Page 69 - 中国全科医学2022-05
P. 69
·578· http://www.chinagp.net E-mail:zgqkyx@chinagp.net.cn
from January 2014 to April 2020 were selected. There were 10 781 patiens who met the inclusion and exclusion criteria. According
to whether the Huoxue Sanfeng acupuncture method was applied during hospitalization,the patients were divided into basic
treatment group(n=10 424)and Huoxue Sanfeng group(n=357). The propensity score matching(PSM)was used to obtain
a new sample with balanced covariates between groups,and the linear mixed effects model was used to compare the average daily
blood pressure and morning blood pressure of the two groups in the new sample,which was used to evaluate the effect of Huoxue
Sanfeng acupuncture in controlling blood pressure. Results There was no statistically significant difference in gender,age,
coronary heart disease,diabetes,atrial fibrillation,the levels of HCY,TC,TG,LDL,and Cr levels before matching(P>0.05),
while the levels of HDL and Ur in basic treatment group were higher than those in the Huoxue Sanfeng group(P<0.05).After
matching,the differences in gender,age,coronary heart disease,diabetes,atrial fibrillation,the levels of HCY,TC,TG,
HDL,LDL,Cr,Ur were not statistically significant difference between the two groups(P>0.05). The results of the linear
mixed effect model showed that the average systolic blood pressure in the Huoxue Sanfeng group was lower than the basic treatment
group(P=0.002);the average level of diastolic blood pressure in the Huoxue Sanfenggroup and the basic treatment group was
not statistically significant difference(P=0.083);there was no interaction between treatment methods and hospital admission
time(P=0.532,P=0.775). The results of the mixed effect model showed that after the intervention of different treatments,
the systolic blood pressure in theHuoxue Sanfenggroup was lower than the basic treatment group in the morning(P=0.012);
the morning diastolic blood pressure of the Huoxue Sanfenggroup and the basic treatment group was not statistically significant
difference(P=0.539);there was no interaction between the treatment method and hospital admission time(P=0.974,
P=0.985). Conclusion Huoxue Sanfeng acupuncture can further control the daily average systolic blood pressure and early
morning systolic blood pressure in hospitalized patients with cerebral infarction and hypertension.
【Key words】 Hypertension;Cerebral infarction;Huoxue Sanfeng acupuncture;Systolic pressure;Diastolic
pressure;Real-world research
高血压是脑卒中、心血管疾病及血管事件的重要高 等)予以抗血小板聚集、降压、降脂等基础治疗,基础
危因素 [1-2] ,是导致我国及全世界死亡及残疾负担的最 治疗参考《中国脑血管病防治指南》 [19] ,另外本院脑
重要的可控因素 [3-4] 。我国成年人中约有 2.45 亿患有 卒中基础治疗含石氏中风单元治疗中的中西医结合治疗
高血压 [5] ,而我国高血压的治疗率、控制率远低于西 法。(2)活血散风组采用基础治疗结合活血散风针刺
方国家 [6-7] 。活血散风针刺法作为国医大师石学敏院士 法。活血散风针刺法处方为双侧人迎、合谷、太冲、曲
针刺降压的经验处方,临床上广泛使用且获得满意疗效, 池、足三里。具体的手法量学操作为:先刺人迎穴,
并且具有一定的临床研究基础 [8-17] 。随机对照试验是 患者去枕仰卧位,取喉结旁开 1.5 寸,胸锁乳突肌前缘
在严格控制纳入、排除标准下的理想世界进行的,其结 处,手指轻压搏动处以避开动脉在旁直刺,缓慢刺入
果外推性较差,因此真实世界的效果研究越来越受到重 1.0~1.5 寸,可见针体随动脉搏动节律而摆动,双侧人
视 [18] 。本研究旨在观察高血压合并脑梗死的住院患者, 迎穴行小幅度(捻转幅度小于 90°)高频率(捻转频
采用基础治疗结合活血散风针刺法控制血压的效果,为 率为 120~160 r/min)捻转补法;双侧曲池、足三里直刺
临床运用针刺降压提供依据。 约 1 寸,双侧同时施作用力方向为向心的补法(即术者
1 对象与方法 面对患者时,以患者任督二脉为中心,医者两手拇指捻
1.1 研究对象 选取 2014 年 1 月至 2020 年 4 月就诊 转时作用力切线的方向为向心,即捻转时患者的右侧逆
于天津中医药大学第一附属医院针灸科病房患者。纳入 时针方向捻转用力,患者左侧顺时针方向捻转用力,倒
标准:(1)入院诊断包含高血压和脑梗死;(2)年龄 转时针体自然退回);双侧合谷、太冲穴分别直刺 0.8~1.0
≥ 18 岁;(3)住院时间≥ 3 d。排除标准:(1)合并 寸,双侧同样施作用力方向为离心的泻法。各穴位行手
脑出血、脑肿瘤、脑创伤等疾病;(2)研究中所涉及 法 1 min,留针 30 min,住院期间每日针 1 次。
的指标数据不详。符合纳入、排除标准的患者 10 781 例。 1.4 观察指标
1.2 研究设计 本研究为基于真实世界和倾向性评分 1.4.1 收集患者一般资料 一般资料包括:性别、年龄、
匹配的回顾性研究。 是否有冠心病、是否有糖尿病、是否有心房颤动、同型
1.3 研究分组 本研究根据住院期间是否使用活血散 半胱氨酸(HCY)、总胆固醇(TC)、三酰甘油(TG)、
风针刺法降压,将患者分为活血散风组(n=357)和基 高密度脂蛋白(HDL)、低密度脂蛋白(LDL)、肌酐(Cr)、
础治疗组(n=10 424)。(1)所有患者根据其病情, 尿素(Ur)及尿蛋白(TP)。
对脑卒中、高血压及合并的基础病(糖尿病、高脂血症 1.4.2 收集患者平均血压及清晨血压 数据来源于住院