针刺夹脊穴对脓毒血症腹腔内压、胃腔残留量疗效评估
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摘要
目的观察针刺夹脊穴治疗脓毒血症胃肠功能障碍的临床疗效。方法将40例脓毒血症胃肠功能障碍患者随机分为对照组和治疗组,每组20例,对照组予鼻饲枸橼酸莫沙必利、双歧杆菌三联活菌胶囊,静脉滴注奥美拉唑,合理选用抗生素,维持心、肺、脑、肾等重要脏器的功能和水电解质平衡及对症治疗;治疗组在对照组常规处理的基础上加针刺夹脊穴。观察两组治疗前后慢性健康状况评分(APACHEⅡ)、腹腔内压、胃残余量、肠鸣音变化。结果两组治疗前患者APACHEⅡ评分、腹腔内压、胃腔残留量比较差异无统计学意义(P>0.05);治疗组治疗第3天、第6天、第10天患者APACHEⅡ评分、腹腔内压、胃腔残留量均低于对照组,肠鸣音高于对照组,差异均有统计学意义(P<0.05);两组治疗前后APACHEⅡ评分、腹腔内压、胃腔残留量比较差异有统计学意义(P<0.05);治疗组治疗后APACHEⅡ评分、腹腔内压、胃腔残留量与对照组比较差异有统计学意义(P<0.05)。结论针刺夹脊穴治疗脓毒血症胃肠功能障碍具有良好的疗效。
Objective To observe the clinical efficacy of acupuncture at Jiaji(EX-B2) points in treating gastrointestinal dysfunction in sepsis. Method Forty patients with gastrointestinal dysfunction due to sepsis were randomized into a control group and a treatment group, with 20 cases in each group. The control group was intervened by mosapride citrate and bifidobacterium triple viable capsules via nasogastric tube, intravenous injection of omeprazole, appropriate use of antibiotics, maintaining the function of important organs including heart, lungs, brain and kidney, and water and electrolyte balance, and other symptomatic treatments; the treatment group was additionally given acupuncture at Jiaji(EX-B2) points. The acute physiology and chronic health evaluation scoring system(APACHE Ⅱ), intra-abdominal pressure, gastric residual volume, and bowel sound in the two groups were observed before and at the end of treatment. Result Before treatment, there were no significant differences in the APACHE Ⅱscore, intra-abdominal pressure and gastric residual volume between the two groups(P>0.05); the APACHE Ⅱ score,intra-abdominal pressure and gastric residual volume in the treatment group were lower than those in the control group and the bowel sound was more active than that in the control group at treatment day 3, 6 and 10, respectively, and the differences were statistically significant(P<0.05); the APACHE Ⅱ score, intra-abdominal pressure and gastric residual volume all showed a significant change after treatment in both groups(P<0.05); after treatment, the APACHE Ⅱ score,intra-abdominal pressure and gastric residual volume in the treatment group were significantly different from those in the control group(P<0.05). Conclusion Acupuncture at Jiaji(EX-B2) points can produce satisfactory efficacy for gastrointestinal dysfunction in sepsis.
Objective To observe the clinical efficacy of acupuncture at Jiaji(EX-B2) points in treating gastrointestinal dysfunction in sepsis. Method Forty patients with gastrointestinal dysfunction due to sepsis were randomized into a control group and a treatment group, with 20 cases in each group. The control group was intervened by mosapride citrate and bifidobacterium triple viable capsules via nasogastric tube, intravenous injection of omeprazole, appropriate use of antibiotics, maintaining the function of important organs including heart, lungs, brain and kidney, and water and electrolyte balance, and other symptomatic treatments; the treatment group was additionally given acupuncture at Jiaji(EX-B2) points. The acute physiology and chronic health evaluation scoring system(APACHE Ⅱ), intra-abdominal pressure, gastric residual volume, and bowel sound in the two groups were observed before and at the end of treatment. Result Before treatment, there were no significant differences in the APACHE Ⅱscore, intra-abdominal pressure and gastric residual volume between the two groups(P>0.05); the APACHE Ⅱ score,intra-abdominal pressure and gastric residual volume in the treatment group were lower than those in the control group and the bowel sound was more active than that in the control group at treatment day 3, 6 and 10, respectively, and the differences were statistically significant(P<0.05); the APACHE Ⅱ score, intra-abdominal pressure and gastric residual volume all showed a significant change after treatment in both groups(P<0.05); after treatment, the APACHE Ⅱ score,intra-abdominal pressure and gastric residual volume in the treatment group were significantly different from those in the control group(P<0.05). Conclusion Acupuncture at Jiaji(EX-B2) points can produce satisfactory efficacy for gastrointestinal dysfunction in sepsis.
