Name: 温针灸治疗慢性阻塞性肺疾病伴腹胀的初步研究 (视频) | JoVE Journal
Uploaded: 2023-09-01T14:35:00.000+00:00
Duration: 5 min 19 s
Description: 了解温针灸治疗慢性阻塞性肺疾病伴腹胀的标准化操作方法。该方法操作简便、疗效显著且成本低廉，有助于改善患者症状并提升传统中医疗法的临床应用价值。

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5 minutes

本工作得到2022年&#34;天府青城计划&#34;天府科技领军人才项目（川青城〔2022〕1090号）、国家中医药临床优秀人才研修项目（国中医药人教函〔2022〕1号）、&#34;100人才计划&#34;成都中医药大学附属医院项目（院办〔2021〕42号）、四川省中医药管理局科研专项课题（2021MS093、2021MS539、2023MS608）的资助。

本临床研究方案已通过成都中医药大学附属医院呼吸与危重症医学科临床研究审批委员会的审查与批准（记录编号：KY 2022010）。
1. 仪器设备准备
<ol>
	<li>准备一次性无菌针灸针（规格 0.25 mm × 40 mm）、艾条（规格 1.2 cm × 1.2 cm）、医用消毒棉签、碘伏棉签、打火机以及若干 60 mm × 60 mm 的纸板（见图1）。</li>
</ol>
2. 医生准备
<ol>
	<li>确保患者符合《慢性阻塞性肺疾病基层诊疗指南》中慢性阻塞性肺疾病（COPD）的诊断标准，并伴有腹胀症状。</li>
	<li>排除以下情况的患者：(1) 存在皮肤溃疡、血糖控制不佳、血压控制不良及头晕者；(2) 患有矽肺、结核病、恶性肿瘤、哮喘、凝血功能障碍及严重心功能不全者；(3) 患有风湿性心脏病、先天性心脏病、肾功能衰竭、肝功能衰竭等疾病者；(4) 依从性差的患者。</li>
	<li>佩戴医用口罩和帽子。</li>
	<li>用肥皂水洗手，待其自然干燥后，在持针操作前使用酒精类手消毒剂进行手部消毒。</li>
</ol>
3. 患者准备
<ol>
	<li>嘱患者排空膀胱。</li>
	<li>测量患者的血压、心率、呼吸频率和血氧饱和度。</li>
	<li>确保皮肤无损伤和化脓情况。</li>
	<li>上述基本体征正常后，指导患者选择仰卧位或俯卧位，以暴露针灸穴位。</li>
	<li>建议患者在操作过程中如感不适，应及时告知医师。</li>
</ol>
4. 腧穴选择
<ol>
	<li>用碘伏棉签擦拭需要针刺部位的皮肤。</li>
	<li>根据标准化的穴位定位，选取肺俞（BL13）、太渊（LU9）、定喘（EX-B1）、足三里（ST36）、中脘（RN12）、天枢（ST25）24,25,26（见图2）。</li>
</ol>
5. 针灸与针刺手法
<ol>
	<li>将左手五指伸直摊平，在进针部位将示指与中指分开。</li>
	<li>用右手拇指与示指持针柄，中指指端靠近针尖，指腹抵住针身。</li>
	<li>拇指与示指向下按压，同时中指屈曲，将针刺入符合国际标准化要求的针灸角度和深度。</li>
	<li>沿针灸角度均匀提插针柄，深度约为 3 mm，频率约为 60 次/分钟27。</li>
	<li>前后旋转针柄，旋转角度不超过 180 度，频率约为 60 次/分钟，直至患者产生得气感27。</li>
</ol>
6. 放置艾条
<ol>
	<li>从距离皮肤2-3 cm的底部点燃艾条28，使患者产生温热感，并出现体表发红。治疗持续约30分钟。</li>
</ol>
7. 放置纸板
<ol>
	<li>将60 mm × 60 mm的纸板置于艾条下方，以防止艾条燃烧产生的灰烬烫伤皮肤，直至艾条完全燃尽（见图3）。</li>
</ol>
8. 挑选针头
<ol>
	<li>用竹签末端轻轻夹起燃尽的艾条。</li>
	<li>用手持医用消毒棉签轻轻按压针刺部位。</li>
	<li>将针轻轻旋转，缓慢提至皮下，停留片刻后拔出。</li>
	<li>出针后，用医用消毒棉签轻压针孔片刻，以防止出血并减轻疼痛。</li>
	<li>拔针后，仔细检查针孔是否出血，询问患者有无不适，并核对针数有无遗漏。</li>
</ol>

