| 江春梅,刘茜茜.归脾颗粒联合督脉灸治疗冠心病合并失眠的疗效及对心功能、睡眠质量、血清神经递质的影响[J].安徽医药,2021,25(1):164-168. |
| 归脾颗粒联合督脉灸治疗冠心病合并失眠的疗效及对心功能、睡眠质量、血清神经递质的影响 |
| Effect of Guipi granules combined with moxibustion at governor meridian on coronary heart disease combined with insomnia and its influence on cardiac function，sleep quality and serum neurotransmitter |
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| DOI：10.3969/j.issn.1009?6469.2021.01.041. |
| 中文关键词: 冠心病 失眠 灸法 归脾颗粒 督脉灸 心功能 睡眠质量 γ氨基丁酸 去甲肾上腺素 |
| 英文关键词: Coronary heart disease Insomnia Moxibustion Guipi granule Moxibustion at governor meridian Cardiac function Sleep quality Gamma?aminobutyric acid Norepinephrine |
| 基金项目:南通市卫生健康委员会科研立项课题(MB2019038) |
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| 中文摘要: |
| 目的观察归脾颗粒联合督脉灸治疗冠心病合并失眠的临床效果，探讨其对病人心功能、睡眠质量、血清神经递质的影响。方法选取 2018年 4月至 2019年 4月海安市中医院收治的冠心病合并失眠病人 120例，按照随机数字表法分为对照组和观察组，各 60例。对照组病人给予常规西药(营养心肌、抗凝、助眠 ——硝酸甘油、阿司匹林、琥珀酸美托洛尔、阿托伐他汀钙、艾司唑仑等)口服；观察组病人则在对照组基础上加用归脾颗粒联合督脉灸治疗。监测心功能指标变化，用匹兹堡睡眠质量指数量表(PSQI)评估睡眠质量，检测血清中 γ?氨基丁酸(GABA)、去甲肾上腺素(NE)等神经递质含量，观察用药的有效性和安全性。结果观察组有效率 91.67%(55/60)，对照组有效率 75.00%(45/60)观察组疗效更好(P＜0.05)；观察组病人治疗后的心功能参数左室射血分数(LVEF)、心脏指数(CI)、心排血量(CO)水平相比治疗，前及对照组显著升高，左室舒张末内径(LVEDd)、左室收缩末期内径(LVESd)则相较于治疗前、对照组显著降低(P＜0.05)；观察组病人治疗后的主观睡眠质量、睡眠时间、入睡时间、睡眠障碍、睡眠效率、催眠药物、日间功能障碍等方面的 PSQI评分明显低于治疗前及对照组(P＜0.05)；观察组病人治疗后的血清中 GABA(310.42±40.26)mg/L显著高于治疗前及对照组病人的(204.15±34.57)mg/L、(262.30±31.56)mg/L，NE(0.24±0.05) μg/mL显著低于治疗前及对照组病人的(0.52±0.13)μg/mL、(0.40±0.07)μg/mL(P＜0.05)；观察组病人不良反应发生率 6.67%(4/ 60)，显著低于对照组 18.33%(11/60)(P＜0.05)。结论归脾颗粒联合督脉灸治疗冠心病合并失眠有确切疗效，利于改善病人的心肌功能，提高睡眠质量，其起效机制可能是通过调节神经递质含量实现的，且用药安全可靠，值得进行临床推广。 |
| 英文摘要: |
| Objective To observe the clinical effect of guipi granules combined with moxibustion at governor meridian in the treatment of coronary heart disease combined with insomnia，and to explore its influence on patients’cardiac function，sleep quality and serum neurotransmitters.Methods A total of 120 patients with coronary heart disease and insomnia admitted to Hai??an Hospi?tal of Traditional Chinese Medicine from April 2018 to April 2019 were selected and divided into control group and observationgroup according to the random number table method，60 patients in each group.Patients in the control group were given convention? al western medicine orally(Myocardial nutrition，anticoagulation，sleep aid?nitroglycerin，aspirin，metoprolol succinate，atorvastatin calcium，estazolam，etc.).The treatment group patients were given guipi granule combined with moxibustion at governor meridian onthe basis of the control group.Changes of cardiac function indicators were monitored，sleep quality was evaluated by Pittsburgh sleep quality index(PSQI)， and contents of neurotransmitters such as gamma?aminobutyric acid(GABA) and norepinephrine(NE)in serum were detected，and efficacy and safety of medication were observed.Results The effective rate of the observation group was 91.67%(55/60)，while the control group was 75.00%(45/60).The efficacy of the observation group was better(P＜0.05). After treatment，the cardiac functional parameters of the observation group，including left ventricular ejection fraction(LVEF)，cardi?ac index(CI)and Cardiac output(CO)，were significantly increased compared with those before treatment and the control group， while the left ventricular end diastolic diameter(LVEDd)and left ventricular endsystolic diameter(LVESd)were significantly de? creased compared with those before treatment and the control group(P＜0.05).The PSQI scores of the observation group on subjec? tive sleep quality，sleep time，fall asleep time，sleep disorder，sleep efficiency，hypnotic drugs，daytime dysfunction and other aspects after treatment were significantly lower than those before treatment and the control group(P＜0.05).After treatment，the content of neurotransmitter GABA in the serum of the observation group after treatment was(310.42±40.26)mg/L，which was significantly higher than that before treatment(204.15±34.57)mg/L and after treatment(262.30±31.56)mg/L in the control group.The content of NE was(0.24±0.05)g/mL，which was significantly lower than that before treatment(0.52±0.13)g/mL and control group(0.40±0.07)g/mL(P＜0.05).The incidence of adverse reactions in the observation group was 6.67%(4/60)，which was significantly low? er than that in the control group of 18.33%(11/60)(P＜0.05).Conclusion Guipi granules combined with moxibustion at gover?nor meridian in the treatment of coronary heart disease combined with insomnia has definite curative effect，is conducive to improve the myocardial function of patients and the quality of sleep，its effective mechanism might be achieved by regulating the content of neurotransmitters，and the drug is safe and reliable，which is worthy of clinical promotion. |
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