针刺联合物理康复治疗脓毒症相关性肌病的临床研究  

Clinical Research on Acupuncture combined with Physical Rehabilitation Treatment of Sepsis-induced Myopathy

作　　者：张云海[1,2] 陈新禧[1] 柳松涛 张永东 邓梦华 ZHANG Yun-Hai;CHEN Xin-Xi;LIU Song-Tao(The 8th Clinical Medicine College of Guangzhou University of Chinese Medicine,Foshan 528000,Guangdong,China)

机构地区：[1]广州中医药大学第八临床医学院,广东佛山528000 [2]佛山市中医院重症医学科

出　　处：《吉林医学》2024年第10期2355-2360,共6页Jilin Medical Journal

基　　金：广东省中医药局科研项目[项目编号:20211369]。

摘　　要：目的:观察益气活血通络针刺法联合物理康复治疗脓毒症相关性肌无力(SIM)的临床疗效及作用机制。方法:选取佛山市中医院2021年1月~2023年10月收治的90例SIM患者为研究对象,随机分为对照组、物理康复组与观察组各30例。对照组给予常规治疗,如抗感染、营养支持、维持水电解质酸碱平衡等。物理康复治疗组在对照组治疗的基础上,予肢体物理康复治疗,30 min/次,2次/d。观察组在物理康复组治疗的基础上,予益气活血、化瘀通络法针刺治疗,疗程为7 d。比较三组患者治疗前后的肌肉力量评分(MRCs)、白细胞介素-6(IL-6)、股直肌横截面积(RFCSA)、急性生理与慢性健康评分(APACHEⅡ)和序贯器官衰竭评分(SOFA),统计三组患者ICU住院时间、总住院时间、28 d死亡率和第28天存活患者的日常生活活动能力评定(ADL评分)。结果:与治疗前比较,三组治疗后的IL-6均显著降低,差异有统计学意义(P<0.05),MRC评分显著提高,差异有统计学意义(P<0.05),对照组和物理康复组的RFCSA均显著减小,差异有统计学意义(P<0.05),而观察组减小的差异无统计学意义(P>0.05)。与对照组比较,观察组治疗后的IL-6显著降低,差异有统计学意义(P<0.05),观察组和物理康复组治疗后的RFCSA均明显增大,差异有统计学意义(P<0.05),观察组的MRC评分显著提高,差异有统计学意义(P<0.05)。与物理康复组比较,观察组治疗后的IL-6、RFCSA和MRC评分改善更明显,差异有统计学意义(P<0.05)。三组治疗后的APACHEⅡ评分和SOFA评分均较治疗前显著降低,差异有统计学意义(P<0.05),观察组治疗后的APACHEⅡ评分和SOFA评分均较对照组降低更显著,差异有统计学意义(P<0.05),而物理康复组与对照组、观察组比较均差异无统计学意义(P>0.05)。在ICU住院时间方面,物理康复组和观察组显著短于对照组,差异有统计学意义(P<0.05),而观察组和物理康复组差异无统计学意�Objective To observe the clinical efficacy and mechanism of Yiqi Huoxue Tongluo acupuncture combined with physical rehabilitation in the treatment of sepsis-induced myopathy(SIM).Method Ninety patients with SIM admitted to Foshan Traditional Chinese Medicine Hospital from January 2021 to October 2023 were selected as the research subjects,and they were randomly divided into the control group,the physical rehabilitation group or the observation group,30 patients in each group.All of the groups received basic treatment for sepsis,the physical rehabilitation group received passive or active rehabilitation of limbs,30 minutes each time,twice a day,and the observation group was treated with acupuncture treatment of Yiqi Huoxue Huayu Tongluo method basic on the treatment of the rehabilitation for 7 days.The muscle strength score(MRCs),interleukin-6(IL-6),cross-sectional area of rectus femoris(RFCSA),acute physiology and chronic health score(APACHEⅡ)and sequential organ failure score(SOFA)were compared before and after treatment among the 3 groups.The length of ICU stay,total length of hospital stay,28-day mortality,and the activity of daily living(ADL)scores of the survivors at 28 days were recorded.Results Compared with before treatment,the IL-6 of the 3 group was significantly decreased(P<0.05)and the MRCs was significantly increased(P<0.05),the RFCSA of the control group and the physical rehabilitation group were significantly decreased(P<0.05),while there was no significant change in the observation group(P>0.05).Compared with the control group,the IL-6 of the observation group after treatment was significantly reduced(P<0.05),the RFCSA of the observation group and the physical rehabilitation group were significantly larger after treatment(P<0.05),and the MRCs of the observation group were significantly increased(P<0.05).Compared with the physical rehabilitation group,the IL-6,RFCSA and MRCs of the observation group were more significantly improvement(P<0.05).The APACHEⅡand SOFA scores of the 3 group were signi

关 键 词：针刺 物理康复治疗 脓毒症相关性肌病 炎性反应 获得性肌无力 

分 类 号：R631[医药卫生—外科学]