosen,all patients accord with the diagnosis standard of 1979 WHOs about coronary heart disease in average age 58±10s in which 40 male example and 32 female examples.All Patients were randomly classified into two groups,of which 36 were control group receiving conventional medicine treatment such as nitroglycerine,aspirin.36 were ultrasound-laser treatment group.On the foundation of medicine treatment ultrasound-laser treatment group received treatment of full automatic ultrasonic scanning heart-brain treatment instrument of frequency 800KHz,sound intensity 0.75～1.25W/cm~2. 4 ultrasonic probes that have ultrasonic couplant were set up respectively to the breastbone left rib of 4th between,the breastbone right·rib of 4th between,heart sharp department,the intermediate place of link line in heart tip and chest left rib of 3th.At the same time,patients received low-power laser irradiation therapy of power 4.5mW,wavelength 632.8nm. Patients received the treatment of external ultrasound and extravascular low-power laser irradiation therapy for 20～30 minutes every day.It is a course of treatment ten times.They were treated for 30 days.Two groups of patients were inquired and recorded the frequency that angina pectoris breaks out every day and need for nitroglycerine tablets.Patients were carried out 24 hours of development electrocardiogram as well as the blood enzyme of cardiac muscle to study,blood fat,blood flow to change study and quality of life assessment in treatment around.All data collected were analyzed with SPSS13.0 software.Results:①After treatment the ultrasound-laser treatment group. Shows 9 obvious-effect examples,20 effective examples and 7 invalid examples,effective 80.6%.Control group Shows 5 obvious-effect examples, 16 effective examples and 15 invalid examples,effective 58.3%.Effects of the ultrasound-laser treatment group and control group were significantly different(P＜0.05).Effects of the external ultrasound and extravascular low-power laser irradiation therapy in treating coronary heart disease is notable.②After treating,completely blood viscosity,the viscosity of blood plasma and red blood cell press product of the ultrasoundlaser treatment group,reduce apparently before treatment(P＜0.01); significantly different was in the ultrasound-laser treatment group and control group(P＜0.05).③After treating,blood triglyceride,cholesterol and low density lipoprotein of the ultrasound-laser treatment group reduce apparently before treatment(P＜0.05);high density lipoprotein of the ultrasound-laser treatment group after treating is notable to compare to go up before treatment(P＜0.05).Significantly different was in the ultrasound-laser treatment group and control group(P＜0.05).④After treating,the body function,mental health,role psychology,vitality/ energy,bodily pain and general health of the ultrasound-laser treatment group are improved obviously before treatment(P＜0.05);significantly different was in the ultrasound-laser treatment group and control group(P＜0.05). Conclution:1.Treatmenting coronary heart disease,the external ultrasound forms a series of treatment role such as strengthening contract force of cardiac muscle,promoting the establishment of side branch cycle,restoring damage cardiacmuscle,reducing scar range,reducing blood pressure to reduce heart rear load,reducing blood fat to soften blood vessel,dissolving bolt to unobstructed blood vessel again.And confirm that proper sound intensity does not have any infringement for cardiac muscle,it is a kind of simple safety and effect good treatment method.2.Extravascular low-power laser irradiation therapy in treating coronary heart disease reduces a series of treatment role such as reducing assemble function of blood platelet,rising active of fibrinolysin,rising the level of endogenous heparin,reducing blood viscosity and blood fat,then improves the clinical symptom of coronary heart disease3.In this research,patients with coronary heart disease received the external ultrasound and extravascular low-power laser irradiation therapy on the foundation of conventional medicine treatment.Two are organic to combine which have synergism,Its effect Is better than conventional medicine treatment obviously.更多还原