Warm Acupuncture and Moxibustion to Relieve COPD with Abdominal Distension

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<li>Shi, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Acupuncture+and+Moxibustion%5BTitle%5D)+AND+%22Chinese+Traditional+Clinical+Medicine+Series%22%5BJournal%5D)">Acupuncture and Moxibustion.</a> Chinese Traditional Clinical Medicine Series. , (2004).</li>
<li>National Standard of the People's Republic of China. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((Acupuncture+technical+practice+part+1%3A+Moxibustion%5BTitle%5D)+AND+%22Chinese+Acupuncture%22%5BJournal%5D)">Acupuncture technical practice part 1: Moxibustion.</a> Chinese Acupuncture. 30 (06), 501-504 (2010).</li>
<li>Zhang, M., Gao, X. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/pubmed?term=((The+clinical+application+of+warm+acupuncture+and+penetration+moxibustion+by+professor+GAO+Xiyan%5BTitle%5D)+AND+%22Zhongguo+Zhen+Jiu%22%5BJournal%5D)">The clinical application of warm acupuncture and penetration moxibustion by professor GAO Xiyan.</a> Zhongguo Zhen Jiu. 38 (12), 1325-1328 (2018).</li>
</ol>

作者声明无任何利益冲突。

众所周知，慢性阻塞性肺疾病（COPD）引起腹胀的发病机制尚未完全阐明，这阻碍了新疗法和药物的开发。近年来，温针灸和艾灸已广泛应用于COPD合并腹胀的治疗。温针灸和艾灸的治疗机制主要涉及针刺作用、艾灸的温热效应以及针体的导热效应31。艾灸侧重于对穴位局部的温热刺激，可激活局部特异性受体、热休克蛋白、热敏性免疫细胞等，从而发挥温通经络、开通络脉的局部效应32。现代中医认为，对RN12、ST25和ST36穴位进行针灸和艾灸可发挥胃黏膜的细胞保护作用33。温针灸和艾灸能有效改善COPD合并腹胀的症状25，使其在改善COPD所致腹胀方面具有突出优势。
进行温针灸和艾灸操作时需注意以下几点：治疗室应定期消毒，并确保具备良好的通风换气设备。治疗床上的床垫、枕套、被褥、垫子等物品应按时更换并晾晒干燥34。操作前可进行以下准备练习，以达到理想的治疗效果：（1）指力...

