推拿五法作用于DVT模型大鼠血栓形成前后安全性的实验研究

Thromboembolism, which includes deep venous thrombosis, cerebral thrombosis, etc., is a common clinical disease and poses a serious threat to human welfare. Tuina theory considers certain manipulations to be effective at promoting blood circulation and removing stasis. However, recent clinical reports indicate that tuina may give rise to the formation or detachment of thrombi. Therefore, the safety of applying tuina in the treatment of thrombotic diseases pre- and post-thrombus formation remains an urgent medical problem in need of answering. To address this concern, two questions were raised. Firstly, whether the continuous application of tuina manipulations changes the mechanics of blood flow by affecting vascular endothelial cells, blood platelets, coagulation system，fibrinolytic system or hemodynamic changes and thereby aggravates DVT formation in veins. Secondly, does the continuous application of tuina manipulations lead to the detachment of thrombi by means of affecting the stiffness of the thrombi and mechanical characteristics of blood vessels. To answer the above questions, incomplete blockage of the femoral vein was used to establish a DVT rodent model, and tuina manipulation simulators were used to perform pressing method, circular-rubbing method, strumming method, pushing method and traction method at regions where the thrombi form. Tuina simulator were used as the intervention method to maintain qualitative and quantitative control. Using molecular biology, morphometry, imaging and biomechanical methods, this study will investigate the influence of various tuina manipulations on the formation and detachment of thrombi, and thereby provide scientific evidence on the safety of applying tuina manipulations in pre- and post-thrombotic conditions.

血栓性疾病包括深静脉血栓（Deep venous thrombosis，DVT）、脑血栓等栓塞性疾病，是临床常见病症，严重威胁人类健康。推拿理论认为手法具有活血祛瘀的作用，但有临床报道推拿可能导致血栓形成或引起血栓脱落，因此在血栓形成前后应用推拿手法是否安全成了亟待回答的问题。为此我们提出2个科学问题：①血栓形成前，反复施加推拿手法，是否会影响血管内皮细胞、血小板、凝血系统、纤溶系统功能，引起血流动力学改变，从而加重静脉血栓的形成？②血栓形成后，反复施加推拿手法，是否会影响血栓硬度和血管力学特性，从而引起血栓脱落？为此，本研究拟采用不完全阻滞股静脉法制作大鼠DVT 模型，运用手法模拟仪对模型大鼠血栓部位分别进行点法、揉法、拨法、推法、牵拉法的定性定量干预，采用分子生物学、形态计量学、影像学、生物力学方法研究推拿五法对血栓形成和脱落的影响，从而为推拿手法在血栓形成前后的安全应用提供科学依据。

背景：血栓性疾病包括深静脉血栓（Deep venous thrombosis，DVT）、脑血栓等栓塞性疾病，是临床常见病症，严重威胁人类健康。推拿理论认为手法具有活血祛瘀的作用，但有临床报道推拿可能导致血栓形成或引起血栓脱落，因此在血栓形成前后应用推拿手法是否安全成了亟待回答的问题。.研究内容：为探究推拿五法对于血栓形成和脱落的影响，本研究采用不完全阻滞股静脉法制作SD大鼠深静脉血栓模型，并运用手法模拟仪对模型大鼠分别进行点法、揉法、拨法、推法、牵拉法的定性定量干预，分别从血管内皮细胞功能、血小板功能、凝血系统功能、纤溶系统功能以及血流动力学改变角度，研究推拿手法对于血栓形成的影响；从栓子硬度变化和血管力学特性方面，研究推拿手法对于血栓脱落的影响。.重要结果及关键数据：凝血、纤溶功能（PT、APTT、TT、FIB、D-二聚体、TXB2、6-Keto-PGF1α）表明：推拿五法干预3天后，点法、推法、牵拉法作用于DVT大鼠安全性高，但干预10天后，点法、推法、牵拉法存在一定风险；3天，10天两个时间点，拨法、揉法作用于DVT大鼠均存在风险。血液流变学（低切变率、中切变率、高切变率、血浆粘度）表明：推拿五法作用于DVT大鼠无风险。超声弹性（超声弹性成像、应变率比值）表明：推拿五法作用于DVT大鼠无风险。.科学意义：①得出推拿手法安全应用的初步结论：推拿五法中点法、推法、牵拉法对于DVT大鼠的早期干预安全性高，但随着干预天数的增加，点法、推法、牵拉法也存在一定风险；拨法、揉法作用于DVT大鼠存在风险。②建议推拿临床中深静脉血栓的治疗多用点法、推法等轻柔手法，拨法、揉法慎用，为推拿和血栓性疾病的临床诊治提供理论依据。③提示了推拿手法作用于血栓性疾病的时间选择、力量大小等需要进一步研究的科学问题。

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