温针灸治疗慢性阻塞性肺疾病伴腹胀的初步研究
Summary
在这里，我们提出了一种正确操作温针灸治疗腹胀慢性阻塞性肺病 （COPD） 的方案。
Abstract
大多数 COPD 患者同时存在腹胀，这已被证明会对 COPD 患者的肺部症状、急性加重频率和生活质量产生不利影响。温针灸已被证明可有效缓解慢性阻塞性肺病合并腹胀患者的症状。温针和艾灸是高效、易于执行且价格低廉的中医治疗形式。温针灸的规范做法对于COPD合并腹胀的治疗非常重要。具体步骤包括通过辨证治疗选择合适的穴位进行针刺，以及选择合适长度的艾条进行脱气后约30分钟的艾灸。治疗过程持续一周。具体评估以下指标：COPD评估测试（CAT）和腹胀视觉模拟量表（VAS）的评分。本文将清楚地说明如何规范温针灸的操作，以缓解COPD合并腹胀。
Introduction
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。慢性阻塞性肺病患者主要表现为慢性咳嗽和咳痰，病情进展，肺功能逐渐下降。疾病后期可并发慢性肺心病、呼吸衰竭、心力衰竭等，严重影响患者生活质量。据报道，肠道微生物群的改变与 COPD1 的疾病进展有关。除肺部症状外，40.31%的稳定期COPD患者报告腹胀。腹胀可对肺部症状恶化、增加 COPD 急性加重的频率以及损害稳定期 COPD 患者的生活质量产生重大影响 2,3。慢性阻塞性肺病腹胀的原因被认为是多因素的，可能包括以下几点：（1）细菌菌群失调;（2）腹水，增加腹内压;（3）电解质紊乱;（4）右心衰竭和肝脏或消化道充血;（5）长期卧床休息4;（6）药物5和机械通气6。
有中医学者提出，慢性阻塞性肺病的发展过程是四种状态的过程：（1）肺气虚;（2）脾气虚;（3）肾气虚;（4）阴阳虚 7,8.如果脾脏无法运输和转化，胃虚弱而无法接收，则可能会发生腹胀，进而导致肌肉因缺乏化学来源而变薄和无力9.目前，临床上常用的COPD药物有支气管扩张剂、糖皮质激素、抗生素等药物10。目前尚无指南规定COPD合并腹胀的标准化治疗方案，腹胀通常以对症治疗。
中医温针灸，可引导气疏通经络，活血化瘀，补虚温阳，消寒。它们可以产生抗氧化物质，从而发挥调节作用，从而促进免疫系统应激反应并改善血液循环11,12。温针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。实验研究表明，针灸可以通过调节脑肠轴18来缓解腹胀。针灸联合艾灸可显着减少腹胀19，腹胀可以通过调节血浆前列腺素 E2 和血浆和胃粘膜组织中的胃泌素水平20 来发挥。同时，温针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。针灸可以加强横膈膜，缓解呼吸肌疲劳，以及改善二氧化碳潴留和缺氧，预防和缓解呼吸衰竭22。温针和艾灸可改善稳定期慢性阻塞性肺病患者的肺功能、临床症状和生活质量23,24。
根据中医“肺与大肠内外关系”的理论，本研究采用温针灸治疗，旨在促进胃肠功能的恢复，提高肺功能和生活质量。温针和艾灸是高效、易于执行且价格低廉的中医治疗形式。综上所述，有必要就如何正确操作使用温针和艾灸来缓解腹胀性COPD提出标准方案。本文介绍如何正确操作使用温针和艾灸治疗来缓解腹胀的COPD。
Protocol
该临床研究方案经成都中医药大学附属医院呼吸内科临床研究审批委员会审批（备案号.肯塔基州2022010）。 1、设备准备 准备一次性无菌针灸针（尺寸为0.25 mm x 40 mm），艾条（尺寸为1.2 cm x 1.2 cm），医用灭菌拭子，碘伏拭子，打火机和几个60 mm x 60 mm纸板（见 图1）。 2. 医生准备 确保患者?…
Representative Results
一般条件将12例COPD合并腹胀患者（表1）分为观察组和对照组，每组6例。所有患者均符合《慢性阻塞性肺疾病初级保健指南（2018）》29 的诊断标准，并有腹胀。对照组给予假针刺。我们选择与观察组相同的穴位，在这些穴位旁边 2.5 厘米处垂直插入皮肤，并在没有针刺和艾灸的情况下将它们表面刺穿 1-3 毫米。对照组患者根据《慢性阻塞性肺疾病初级?…
Discussion
众所周知，慢性阻塞性肺病引起的腹胀的发病机制尚不完全清楚，这阻碍了新疗法和新药的开发。近年来，温针灸被广泛应用于COPD合并腹胀。温针灸的治疗机理主要是针灸的效果、艾灸的温热作用、针体的导热作用31。艾灸的重点是穴位的局部变暖。它激活局部特异性受体、热休克蛋白、热敏免疫细胞等，发挥温经、开通侧支的局部作用32。现代中医认为，RN12?…
Disclosures
The authors have nothing to disclose.
Acknowledgements
2022年“天府青城计划”天府科技领军人才项目（川清城1090号）、国家中医临床优秀人才培养计划（国家中医仁教函[2022]1号）、成都中医药大学医院“百人计划”项目（院办[2021]42）、四川省中医药管理局科研专项（2021MS093、 2021MS539、2023MS608）。
Materials
| Moxa stick | Dr. Moxi | N/A | size: 1.2 cm x 1.2 cm |
| Disposable sterile acupuncture needle | HWATO | 2001-0020 | size: 0.25 mm x 40 mm |
| Iodophor swabs | BEIJIAER | 20162140536 | |
| Cardboard | In-house | In-house | size: 60 mm x 60 mm |
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Cite This Article
Yu, S., Wang, T., Ying, R., Zhu, Y., Liu, K., Yuan, F., Yang, H., Chen, K., Shi, J., Luo, X. A Preliminary Study on Warm Acupuncture and Moxibustion for Treating Chronic Obstructive Pulmonary Disease with Abdominal Distension. J. Vis. Exp. (199), e65318, doi:10.3791/65318 (2023).