| Objective:By observing the changes of TCM clinical symptoms,heart rate variability,blood pressure variability,neurometabolites and vascular endothelial function in patients with cardiovascular autonomic nervous dysfunction after high SCI treated by abdominal acupuncture,the clinical efficacy,mechanism,prognosis and safety of abdominal acupuncture in improving cardiovascular autonomic nervous dysfunction after high SCI were discussed.The treatment of cardiovascular autonomic nervous dysfunction after Cl provides a theoretical basis.Methods:In this study,a multi-center randomized controlled clinical research method was used.Abdominal acupuncture was used as the observation group and acupoint sham acupuncture as the control group.The patients were randomly divided into treatment group and control group according to the ratio of 1:1.The treatment group was treated with Bo's abdominal acupuncture,while the control group was treated with sham acupuncture.The frequency of treatment is once a day,6 days a week,a total of 12 weeks,each needle 30 minutes.The patients with cardiovascular autonomic nervous dysfunction after high SCI were evaluated before the first treatment,at the end of the course of treatment and at the time of 1 month follow-up.The dizziness,headache,TCM symptom score and curative effect,maximum blood pressure,minimum blood pressure,average blood pressure,blood pressure value,blood pressure variability(BPV),tolerance to maximum standing angle,24-hour total heart beat and level were observed at different time points.The changes of mean heart rate,slowest heart rate,heart rate variability(HRV),24-hour urinary adrenaline content,plasma norepinephrine(NE)concentration and vascular endothelial function during sympathetic hyperreflex were studied to explore the efficacy,mechanism,prognosis and safety of abdominal acupuncture in the treatment of cardiovascular autonomic nervous dysfunction after high spinal cord injury.Results:1.With 70 out of 72 patients completing the experimental study,including treatment group dropped 1 cases,completed 35 cases,the control group dropped 1 cases,completed 35 cases,two groups of patients before treatment in gender,age,course of disease,injury segment,injury degree,dizziness TCM symptom score,head pain symptom score,average blood pressure,BPV,average heart rate,HRV,NE concentration of bladder percussion,24 hours have no significant difference in adrenal content(P>0.05).The baseline was consistent and comparable.2.In terms of TCM symptoms,the scores of dizziness and headache symptoms in the treatment group at the end of the course of treatment and one month of follow-up were lower than those before treatment(P<0.05).The scores of dizziness symptoms in the control group at the end of the course of treatment were lower than those before treatment(P<0.05).The scores of dizziness symptoms in the control group at the end of the course of follow-up were less obvious than those before treatment(P The scores of headache symptoms in the control group at the end of treatment and 1 month follow-up were not significantly lower than those before treatment,and there was no significant difference between the two groups(P<0.05).Compared with the control group,the scores of dizziness and headache symptoms in the treatment group were lower at the end of the course of treatment and 1 month of follow-up(P<0.05).The effective rate of the treatment group was higher than that of the control group(P<0.05).3.In terms of blood pressure regulation,compared with before treatment,the mean systolic pressure,mean diastolic pressure and minimum systolic pressure of the patients in the treatment group increased at the end of the course of treatment and 1 month of follow-up.The difference was statistically significant(P<0.05).The maximum systolic pressure and maximum diastolic pressure decreased significantly(P<0.05),the standard deviation of 24-hour systolic pressure(24hSSD)and 24h after treatment.The standard deviation of diastolic blood pressure(24hDSD),daytime systolic blood pressure(dSSD)and nighttime diastolic blood pressure(nDSD)were significantly lower than those before treatment(P<0.05).The mean systolic blood pressure and diastolic blood pressure in the treatment group were higher than those in the control group at the end of the course of treatment and 1 month of follow-up(P<0.05).The 24-hour SSD,24-hour DSD,dSSD,dDSD and nDSD in the treatment group were lower than those in the control group(P<0.05).4.In terms of blood pressure regulation when patients can tolerate the maximum standing