针刺补法对脓毒症肾上腺皮质功能不全患者的影响  

Effects of Acupuncture and Tonifying Therapy on Patients with Adrenalcortical Function Insufficiency in Sepsis

作　　者：严雪丽 李永新 易小琳 Yan Xueli;Li Yongxin;Yi Xiaolin(Suining Hospital of Traditional Chinese Medicine Affiliated to North Sichuan Medical University,Sichuan,Suining 629000,China)

机构地区：[1]川北医学院附属遂宁中医医院,四川遂宁629000

出　　处：《中国中医急症》2023年第9期1552-1555,共4页Journal of Emergency in Traditional Chinese Medicine

基　　金：四川省中医药管理局科技项目(2021MS129)。

摘　　要：目的通过针刺补法刺激关元、肾俞、足三里穴,观察下丘脑-垂体-肾上腺轴(HPA)对脓毒症肾上腺皮质功能不全患者的影响。方法66例脓毒症肾上腺皮质功能不全患者随机分为针刺组与对照组各33例。对照组依照《2016国际脓毒症和感染性休克指南》常规治疗,并加用小剂量糖皮质激素;针刺组在对照组基础上加用针刺补法刺激关元、肾俞、足三里,连续治疗7 d。治疗第3天及第7天后,检测患者的促肾上腺皮质激素(ACTH)、血清皮质醇(COR)、降钙素原(PCT)水平,采用急性生理与慢性健康量表(APACHEⅡ)评价患者疾病恢复程度,并对比两组患者ICU住院时长和28 d病死率。结果治疗后,针刺组的ACTH、COR及PCT数值均较入组时显著下降且明显低于同时期对照组(P<0.05);两组治疗第3天及第7天APACHEⅡ评分均显著下降,且针刺组明显低于对照组(P<0.05)。针刺组ICU住院时间明显短于同对照组(P<0.05)。两组28 d病死率相近(P>0.05)。结论针刺补法刺激关元、肾俞、足三里穴能有效调节HPA轴降低脓毒症肾上腺皮质功能不全患者的ACTH、COR及PCT水平,从而改善肾上腺皮质功能,增强机体抗炎作用及缩短ICU住院时长,但对28 d病死率无明显影响。本研究表明针刺补法可成为治疗脓毒症肾上腺皮质功能不全患者的一种有效新方法。Objective:To investigate the effect on the hypothalamus-pituitary-adrenal(HPA)axis in patients with sepsis-induced adrenocortical function insufficiency by stimulating Guanyuan,Shenshu,and Zusanli acupoints using a tonifying therapy.Methods:A total of 66 patients with sepsis-induced adrenocortical function insufficiency were randomly assigned to either the acupuncture group(n=33)or the control group(n=33),based on random number table method.The control group received standard treatment according to international guidelines for management of sepsis and septic shock(2016 version),including low-dose glucocorticoids,while the acupuncture group received additional acupuncture and tonifying therapy to stimulate Guanyuan,Shenshu,and Zusanli acupoints,for seven consecutive days.ACTH,COR,and PCT levels were assessed on the acupuncture group on the 3rd and 7th days of treatment,as compared to the levels before treatment and the levels of the control group.The APACHEⅡ score was used to evaluate the degree of disease recovery,and the length of ICU stay and 28 day case fatality rate of the two groups were compared.Results:After 7 days of treatment,the ACTH,COR and PCT values of the acupuncture group decreased significantly compared with the control group at enrollment and were significantly lower than those in the control group(P<0.05)during the same period;the APACHEⅡ scores decreased significantly on the 3rd and 7th days of treatment in both groups,and the acupuncture group was significantly lower than those in the control group(P<0.05).The ICU stay in the acupuncture group was significantly shorter than that in the control group(P<0.05).The difference of the 28-day case fatality rate in the two groups was not statistically significant(P>0.05).Conclusion:Acupuncture at Guanyuan,Shenshu,and Zusanli acupoints and tonifying methods can effectively modulate the HPA axis and decrease ACTH,COR,and PCT levels in patients with sepsis-induced adrenocortical function insufficiency,which leads to improved adrenocortical function,e

关 键 词：脓毒症肾上腺皮质功能不全 针刺补法 下丘脑-垂体-肾上腺轴 促肾上腺皮质激素 皮质醇 

分 类 号：R631[医药卫生—外科学]