慢性阻塞性肺疾病（COPD）是一种常见的呼吸系统慢性消耗性疾病。COPD 患者主要表现为慢性咳嗽和咳痰，随着疾病进展，肺功能逐渐下降。疾病晚期可能并发慢性肺源性心脏病、呼吸衰竭和心力衰竭，严重影响患者生活质量。据报道，肠道微生物群的改变与 COPD 的疾病进展相关1。除了肺部症状外，40.31% 的稳定期 COPD 患者报告有腹胀症状。腹胀可能显著加重肺部症状，增加 COPD 急性加重的频率，并损害稳定期 COPD 患者的生活质量2,3。COPD 患者出现腹胀的原因被认为是多因素的，可能包括以下方面：（1）细菌失调；（2）腹水导致腹内压升高；（3）电解质紊乱；（4）右心衰竭及肝脏或消化道充血；（5）长期卧床4；（6）药物5和机械通气6。
一些中医学者提出，慢性阻塞性肺疾病（COPD）的发展过程表现为四种证候状态：（1）肺气虚；（2）脾气虚；（3）肾气虚；（4）阴阳两虚7,8。若脾失运化、胃弱纳呆，则可出现腹胀，进而因化源不足而导致肌肉消瘦、乏力9。目前，临床上治疗COPD常用的药物包括支气管扩张剂、糖皮质激素、抗生素及其他药物10。对于COPD合并腹胀的情况，尚无指南明确规范标准化治疗方案，临床上多采取对症治疗。
温针灸和艾灸作为中医传统疗法，能够引导气机以疏通经络，促进血液循环，消除血瘀，补益虚损以温阳散寒。这些疗法可产生抗氧化物质，从而发挥调节作用，促进免疫系统的应激反应，并改善血液循环。11,12温针灸和艾灸可用于治疗颈椎病13膝关节炎14痛经15便秘16肠易激综合征17，等等。实验研究表明，针灸可通过调节脑-肠轴来缓解腹胀18针灸联合艾灸显著减轻腹胀19，这可能是通过调节血浆以及胃黏膜组织中前列腺素E2和胃泌素水平实现的20同时，温针灸和艾灸在改善功能性消化不良症状方面优于促动力药和假针灸21针灸可增强膈肌功能，缓解呼吸肌疲劳，改善二氧化碳潴留和缺氧状况，并预防及缓解呼吸衰竭。22温针灸和艾灸可改善稳定期慢性阻塞性肺疾病患者的肺功能、临床症状及生活质量23,24.
根据中医理论 &#34;肺与大肠相表里&#34;本研究采用的温针灸与艾灸治疗旨在促进胃肠功能恢复，改善肺功能及生活质量。温针灸和艾灸是疗效显著、操作简便且成本低廉的中医传统疗法。综上所述，有必要制定标准化操作规程，以规范温针灸与艾灸治疗慢性阻塞性肺疾病（COPD）合并腹胀的临床应用。本文详细阐述了如何正确实施温针灸与艾灸治疗以缓解COPD伴发的腹胀症状。

<table><tbody><tr><td>艾条</td><td>Dr. Moxi</td><td>N/A</td><td>尺寸：1.2 cm × 1.2 cm</td></tr><tr><td>一次性无菌针灸针</td><td>HWATO</td><td>2001-0020</td><td>尺寸：&amp;nbsp;0.25 mm × 40 mm</td></tr><tr><td>碘伏棉签</td><td>BEIJIAER</td><td>20162140536</td><td></td></tr><tr><td>纸板</td><td>自制</td><td>自制</td><td>尺寸：60 mm × 60 mm&amp;nbsp;</td></tr></tbody></table>

一种温针灸与艾灸治疗慢性阻塞性肺疾病伴腹胀的初步研究

A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension

大多数慢性阻塞性肺疾病（COPD）患者伴有腹胀，研究表明腹胀会加重COPD患者的肺部症状，增加急性加重频率，并影响其生活质量。温针灸和艾灸已被证实对缓解COPD合并腹胀患者的症状具有疗效。温针灸和艾灸是高效、操作简便且成本低廉的中医传统治疗方法。在治疗COPD合并腹胀时，规范实施温针灸与艾灸操作至关重要。具体步骤包括：通过辨证论治选择合适的针刺穴位，并在得气后选用适当长度的艾条进行约30分钟的艾灸。疗程持续一周。需重点评估以下指标：COPD评估测试（CAT）评分和腹胀视觉模拟量表（VAS）评分。本文将详细阐述如何规范操作温针灸与艾灸，以缓解COPD合并腹胀症状。

一般条件 
共计12名患者（表1慢性阻塞性肺疾病合并腹胀患者共12例，按观察组和对照组各6例进行分组。所有患者均符合《慢性阻塞性肺疾病基层诊疗指南（2018）》的诊断标准29 并伴有腹部胀满。对照组接受假针刺治疗。我们选取与观察组相同的穴位，在距离这些穴位旁开2.5 cm处垂直进针，浅刺皮肤1-3 mm，不进行针刺手法及艾灸。对照组患者根据《慢性阻塞性肺疾病基层诊疗指南（2018年）》接受基础治疗。29观察组患者在给予慢性阻塞性肺疾病基层诊疗指南（2018）推荐的基本治疗基础上，加用温针灸和艾灸治疗。29两组患者均接受为期1周的治疗。
观察指标 
比较两组之间的生命质量（慢性阻塞性肺疾病评估测试 [CAT] 评分）29 和腹胀视觉模拟量表（VAS）评分<sup class="xre...

