电针足三里穴和尺泽穴对脓毒症患者急性肺损伤的影响  

Effect of electroacupuncture at Zusanli and Chize on sepsis-induced acute lung injury

作　　者：李莉[1] 穆蕊[1] 余剑波[1] 邵伟[2] 陆盛[2] 张桂诚[3] 

机构地区：[1]天津市南开医院麻醉科,300100 [2]天津市南开医院重症医学科,300100 [3]天津医科大学研究生院

出　　处：《中华麻醉学杂志》2013年第5期626-629,共4页Chinese Journal of Anesthesiology

基　　金：天津市科技支撑计划重点项目（12ZCZDSY03300）

摘　　要：目的评价电针足三里穴和尺泽穴对脓毒症患者急性肺损伤的影响。方法脓毒症并发急性肺损伤／急性呼吸窘迫综合征患者60例，性别不限，年龄43～78岁，体重49～89奴，急性病生理学和慢性健康评价．U评分（APACHE一Ⅱ评分）16～23分，氧合指数125～256mmHg。采用随机数字表法，将患者分为3组（n=20）：常规治疗组（S组）、常规治疗＋电针非穴位组（SNE组）和常规治疗＋电针穴位组（SE组）。S组给予常规治疗，sE组在常规治疗基础上，电针刺激足三里和尺泽穴，参数：疏密波（2／50Hz）波宽300μs，刺激电流由0开始，以0．1mA的梯度逐渐增大，逐渐达到患者能耐受的最大水平，然后维持刺激强度在此水平，持续刺激30rain，1次／d，连续5d。SNE组常规治疗基础上，电针刺激非穴位，电针刺激参数同sE组。于电针刺激前（T1）、电针刺激结束后3d（T2）及5d（T1）时取动脉血样，行血气分析，计算氧合指数，行APACHE-Ⅱ评分。T1、T2时取静脉血样和行肺泡灌洗，取支气管肺泡灌洗液（BAt。F），采用ELISA法测定血清及BALF中TNF—α和IL-10的浓度。记录电针刺激结束后5d内器官功能障碍综合征的发生情况和生死情况。结果与T1时比较，T2、L时3组氧合指数均升高，APACHE。n评分降低，B时3组血清和BALFTNF—α浓度降低，IL—10浓度升高（P〈0．05或0．01）；与T1时比较，己时3组氧合指数均升高，APACHE-Ⅱ评分降低（P〈0．05）；与S组比较，SE组．T2、T3时氧合指数升高，T3时APACHE-Ⅱ评分降低，血清和BALF中TNF—α浓度降低，IL-10浓度升高（P〈0．05或0．01），SNE组上述指标差异无统计学意义（P〉0．05）。3组器官功能障碍综合征发生率和生存率差异无统计学意义（P〉0．05）。结论电针刺足三里和尺泽穴有助于减轻脓毒症患者急性肺损伤，其机制可能与调节促炎因子／抗炎因�Objective To evaluate the effects of electroacupuncture （EA） at Zusanli and Chize on sepsisinduced acute lung injury （ALI） in patients. Methods Sixty patients with sepsis-induced ALl/respiratory distress syndrome, aged 43-78 yr, weighing 49-89 kg, with their APACHE- II scores of 16-23 and oxygenation index of 125-256 mm Hg, were randomly divided into 3 groups （n -- 20 each）： conventional therapy group （group S）, conventional therapy ＋ acupuncture at non-acupoint group （group SNE） and conventional therapy ＋ acupuncture at acupoint group （group SE）. Bilateral Huantiao and Chize points were stimulated with electric stimulator （frequency 2/50 Hz, wave length 300μs, starting at a voltage of 0 and increasing by 0.1 mA every time until the maximal tolerance level was reached） for 30min once a day for 5 days based on the conventional therapy in group SE. In group SNE, EA was performed at the non-acupoint based on the conventional therapy and the parameters of EA were same as those previously mentioned in group SE. Before EA stimulation （T2） and at 3 and 5 days after the end of EA stimulation （T2_3）, arterial blood samples were taken for blood gas analysis, oxygenation index （OI） was calculated, and APACHE- l] scores were assessed. Venous blood samples were collected at T1 and T3 for detection of TNF-a and IL-10 concentrations in the broncho-alveolar lavage fluid （BALE） and serum （by ELISA）. Results Compared with the baseline value at T1 , T1 was significantly increased and APACHE- II scores were decreased at T2 and T3, and TNF-a concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALE and serum were increased at T3 in the three groups （ P 〈 0.05 or 0.01 ） . The OI was significantly higher and APACHE- II scores were lower at T3 than at T2 in the three groups （ P 〈 0.05）. Compared with group S, the OI was significantly increased at T2 and T3 , APACHE- II scores and TNF-α concentrations in the BALF and serum were decreased at

关 键 词：电针 穴 足三里 穴 尺泽 内素素血症 呼吸窘迫综合征 成人 

分 类 号：R245[医药卫生—针灸推拿学]