基于微循環(huán)相關指標的老年患者針刺治療效果評價

基于微循環(huán)相關指標的老年患者針刺治療效果評價

用于currentacudic研究的微囊教育和再植生物是可接受的，而康乃馨和康乃馨都是接受的。這是一個非常授權的可執(zhí)行的自我控制基準（rcm）。unfort，一個低于可支配的區(qū)域，而非正確反映的表面特征。這是魅力所在的嘗試，而不是表面痕跡的管理者。這條直接插入式微管的數(shù)量是基本的。這是一封緩慢的命令，其本質上是一封非正義的協(xié)議。IthasbeenhypothesizedbytheHeidelberg(HD)ModelthattheTCMdiagnosismayberegardedasavegetativefunctionalstatus.Para-meterizationofthevegetativepretreatmentstatusmaythereforeleadtobetterstandardizationandfunctionalhomogenizationofpatientsinclinicaltrials,thusmakingthembettercomparable.Hence,thereisacleardemandformeasurableparametersthathelpparameterizethecurrentvegetativestate(theTCMdiagnosis)ofapatientinordertoenableamoreaccuratedefinitionofthestudypopulationsinacupuncturetrials.ThebackboneofTCMistheteachingoftheeightguidingcriteriawhichinclude“heat”(calor)and“cold”(algor),whichrefertothedynamicsofxue(blood).Xueisreferredtoasthe“movedstructuralyin”.Thefunctionalpower(energy)xuebelongs,likeqiorshen,tothealmostuntranslatableconceptsofTCM.BloodinTCMdiffersfromtheWesternconcept.AccordingtotheauxiliaryvegetativedefinitionoftheHDModel,“xueisaformof‘energy’boundtocirculatingbodyfluidswithfunctionssuchaswarming,moisturizing,creatingqiandnutrifyingatissue”.Thefunctionalstatusofthisenergyisevaluatedbyavarietyofkeysymptoms,suchasredtongue,fastpulse,andsparse,yellowishurine.Wehaverecentlypublishedapathophysiologicalexplanatorymodelfortheseclinicalsigns,whichexplainsthemaslocalandsystemicindicatorsofenhancedmicrocirculation(MC).TheHDModelleadstothehypothesisthat“heat”isastateofaugmentedMC,whereas“cold”mayrepresentastateofalowoverallcapillaryperfusion(MC).Therefore,wetriedtoevaluateboththediagnosisofTCM(heatorcoldstates)aswellasacupunctureeffectsbymeasuringMC-relatedparameterslikecapillarybloodflow,velocity,oxygensaturationandhaemoglobincontentoftheskin.Inourpathophysiologicalmodelof“heat”(calor),enhancedMCleadstothekeysymptomsof“heat”astaughtinTCM:localsignsofreddishness(tongue,skin)andaburningsensationlikeinapre-inflammatorystate.Systemicsignsoriginatefromarelativelackoffluidincentralvessels,leadingtohigherpulserate,sympatheticreactions(“l(fā)iver”signs)andwater-savingmechanisms(thirst,drymouthandmucosa,dryconstipation,sparse,yellowurine).Theguidingcriterion“cold”referstotheoppositestateandsymptoms,duetoageneralstateoflowperfusion(MC).Thepathogenicfactor“cold”,however,referstoareflexstatuswithregionalimpairmentofMCleadingtolossofmuscularpowerandstiffness,forexample.Wechosetheclinicalscenariooffracturesofthefemurforanumberofreasons.AccordingtoTCMtheory,fracturesarenormallyrelatedtothediagnosisofcoldpatternswhichaccordingtotheHDModelofTCMmayberegardedasaregionallackofMC.AlsoinWesternmedicinefracturesoftheproximalfemurareacommonandimportantcauseoffunctionalimpairment,immobilizationandageneralincreaseofmorbidityinelderlypatients.Postoperativerecoveryisoftencomplicatedbymultipleinjuriesandhighratesofavascularnecrosisofthefemoralheadduetodisruptedbloodsupplyandnon-union,allassociatedwithadeficientcapillarybloodflow.Wehavepreviouslydemonstratedthatacupuncturemayleadtomeasureablegaitimprovementwithinthisscenarioanditwashypothesizedthatthiswasatleastpartlyduetoanaugmentedcapillaryflowinthelegafteracupuncture.InTCM,acupunctureisusedtoreducetheaforementionedcomplicationsandcomplains.AccordingtoacontemporaryinterpretationoftheShanghanlun,aregionallackofMCinducedbythefactoralgorprovokeshumoro-vegetativereactionswithageneralincreaseinMC,alsoknownas“reactiveheat”.Thiscorrelateswithtypicalpathophysiologicalchangesaspartofwhatisknownasthepost-operativeinflammatoryresponseinWesternmedicine.SomestudieshavealreadyinvestigatedMCinaTCMcontextusingwhitelightspectroscopyandlaserDoppler.TheaimofthisstudywastodemonstrateifitispossibletoobjectivelyassesstheeffectsofacupuncturebyMC-relatedparametersintheclinicalscenariooffractureofthefemur,toevaluatethesignificanceofthestatusofcapillaryperfusionpriortoacupunctureforthetreatmentofaclinicalcoldpattern,andtoevaluatethepossibleroleofMC-relatedparametersforthefutureparametrizationoftheTCMdiagnosis.1hnikgmbh,measunity,性別,年齡1.1StudydesignThestudywasaprospective,uncontrolled,unblindedpreliminarytrialincluding32elderlypatients(25females)withameanageof(86.4±6.3)yearsaftersurgicaltreatmentoffemoralfractures.Thepatientsreceivedacupunctureusingthe“l(fā)eopardspottechnique”onLiangqiu(S34/ST34),whilerestinginasupineposition.MeasurementofMCparameters(bloodvelocity,bloodflow,haemoglobinandoxygensaturation)wasperformedusingwhitelightspectroscopyandlaserDoppler(O2Cdevice,LEAMedizintechnikGmbH,D-35394Gieβen,Germany).Measurementsofallfourvariablesweretakenat3and6mmtissuedepth,respectively.Inordertodeterminethedifferencebetweenbaseline(pretreatment)andpost-interventionvaluestheaverageof15consecutivemeasurements(30s)weretakeneachbeforeandaftertreatment.TheflowchartofthisstudywasshowninFigure1.1.2InclusioncriteriaWeincludedgeriatricpatientsfromarehabilitationwardwithproximalfractureoffemurandareportofgaitimpairment.Weexcludedpatientswithdementia(scoreoftheMini-MentalStateExamination<24)aswellaspatientsonanticoagulationtherapyinordertominimizetheriskofsecondaryhaemorrhageafterblood-lettingacupuncture.Aninformedconsenthadbeenobtainedfromallpatients.Anethicalapprovalhadbeenobtained.1.3OutcomemeasuresThefollowingMCparametersweremeasuredbyO2C:haemoglobincontent,oxygensaturation,bloodvolumeflowandbloodflowvelocity.1.4StatisticalanalysisForstatisticalanalysis,SPSS17softwarewasused.Thevariablestestedwerebloodvelocity,bloodflow,haemoglobinandoxygensaturation.Theoxygensaturationwasgiveninpercentages.Allotherunitsofmeasurementswererelative,namely,arbitraryunits(AU).Thenullhypothesiswasthattherewerenosignificantchangesinthevariablesaftertheintervention.ThestudiedsampledidnotpresentaGaussiandistribution;therefore,significantdifferenceswereassessedusingthetwo-sidedWilcoxonsigned-ranktest.Thestudywastestedata5%significancelevel.2抗混合性能共聚非定相關定義/分類標準/表3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.3.2.1High-perfusionandlow-perfusiongroupsTheanalysisofMCdatarevealedthatthepretreatmentbaselinevaluesofthepatientscouldbedividedintotwogroupsaccordingtobloodflow(Figure2).Therewere26patientsinthelow-perfusiongroup.Lowperfusionwasdefinedaswithintwostandarddeviationsfromthemeaninapproximationtoaplausibledefinitionofnormalvalues.Thislow-perfusionstatuswasconsideredtobenormalinthegivenclinicalscenario.Thehigh-perfusiongroupcomprisedof6patientswith6-to17-foldincreaseincomparisontothemean.2.2Bloodflowinthelow-perfusiongroupRegardingthebloodflowandvelocitytherewasanobjectiveeffectofS34/ST34inthelow-perfusiongroupthatcouldbemeasuredbyMC-relatedparameters.Afteracupuncturetreatment,themeanbloodflowincreasedby50.4%from44.69to67.21atadepthof3mm,andby16.8%from79.85to93.23at6mmdepth.Figure3displaysthedistributionofbloodflowmeasurementsatbaselineandafteracupunctureintervention.Thedifferenceswerestatisticallysignificant(P=0.002at3mmdepthandP=0.012at6mmdepth).2.3Bloodvelocityinthelow-perfusiongroupRegardingvelocitytherewasalsoameasurableeffectinthelow-perfusiongroup.Afteracupuncturetreatmentthemeanvelocityincreasedby17.6%from13.96to16.42atadepthof3mm,andby11.9%from20.38to22.80atadepthof6mm.Thedifferenceswerestatisticallysignificant(P<0.001at3mmdepthandP=0.006at6mmdepth).SeeFigure4.2.4Haemoglobinandoxygensaturationinthelow-perfusiongroupInthehaemoglobinanalysistherewerenosignificantchangesafteracupuncture(P=0.757at3mmandP=0.751at6mm).Theoxygensaturationanalysisrevealednorelevantchange.Afteracupuncturetherewasa1%increaseat3mmfrom45.9%to46.4%saturation(P=0.603)andanincreaseby5.2%from78.1%to82.1%saturationat6mm(P=0.032).2.5High-perfusiongroupandtotalgroupThepresenceofthehigh-perfusiongroupshowedthatdifferentvegetativefunctionalstatesmaycoexistwithinthesameWesterndiagnosis.Thestatisticalanalysisofallpatients(totalgroup)regardlessoftheirallocationtothelow-perfusionorhigh-perfusiongroupsresultedinnosignificantalterationsofbloodflow,velocity,haemoglobinandoxygensaturationafteracupuncture.3“heat”me現(xiàn)行TwogroupsofpatientscanbedefinedbyMC-relatedvaluesthatshoweitherloworhighperfusion.AccordingtoTCMtheorythecomplaintswithinthisscenarioaremostlyduetocoldpatterns.TheHDModelstatesthatthesecorrelatewithimpairedlocalMC,whichiscompatiblewithourresults.ThepointS34/ST34isknowntobesuitableforcoldpatterns.Asthelow-perfusiongrouprepresentscoldpatterns,theenhancementofflowandvelocityofMCinthisgroupmayreflectthesuitabilityofthispointforthisconditionasdescribedinTCMtheory,andthepossibilityofparameterizingthiscoldpatternbyMC-relatedvalueswithinthechosenscenario.Haemoglobinispredominantlylocatedinvenousbranchesofthecapillaries.AccordingtotheHDModelthisiscorrelatedtothestagnationofblood,andthisconditionwasnotbeingtreatedsotheresultiscompatiblewiththetheoryofTCM.ThelackofeffectthereforeisasexpectedbythepredictionsofthefunctionalhypothesesoftheHDModelofTCM.Oxygensaturationlevelsalsoremainedunchanged.Thisresultwastobeexpectedaseveninthelow-perfusiongroupthevalueswerealreadyhigh.WehypothesizedthattheTCMdiagnosis“heat”meanshighand“cold”meanslowperfusion.ThismeansthatS34/St34isasuitabletreatmentratherinlowperfusion.Mixingpatientsinwhomthepointisindicatedwithpatientswhereitisnot,mayresultinhidingexistingacupunctureeffects.AccordingtotheHDModel,notdifferentiatingbetweenwithhigh-perfusionorlow-perfusionpatientsisequivalenttomixing“heat”and“cold”patients.Consequently,theinclusioncriteriashouldnotonlybedefinedbytheWesterndiagnosiswithoutregardtothegivenvarietyofTCMdiagnoses(vegetativefunctionalpatterns),sincethisresultsinhidingtheeffi