早期穴位电刺激对脓毒症休克患者下肢肌力的影响  

Effect of early acupoint electrical stimulation on lower limb muscle strength in patients with septic shock

作　　者：王双乐 朱瑾 赵志刚[1] 刘欢[1] 倪海滨[2] 胡星星 WANG Shuang-le;ZHU Jin;ZHAO Zhi-gang;LIU Huan;NI Hai-bin;HU Xing-xing(Third Clinical Medical College of Nanjing University of Chinese Medicine,Nanjing 210023,Jiangsu Province,China;Department of Emergency and Critical Medicine,Affiliated Hospital of Integrated Traditional Chinese and Western Medicine,Nanjing University of Chinese Medicine;Department of Emergency,Lishui District Hospital of TCM/Southern District of Jiangsu Hospital of Integrated Traditional Chinese and Western Medicine,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11期1173-1177,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:观察早期穴位电刺激对脓毒症休克患者因重症监护病房获得性衰弱(ICU-AW)所致下肢肌力下降的影响。方法:将58例因脓毒症休克而致ICU-AW的患者随机分为观察组(28例,脱落1例)和对照组(30例,脱落2例)。两组患者均接受常规基础治疗,观察组加用穴位电刺激疗法,穴取环跳、伏兔、足三里、悬钟、太冲。患者穴位以电极片贴敷,连接SDZ-Ⅱ型电子治疗仪(断续波,频率2 Hz,电流强度5 mA),单侧治疗30 min后更换至另一侧,每日2次,连续治疗7d或者直到下肢肌力英国医学研究理事会(MRC)评分≥54分。观察两组患者治疗前与出院时下肢肌力MRC评分、改良Rankin量表(MRS)评分、双下肢股四头肌均厚度及腓肠肌羽状角的变化情况,比较两组入住ICU时间、住院时间、住院期间病死率、出院后28 d病死率,并于出院后28 d随访两组患者MRS评分。结果:两组患者出院时下肢肌力MRC评分均较治疗前升高(P<0.05),出院时、出院后28dMRS评分均较治疗前降低(P<0.05),且观察组出院时下肢肌力MRC评分高于对照组(P<0.05),出院时、出院后28 d MRS评分低于对照组(P<0.05);两组患者出院时股四头肌均厚度、腓肠肌羽状角均较治疗前增大(P<0.05),且观察组均大于对照组(P<0.05);两组患者入住ICU时间、住院时间、住院期间病死率、出院后28 d病死率比较,差异均无统计学意义(P>0.05)。结论:早期穴位电刺激可以改善脓毒症休克获得性衰弱患者的下肢肌力。Objective To observe the effect of early acupoint electrical stimulation on the decline of lower limbs muscle strength in patients with intensive care unit-acquired weakness(ICU-AW) caused by septic shock. Methods A total of58 patients with ICU-AW caused by septic shock were randomly divided into an observation group(28 cases, 1 case dropped off) and a control group(30 cases, 2 cases dropped off). Patients in both groups received routine basic treatment. In the observation group, acupoint electric stimulation therapy was added at Huantiao(GB 30), Futu(ST 32), Zusanli(ST 36),Xuanzhong(GB 39) and Taichong(LR 3). Unilateral point with electrodes were applied, the SDZ-Ⅱ electronic instrument(discontinuous wave, frequency in 2 Hz, strength in 5 mA) was connected and changed to the other side after 30 min of unilateral treatment.The treatment was given 2 times daily, continued for 7 d or until the medical research council(MRC) score being 54 points or more. The changes of lower limb muscle strength MRC score, modified Rankin scale(MRS) score, bilateral quadriceps thickness and gastrocnemius pinnate angle of both groups were observed before treatment and on discharge. The time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge were compared between the two groups. The MRS scores of the two groups were followed up 28 d after discharge. Results The MRC scores of lower limb muscle strength in the two groups on discharge were higher than those before treatment(P<0.05),and the MRS scores on discharge and 28 d after discharge in the two groups were lower than those before treatment(P<0.05).The MRC scores of lower limb muscle strength on discharge in the observation group were higher than thoes in the control group(P<0.05), and the MRS scores on discharge and 28 d after discharge in the observation group were lower than those in the control group(P<0.05). On discharge, bilateral quadriceps thickness and gastrocnemius pinnate angle in the two groups were increase

关 键 词：脓毒症休克 重症监护病房获得性衰弱 穴位电刺激 下肢肌力 

分 类 号：R245.97[医药卫生—针灸推拿学]