针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究  

Clinical Research on Regulation of Gastrointestinal Function and Gastrointestinal Hormone by Acupuncture in Elderly Patients with Severe Sepsis

作　　者：虞意华[1] 金肖青[1] 俞迈红[1] 龚仕金[1] 刘秉宇[1] 李莉[1] 

机构地区：[1]浙江医院,浙江杭州310013

出　　处：《中华中医药学刊》2015年第8期1953-1956,共4页Chinese Archives of Traditional Chinese Medicine

基　　金：浙江省中医药管理局项目(2010ZA002);浙江省重症医学科技创新团队项目

摘　　要：目的:评价针灸对老年严重脓毒症患者胃肠功能及胃肠激素的调节作用及其可能机制。方法:选择医院重症医学科(ICU)收治的严重脓毒症/MODS患者90例,按随机数字表法分为对照组(44例)和针灸组(46例),两组均给予严重脓毒症常规治疗,针灸组在常规治疗基础上行针灸,每日1次,疗程5 d。于治疗前、治疗3d、7 d观察两组患者临床症状、血清胃动素(MOT)、胃泌素(GAS)水平、胃残留量(GRV)、腹腔内压力(IAP)和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、MODS病情严重程度评分的变化,并进行胃肠功能障碍疗效评价。结果:针灸组患者临床胃肠道症状对照组明显改善(P<0.05);两组治疗后MOT增高,GAS降低,治疗7 d GRV减少、IAP下降与对照组同期比较差异有统计学意义(P<0.05);胃肠功能障碍疗效评分显示显效、有效及总有效率均明显高于对照组(显效率:31.8%比15.9%,有效率:40.9%比29.5%,总有效率:72.7%比45.4%,均P<0.05);两组血清MOT水平(pg/L)增高,GAS水平(pg/L)下降、胃残余量(ml)明显减少,腹腔内压力(mmhg)、APACHEⅡ评分(分)、MODS病情严重程度评分(分)均明显降低,而且针灸组在上述指标的改善程度明显优于对照组,以治疗7 d变化更显著(增加MOT水平391.57±123.07比306.37±117.11,GAS水平下降67.56±31.50比103.36±43.93,胃残留量:86.52±77.38比117.27±104.91,腹腔内压力:9.61±3.90比11.93±5.21,APACHEⅡ评分:16.30±4.67b比20.41±4.80,MODS病情严重程度评分:10.15±3.32比11.66±3.28,P<0.05或P<0.01)。结论:针灸能够有效地改善老年严重脓毒症患者的胃肠道临床症状,显著减少胃储留及腹腔内压力水平,增加血清MOT水平,降低GAS水平、降低APACHEⅡ评分及MODS病情严重程度评分,显著提高治疗老年严重脓毒症患者胃肠功能障碍治疗的有效性,其改善胃肠功能机制可能与通过调节胃肠激素水平有关。Objective：To study the regulation of gastrointestinal function and possible mechanism of acupuncture in elderly patients with severe sepsis. Methods ：Ninety patients with severe sepsis or MODS in Intensive Care Unit（ICU） of Zhejiang Hospital were selected and they were randomly divided into control group（ group A,44 cases）and acupuncture group（ group B,g6 cases）, Conventional treatment was given to the two groups, additionally,in group B, acupuncture was applied once a day for 5 days. Before the treatment and 3 and 7 days after treatment, the changes of clinical symptoms, gastrointestinal hormone level, gastric residual volume （ GRV ）, intra - abdominal pressure （ IAP ）, acute physiology and chronic health evaluation II （ APACHE lI ） score, MODS severity score and gastrointestinal symptom scores were observed and the therapeutic effect of gastrointestinal dysfunction was evaluated in the two groups. Results：The improvement of clinical symptoms of group B was significantly better than that of group A. After treatment, the gastrointestinal symptom~ scores of the two groups were lower. On the 7th day, the score in group B compared with that at the same time in group A had statistical significant difference（P 〈0.05）. The gastrointestinal dysfunction score showed marked effectiveness and the total effective rate was obviously higher in group B than those in group A（ marked effectiveness ：31.8% vs. 15.9% ; effectiveness ： 40.9% vs. 29.5% ; the total effective rate ： 72.7 % vs. 45.4%, all P 〈 0.05）. The serum levels of MOT increased and GAS was decreased and GRV and IAP were decreased. APACHE Ⅱ score and the MODS severity score of the two groups were decreased and the improvement degrees of above indexes in group B were better than those in group A. The changes of MOT（ pg/L）, GAS （ pg/L）, GRV （ mL）, IAP （ mmhg）, APACHE II score （points）, MODS severity score （points） for 7 days in the group B were more significant （ level of MOT：391.57 ±123.07

关 键 词：严重脓毒症 胃肠功能 针灸 胃肠激素 胃动素 胃泌素 老年 

分 类 号：R245[医药卫生—针灸推拿学]