合募配穴治疗危重症患者肠内营养喂养不耐受的疗效观察  

Effect of the combination of he-sea and front-mu points on enteral nutrition feeding intolerance in critical illness patients

作　　者：陈晓桐 李璟[1] 王文佳 吴梦蝶 钱义明[1] 谢静[1] 侯瑜超 李俊雄 CHEN Xiao-tong;LI Jing;WANG Wen-jia;WU Meng-die;QIAN Yi-ming;XIE Jing;HOU Yu-chao;LI Jun-xiong(Yueyang Hospital of Integrated Chinese and Western Medicine Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]上海中医药大学附属岳阳中西医结合医院,上海200437

出　　处：《针刺研究》2024年第1期64-70,共7页Acupuncture Research

基　　金：上海市中医诊疗模式创新试点建设项目(No.ZY[2018-2020]-FWTX-6012);上海市进一步加快中医药传承创新发展三年行动计划项目(No.ZY[2021-2023]-0302);上海市临床重点专科(针灸)建设项目(No.shslczdzk04701);上海市名老中医学术经验研究工作室建设项目(No.SHGZS-202212)。

摘　　要：目的:观察合募配穴对危重症肠内营养喂养不耐受(ENFI)患者喂养达标率、腹内压、肠内营养耐受性评分、急性生理学和慢性健康状况评价Ⅱ(APACHE-Ⅱ)评分和胃肠功能损伤(AGI)等级的影响,评价合募配穴治疗ENFI的临床疗效。方法:将70例ENFI患者随机分为对照组、治疗组各35例。对照组采用常规基础治疗联合肠内营养支持;治疗组在对照组治疗基础上取上脘、中脘、下脘、气海、关元及双侧内关、足三里、下巨虚、上巨虚、天枢、大横针刺,其中天枢、大横左右各为一组,分别接电针仪的一对电极,每次30 min,每日1次,连续7 d。观察两组患者治疗期间每日喂养达标人数,计算喂养达标率,记录治疗期间肠内营养耐受性评分、腹内压、APACHE-Ⅱ评分和AGI等级。结果:治疗后两组肠内喂养达标率较治疗前升高,且治疗组除第2天以外肠内喂养达标率均高于对照组(P<0.05);治疗后两组肠内营养耐受性评分、腹内压、APACHE-Ⅱ评分和AGI等级均较治疗前降低(P<0.05, P<0.01),且治疗组低于对照组(P<0.05)。结论:合募配穴可以通过增加ENFI患者肠内营养喂养量,改善ENFI情况,提高患者喂养水平,促进胃肠功能恢复,有利于患者预后。Objective To explore the effects of the combination of he-sea and front-mu points on the feeding compliance rate, the intra-abdominal pressure, the enteral nutrition tolerance score, the score of acute physiological and chronic health evaluation(APACHE)-Ⅱ and gastrointestinal function impairment grade in the patients with enteral nutrition feeding intolerance(ENFI) of critical illness and evaluate clinical effect on ENFI after acupuncture at the he-sea and front-mu points. Methods Seventy patients of ENFI were randomized into a control group and an observation group, 35 cases in each one. In the control group, the patients were treated with routine regimen combined with intestinal nutrition support. In the observation group, on the basis of the treatment as the control group, acupuncture was applied to Shangwan(CV13), Zhongwan(CV12), Xiawan(CV10), Qihai(CV6) and Guanyuan(CV4), as well as bilateral Neiguan(PC6), Zusanli(ST36), Xiajuxu(ST39), Shangjuxu(ST37), Tianshu(ST25) and Daheng(SP15). Of those acupoints, ST25 and SP15 on the same side were attached to one pair of electrodes(20 Hz/100 Hz). Acupuncture was delivered once daily, 30 min each time and for consecutive 7 days. During treatment, the numbers of the cases up to the feeding standard were observed everyday to calculate the feeding compliance rate. The score of enteral nutrition tolerance, the intra-abdominal pressure, the score of APACHE-Ⅱ and the level of acute gastriointestinal injury(AGI) grading were recorded. Results After treatment, the enteral feeding compliance rate was increased in comparison with that before treatment in the two groups, and the rate in the observation group was higher than that of the control group(P<0.05) except that on the 2^(nd) day. The score of the enteral nutrition tolerance, the intra-abdominal pressure, the score of APACHE-Ⅱ and the level of AGI were all reduced(P<0.05, P<0.01) when compared with those before treatment in the two groups, and these indicators in the observation group were lower(P<0.05) than those o

关 键 词：合募配穴 危重症患者 肠内喂养不耐受 胃肠功能 

分 类 号：R246[医药卫生—针灸推拿学]