针刺干预对镇痛镇静治疗的重症患者胃肠功能障碍及预后的影响  

Effect of acupuncture intervention on gastrointestinal dysfunction and prognosis of severe patients treated with analgesia and sedation

作　　者：汪云旗 韦正祥[1] 高璐 杨奎 朱满意[1] WANG Yunqi;WEI Zhengxiang;GAO Lu;YANG Kui;ZHU Manyi(Intensive Care Unit I Ward,Chuzhou First People's Hospital,Chuzhou 239000,Anhui,China)

机构地区：[1]滁州市第一人民医院重症监护室一病区,安徽滁州239000

出　　处：《西部医学》2024年第9期1332-1335,1340,共5页Medical Journal of West China

基　　金：安徽省高等学校科学研究项目(2022AH050791)。

摘　　要：目的探讨针刺干预对镇痛镇静治疗的重症患者胃肠功能障碍及预后的影响。方法选取2019年10月—2022年10月本院ICU收治的83例合并胃肠功能障碍的重症患者为研究对象,采用信封随机法分为针刺组(n=43)和对照组(n=40)。两组患者均给予枸橼酸舒芬太尼镇痛治疗,对照组给予常规治疗,针刺组在常规基础上联合针刺治疗。比较两组急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官功能衰竭(SOFA)评分、二胺氧化酶(DAO)、胃肠激素、尿乳果糖/甘露醇(L/M)值、腹内压、胃排空情况、24 h胃残留量、肠鸣音次数的差异,记录两组住院时间。结果治疗前,两组APACHEⅡ评分、SOFA评分、胃肠激素、DAO、尿L/M值、腹内压、胃排空情况、肠鸣音次数比较,差异无统计学意义(均P>0.05);治疗后,两组APACHEⅡ评分、SOFA评分、胃泌素(GAS)、DAO、尿L/M值、腹内压、胃排空时间、24 h胃残留量较治疗前下降,且针刺组更低(均P<0.05)。两组治疗后胃动素(MOT)、肠鸣音次数较治疗前升高,且针刺组更高(均P<0.05)。针刺组住院时间(18.85±4.66)d短于对照组的(23.69±5.14)d,差异有统计学意义(P<0.05)。结论针刺干预可调节接受镇痛镇静后出现胃肠功能障碍的重症患者胃肠激素,促进肠蠕动,降低腹内压,有利于改善预后。Objective To observe the effect of acupuncture intervention on gastrointestinal dysfunction and prognosis of severe patients treated with analgesia and sedation.Methods 83 patients with severe gastrointestinal dysfunction admitted in ICU of our hospital from October 2019 to October 2022 were selected as subjects,and were randomly divided into two groups by envelope method.Both groups of patients were given sufentanil citrate analgesia,40 patients in the control group were given routine treatment,and 43 patients in the acupuncture group were treated with acupuncture on the basis of routine treatment.To compare the differences between the two groups in disease score,sequential exhaustion of function(SOFA)score,diamine oxidase(DAO),gastrointestinal hormone,urinary lactulose/mannitol(L/M)value,gastric emptying,and the number of bowel sounds,and record the hospitalization time of the two groups.Results There was no significant difference between the two groups in disease score,intra-abdominal pressure and SOFA score before treatment(P>0.05).After treatment,the scores of acute physiology and chronic health condition(APACHEⅡ),intra-abdominal pressure and SOFA in the two groups were lower than before,and the scores in the acupuncture group were lower(P<0.05).There was no significant difference in gastrointestinal hormone,DAO and urine L/M between the two groups before treatment(P>0.05).Motilin(MOT)was higher in the two groups after treatment than before,and higher in the acupuncture group(P<0.05).After treatment,the gastrin(GAS),DAO and urine L/M values in the two groups were lower than before,and the acupuncture group was lower(P<0.05).There was no significant difference in gastric emptying and the number of bowel sounds between the two groups before treatment(P>0.05).After treatment,the number of bowel sounds in the two groups was higher than before,and that in the acupuncture group was higher(P<0.05).After treatment,the gastric emptying time and 24h gastric residue in the two groups decreased,and the acupuncture gro

关 键 词：针刺 枸橼酸舒芬太尼 重症 胃肠功能障碍 胃肠激素 腹内压 预后 

分 类 号：R245.31[医药卫生—针灸推拿学] R57[医药卫生—中医临床基础]