穴位电刺激改善脓毒症胃肠功能障碍患者早期肠内营养耐受性:多中心随机对照研究  

Transcutaneous electrical acupoint stimulation for early enteral nutrition tolerance in patients with sepsis of gastrointestinal dysfunction: a multi-center randomized controlled trial

作　　者：刘欢[1] 朱瑾 倪海滨[2] 胡星星 LIU Huan;ZHU Jin;NHai-bin;HU Xing-xin(Third Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu Province,China;Department of Emergency and Critical Medicine,Affiliated Hospital of Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine;Department of Emergency,Lishui District Hospital of TCM,Nanjing 211200,Jiangsu Province)

机构地区：[1]南京中医药大学第三临床医学院,江苏南京210023 [2]南京中医药大学附属中西医结合医院急重症医学科 [3]南京市溧水区中医院/江苏省中西医结合医院南部院区急诊科,江苏南京211200

出　　处：《中国针灸》2020年第3期229-233,共5页Chinese Acupuncture & Moxibustion

基　　金：江苏省科技厅社会发展面上项目:BE2019764。

摘　　要：目的:比较穴位电刺激配合常规西医治疗与单纯西医治疗对脓毒症患者早期肠内营养耐受性的作用。方法:将49例脓毒症患者随机分为观察组(24例)和对照组(25例)。对照组采用限制性液体复苏、抗感染、维持血流动力学等常规西医治疗,于血流动力学趋于稳定、血管活性药物减量时即可开通肠内营养;观察组在对照组治疗基础上,自肠内营养开通时于天枢、上巨虚、解溪、地机、足三里、中脘、大横行穴位电刺激,予疏密波,频率为2 Hz/10 Hz,每日2次,每次30 min,治疗至肠内营养达标。通过超声评估两组治疗第1、3、5天胃窦运动指数(MI),记录患者自开通肠内营养至肠内营养达标的总时间,并比较两组患者治疗前后急性胃肠损伤(AGI)分级、入住重症加强护理病房(ICU)时间及住院时间。结果:观察组治疗第3、5天胃窦运动指数明显高于对照组(P<0.05);观察组肠内营养达标时间为(5.08±0.65)d,短于对照组的(5.56±0.65)d(P<0.05);观察组治疗后AGI分级改善情况明显优于对照组(P<0.05);观察组住院时间短于对照组(P<0.05)。结论:穴位电刺激配合常规西医治疗能明显促进胃肠道蠕动功能,改善脓毒症患者早期肠内营养耐受性,从而缩短肠内营养达标的时间及住院时间,疗效优于单纯常规西医治疗。Objective To compare the therapeutic effect of transcutaneous electrical acupoint stimulation(TEAS) combined with conventional western medicine and western medicine alone on early enteral nutrition tolerance in patients with sepsis. Methods Forty-nine patients with sepsis were randomly divided into an observation group(24 cases) and a control group(25 cases). The control group was treated with conventional western medicine, including limited fluid resuscitation, anti-infection and maintenance of hemodynamics, and enteral nutrition was provided when the hemodynamics became stable and the dosage of vasoactive drugs was reduced. The observation group, on the basis of the treatment of the control group, was treated with TEAS at Tianshu(ST 25), Shangjuxu(ST 37), Jiexi(ST 41), Diji(SP 8), Zusanli(ST 36), Zhongwan(CV 12) and Daheng(SP 15) when the enteral nutrition was provided(dilatational wave, 2 Hz/10 Hz, twice a day, 30 min each time), and the TEAS stopped when enteral nutrition was normal. The antral motility index(MI) was evaluated by ultrasonography on the first, third and fifth day into treatment in the two groups, and the duration from providing enteral nutrition to normal enteral nutrition was recorded. The acute gastrointestinal injury(AGI) classification, admission time of intensive care unit(ICU) and hospitalization time were compared. Results The antral MI on the third and fifth day into treatment in the observation group was significantly higher than that in the control group(P<0.05). The duration from providing enteral nutrition to normal enteral nutrition was(5.08±0.65) days in the observation group, which was shorter than(5.56±0.65) days in the control group(P<0.05). The improvement of AGI classification after treatment in the observation group was significantly superior to the control group(P<0.05). The hospitalization time in the observation group was shorter than that in the control group(P<0.05). Conclusion TEAS combined with conventional western medicine treatment could significantly promote gas

关 键 词：脓毒症 胃肠功能障碍 早期肠内营养 经皮穴位电刺激 随机对照试验 

分 类 号：R246.1[医药卫生—针灸推拿学]