推拿配合降压药物治疗高血压病的临床观察与机理探讨

【作者】 薛卫国；

【导师】 廖品东；

【作者基本信息】 成都中医药大学 ， 针灸推拿学， 2002， 硕士

【摘要】 目的：观察推拿对轻中度高血压病的辅助治疗作用，并初步探讨其作用机制。方法：采用随机平行对照临床试验，将64例中医辨证为肝阳上亢的轻中度高血压病患者分为药物加推拿组（药推组）和单纯药物组（药物组），降压药物选用硝苯地平缓释片加依那普利，推拿选取头面颈项部手法，平肝潜阳，通络安神，疗程一月。观察治疗前后血压、心率、降压谷峰比值、临床症状、药物用量、血浆一氧化氮（NO）浓度、红细胞膜钠泵（Na⁺—K⁺·ATPase）及钙泵(Ca²⁺—Mg²⁺·ATPase)活性等。结果：两组临床症状改善、血压降幅、降压谷峰比值、降压药物用量、心率变化皆存在差异（P＜0.05）。药推组降压有效率96.4％，血压控制率82.1％，药物组降压有效率93.3％，血压控制率70％，两组不良反应无差异（P＞0.05）。血浆NO浓度、红细胞膜Na⁺—K⁺·ATPase活性变化存在差异（P＜0.05,P＜0.01），Ca²⁺-Mg²⁺·ATPase活性变化无差异（P＞0.05）。结论：推拿与降压药合用可减少降压药物用量，增加药物降压幅度，提高降压平稳性，提高临床症状疗效。推拿对于高血压病不失为一种安全、有效的辅助疗法。其作用机制可能在于改善高血压病患者血管内皮细胞功能，增加NO合成与释放，并影响中枢神经系统，通过下丘脑—垂体—肾上腺轴，降低平滑肌细胞对血管内皮收缩因子的反应性，改善阻力血管的舒张功能。更多还原

【Abstract】 Objective - To assess the auxiliary effect of Tuina (Chinese massage)on primary hypertension and to explore the plausible mechanism for Tuina on lowering blood pressure.Methods-The study is a prospective, randomized and controlled clinical trail. Sixty-four cases, aged 40 to 70 years old, with mild primary hypertension, differentiated as hyperactivity of Liver-yang type, were allocated equally to two groups. The controlled group were treated with Nifedipine and Enalapril and the experimental group were treated with Nifedipine, Enalapril plus Tuina manipulations on the head and neck. The following measurements were taken at the start and the end of the treatment: blood pressures, heart rate, trough:peak ratio, symptoms, drug amounts, serum NO concentration, Na+ -K+ ·ATPase and Ca2+-Mg2+· ATPase activity in RBC membrane,Result- Blood pressure reductions were sizable in both groups and were significantly greater for the experimental group than for controlled group. In the experimental group, trough:peak ratios were higher, drug amount were less, and symptoms were alleviated significantly. Change of serum No concentration and Na+ -K+ ·ATPase activity were significantly different between two groups.Conclusion-Drug treatment in combination with Tuina was more effective in blood pressure reduction than drug treatment alone. The plausible mechanism lies in that Tuina may improve the function of endothelium to synthesis and release more No to relax periphral small arteries. Meanwhile, Tuina may also decrease the vascular reactivity caused by endothelium-derived contracting factors.更多还原