angle and postural changes,the maximum standing angle of patients in the treatment group at the end of the course of treatment and one month of follow-up was higher than that before treatment,and the difference was statistically significant(P<0.05).Compared with the control group,at the end of the course of treatment and one month of follow-up,the maximum standing angle of patients in the treatment group was higher than that in the control group,and the difference was statistically significant(P<0.05).There was no significant difference in blood pressure between the two groups in supine position(P>0.05).At the end of the course of treatment and one month of follow-up,the blood pressure in the treatment group was higher than that in the control group when the supine position was adjusted to the sitting position and the sitting position was adjusted to the standing position(P<0.05).5.In terms of heart rate regulation,the average heart rate of the treatment group increased at the end of the course of treatment and 1 month of follow-up compared with that before treatment(P<0.05).The total standard deviation of HRV indicators in the treatment group(D),the mean standard deviation(SDANN),the square root of the difference(rMSSD),the percentage difference between adjacent RR intervals>50 ms(PNN50),and the high frequency(HF)were better treated.Before treatment,there was a significant difference(P<0.05),while the low frequency(LF)and LF/HF were higher than before treatment,and the difference was statistically significant(P<0.05).At the end of the course of treatment and 1 month follow-up,HF in the control group was lower than that before treatment,and the difference was statistically significant(P<0.05).The average heart rate of treatment group was higher than that of control group at the end of the course of treatment and 1 month follow-up(P<0.05).The average heart rate of treatment group was lower than that of control group in SDANN,rMSSD,PN50 and HF(P<0.05).LF and LF/HF were higher than that of control group,and the difference was statistically significant.6.In the measurement of neurotransmitters,the 24-hour urinary adrenaline level in the treatment group was higher than that before treatment at the end of the course of treatment and 1 month of follow-up(P<0.05).The plasma NE concentration in the bladder tapping group was lower than that before treatment(P<0.05).The difference was statistically significant(P<0.05).The 24-hour urinary adrenaline level in the treatment group was higher than that in the control group at the end of the course of treatment and 1 month of follow-up(P<0.05).The plasma NE concentration in the bladder tapping group was lower than that in the control group(P<0.05).7.In terms of vascular endothelial function,serum NO increased at the end of treatment and 1 month follow-up compared with before treatment(P<0.05),while serum ET-1,sICAM-1 and TXB2 decreased at the end of treatment and 1 month follow-up compared with before treatment(P<0.05).Compared with the control group,serum NO increased at the end of treatment and 1 month follow-up(P<0.05),while serum ET-1,sICAM-1 and TXB2 decreased significantly(P<0.05).Conclusion:1.Abdominal acupuncture can improve TCM clinical symptoms of patients with cardiovascular autonomic nervous dysfunction after high SCI and relieve dizziness,headache,palpitation and other symptoms.2.Abdominal acupuncture treatment can improve 24-hour average blood pressure and minimum blood pressure in patients with cardiovascular autonomic nervous dysfunction after SCI,reduce the highest blood pressure and blood pressure variability.3.Abdominal acupuncture treatment can increase 24-hour average heart rate of patients with cardiovascular autonomic nervous dysfunction after SCI,reduce the index of heart rate variability vagal nerve tension,increase the index of heart rate variability sympathetic nerve tension,and reduce heart rate variability.4.Abdominal acupuncture treatment can increase the adrenaline content in patients with cardiovascular autonomic nervous dysfunction after SCI,thereby improving sympathetic excitability and reducing the degree of sympathetic hyperreflex during bladder tapping.5.Abdominal acupuncture can improve vascular endothelial function in patients with cardiovascular autonomic nervous dysfunction after high SCI6.Abdominal acupuncture is effective in the treatment of cardiovascular dysfunction after high SCI.It is safe,non-toxic,easy to operate and easy to be accepted by patients.It is worth popularizing in clinical practice. |
PDF Full Text Request