电针刺激治疗重型颅脑损伤患者急性胃肠损伤——一项前瞻性随机对照研究  

Electroacupuncture in the treatment of acute gastrointestinal injury in patients with severe traumatic brain injury:a prospective randomized controlled trial

作　　者：邢茜[1] 江荣林[1] 雷澍[1] 徐琦琦 朱美飞[1] 智屹惠[1] 夏国莲[1] 黄立权[1] 毛诗昊 陈哲奇 冯丹丹 Xing Xi;Jiang Ronglin;Lei Shu;Xu Qiqi;Zhu Meifei;Zhi Yihui;Xia Guolian;Huang Liquan;Mao Shihao;Chen Zheqi;Feng Dandan(Department of Intensive Care Unit,the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine,Hangzhou 310006,Zhejiang,China)

机构地区：[1]浙江中医药大学附属第一医院重症医学科,杭州310006

出　　处：《中华危重病急救医学》2021年第1期95-99,共5页Chinese Critical Care Medicine

基　　金：国家自然科学基金(81774070);浙江省中医药科技计划项目(2019ZB039,2019ZQ022)。

摘　　要：目的评价电针刺激对重型颅脑损伤(sTBI)患者急性胃肠损伤(AGI)的疗效。方法采用前瞻性单盲随机对照研究方法,选择2018年1月至2019年12月浙江中医药大学附属第一医院重症医学科连续收治的126例sTBI合并AGI患者。将患者按随机数字表法分为观察组和对照组。两组均给予西医常规治疗,包括治疗原发疾病,留置鼻胃管每6 h回抽胃内容物判断胃残留量(GRV),在生命体征基本稳定后实施肠内营养(EN)并根据GRV调整EN饲入量及速度等,连续治疗7 d;观察组在西医常规治疗基础上,取足三里、天枢、上巨虚、下巨虚、中脘五穴进行电针刺激治疗,每天早晚各1次,每次30 min。观察两组患者治疗前及治疗3 d、7 d胃肠功能指标〔腹内压(IAP)、血清二胺氧化酶(DAO)和胃肠功能衰竭评分(GIF评分)〕的变化;记录两组患者ICU院内获得性肺炎(HAP-ICU)发生率、机械通气(MV)时间、重症监护病房(ICU)住院时间、28 d病死率及电针刺激的不良反应。采用Kaplan-Meier法进行28 d生存分析。结果126例患者在7 d治疗观察过程中有26例退出研究,最终入组100例,观察组和对照组各50例。治疗3 d时两组患者IAP和DAO即较治疗前明显降低〔对照组:IAP(cmH_(2)O,1 cmH_(2)O=0.098 kPa)为13.75±2.76比18.11±3.97,DAO(U/L)为129.88±24.81比158.01±22.64;观察组:IAP(cmH_(2)O)为13.56±2.19比18.50±3.54,DAO(U/L)为129.11±29.32比159.36±28.65;均P<0.01〕;随治疗时间延长,两组患者胃肠功能指标均逐渐改善,且观察组治疗7 d时IAP、DAO和GIF评分均较对照组明显降低〔IAP(cmH_(2)O):11.28±3.61比12.68±3.23,DAO(U/L):49.69±17.56比57.27±20.15,GIF评分(分):2.02±0.74比2.40±0.70,均P<0.05〕。观察组患者MV时间和ICU住院时间均较对照组明显缩短〔MV时间(d):15.72±4.60比18.08±4.54,ICU住院时间(d):16.76±4.68比19.26±5.42,均P<0.05〕,且HAP-ICU发生率和28 d病死率均较对照组显著降低(12.0%比30.0%,22.0%比32.0%,均P<0.05)。Objective To evaluate the therapeutic effect of electroacupuncture on acute gastrointestinal injury(AGI)in patients with severe traumatic brain injury(sTBI).Methods A prospective randomized controlled trial was conducted.126 consecutively hospitalized patients with AGI after sTBI admitted to intensive care unit(ICU)of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2018 to December 2019 were enrolled.The patients were divided into observation group and control group by random number table.All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days,including the treatments of primary diseases,indwelling nasogastric tube to extract gastric contents every 6 hours to determine gastric residual volume(GRV).When vital signs were basically stable,enteral nutrition(EN)was implemented and EN feeding amount and speed were adjusted according to GRV.On the basis of conventional western medicine treatment,the observation group was treated with electroacupuncture at Zusanli,Tianshu,Shangjuxu,Xiajuxu and Zhongwan,once in the morning and once in the evening,30 minutes each time.The gastrointestinal function parameters including intra-abdominal pressure(IAP),serum diamine oxidase(DAO)and gastrointestinal failure(GIF)scores were observed before treatment and at day 3 and day 7 of treatment.The incidence of ICU hospital-acquired pneumonia(HAP-ICU),duration of mechanical ventilation(MV),length of ICU stay,28-day mortality and adverse reactions of electroacupuncture were also observed in the two groups.Kaplan-Meier method was used for 28-day survival analysis.Results During the 7-day treatment and observation,26 cases of 126 patients withdrew from the study,and 100 cases were actually enrolled,50 cases in the observation group and 50 cases in the control group.IAP and DAO at day 3 of treatment in both groups were significantly lower than those before treatment[control group:IAP(cmH_(2)O,1 cmH_(2)O=0.098 kPa)was 13.75±2.76 vs.18.11±3.97

关 键 词：重型颅脑损伤 急性胃肠损伤 电针刺激 

分 类 号：R651.15[医药卫生—外科学] R57[医药卫生—临床医学]