本文介绍一种正确操作温针灸和艾灸治疗慢性阻塞性肺疾病（COPD）伴腹胀的实验方案。

大多数慢性阻塞性肺疾病（COPD）患者伴有腹胀，已被证实腹胀会负面影响肺部症状、急性加重的频率……

我们提出一种标准化的温针灸与艾灸操作方法，用于治疗慢性阻塞性肺疾病（COPD）合并腹胀。该方法有助于解答慢性阻塞性肺疾病伴腹胀领域的关键问题。温针灸与艾灸的主要优势包括操作高效、易于实施以及费用低廉。这些中医治疗方法可使许多患者受益。我们的实验室将致力于研究温针灸和艾灸缓解慢性阻塞性肺疾病（COPD）伴腹胀的基本机制。未来的工作将聚焦于建立更加智能化的温针灸与艾灸操作方法。首先准备该操作所需的设备，包括一次性无菌针灸针、艾条、医用消毒棉签、碘伏棉签、打火机以及若干硬纸板。在开始准备患者之前，佩戴医用口罩和帽子，然后用消毒剂彻底洗手。双手干燥后，使用含酒精的免洗手消毒剂。接下来，测量患者的血压、心率、呼吸频率和血氧饱和度。检查目标区域的皮肤是否有任何损伤或感染迹象。若基本生命体征正常，指导患者取仰卧位或俯卧位，以暴露针灸穴位。使用碘伏棉签擦拭将要针刺部位的皮肤。依据中医理论，选取标准化的针灸穴位：中脘（REN-12）、太渊（LU-9）、天枢（ST-25）、足三里（ST-36）、定喘（EX-B1）和肺俞（BL-13）。将左手五指伸直摊平，用食指和中指分别置于穿刺部位两侧。右手拇指与食指夹持针柄，中指末端靠近针尖，指腹抵住针体。拇指与食指向下施压，同时屈曲中指，以进针。针刺到位后，沿针灸角度均匀提插针柄至适当的深度和频率。然后前后旋转针柄，旋转角度不超过180度，直至患者产生得气感。从底部点燃艾条，将其置于已刺入穴位的针灸针上方，距离皮肤约2至3厘米，使患者感到温热，并出现体表发红现象。在艾条下方放置一张纸板，以防止灰烬烫伤皮肤，并持续治疗直至艾条燃尽。使用棉签的末端轻轻取走燃尽的艾条。随后，从穴位上移除纸板，并用医用消毒棉签对针刺部位施加轻微压力。用针头轻轻旋转一下，缓慢提起至皮下水平，并在此位置停留片刻，然后拔出。拔针后，使用医用消毒棉签轻轻按压穿刺部位片刻，以防止出血并减轻疼痛。检查所有穿刺部位是否有出血迹象，并询问患者的舒适程度。最后，计数针具以确保所有针均已从穿刺部位取出。接受温针灸、艾灸和基础治疗的观察组与接受基础治疗加假针刺的对照组的CAT评分结果显示，两组治疗后的评分均低于治疗前；此外，观察组的评分低于对照组。两组在治疗后的腹部胀满视觉模拟评分均较治疗前降低，观察组的评分低于对照组。

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了解温针灸治疗慢性阻塞性肺疾病伴腹胀的标准化操作方法。该方法操作简便、疗效显著且成本低廉，有助于改善患者症状并提升传统中医疗法的临床应用价值。

一种温针灸与艾灸治疗慢性阻塞性肺疾病伴腹胀的初步研究

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