引文
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[15]王濯,沈梅芬.监测胃残余量在危重症患者肠内营养中应用效果的系统评价[J].护士进修杂志,2016,31(5):406-409.
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[18]杨红臣.探讨大黄对休克后胃肠功能障碍的治疗及对多器官功能障碍综合征的防治作用[J].世界最新医学信息文摘(电子版),2013,13(11):69-70.
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[21]周咏梅,朱早兰,卢小芹,等.中医护理技术在危重症病人胃肠功能障碍治疗中的应用[J].全科护理,2013,11(31):2912-2913.
[22]胡大朝.危重患者急性胃肠功能障碍与衰竭的病因及诊治[J].中国社区医师(医学专业),2012,14(9):7-8.
[23]张志伟,徐艳萍.中药早期干预重症患者胃肠功能障碍的疗效观察[J].中国中医药科技,2018,25(6):909-910.
[24]董军,张淑文,段美丽,等.通腑颗粒对多器官功能障碍综合征胃肠功能障碍患者病情严重程度的影响[J].中国中西医结合急救杂志,2006,13(6):327-330.
[25]韩澎.华佗夹脊穴按摩法治疗新生儿胃肠功能障碍的临床观察[J].护理研究(下旬版),2007,(11):3050.
[26]章珍明,范志勇.浅谈从夹脊穴论治胃肠神经官能症[J].陕西中医,2008,29(3):334-335.
[27]严振国.常用穴位解剖基础[M].上海:上海中医药大学出版社,1990:116-118.
[28]李殿宁,许志泉.背俞穴和华佗夹脊穴的“穴树”机理探讨[J].南京中医学院学报,1994,10(6):32-34.
[29]沙德花,买文菊,郑贵芝,等.电针治疗带状疱疹后遗神经痛87例临床分析[J].现代医药卫生,2014,30(2):287.
[30]费新明.以华佗夹脊穴为主针刺治疗呃逆36例临床观察[J].甘肃中医学院学报,2009,26(2):39-41.
[2]潘娅静,徐敏.血必净注射液对脓毒血症患者的脏器保护作用[J].浙江中医杂志,2010,45(4):306-307.
[3]曹书华.脓毒症与多脏器功能失常综合征[J].中华急诊医学杂志,2010,19(7):781-782.
[4]覃江.脓毒症并发心肌损伤的研究进展[J].临床合理用药杂志,2018,(9):164-165.
[5]崔树英,李济福,张功宝,等.烧伤合并真菌性脓毒血症治疗分析[J].医学信息(西安上半月),2006,19(8):1474-1475.
[6]曾建琼,王桂萍,程青虹,等.脓毒血症患者血糖与预后的关系[J].检验医学,2016,31(2):95-98.
[7]Clark JA,Coopersmith CM.Intestinal crosstalk:a new paradigm for understanding the gut as the“motor”of critical illness[J].Shock,2007,28(4):384-393.
[8]王今达,王宝恩.多脏器功能失常综合征(MODS)病情分期诊断及严重程度评分标准(经庐山95全国危重病急救医学学术会讨论通过)[J].中国危重病急救医学,1995,7(6):346-347.
[9]Liboni KC,Li N,Scumpia PO,et al.Glutamine modulates LPS-induced IL-8 production through IκB/NF-κBin human fetal and adult intestinal epithelium[J].J Nutrit,2005,135(2):245-251.
[10]王华兰,张世卿,张璞璘,等.益气通督手法治疗小儿脾虚泻的多中心随机对照研究[J].中国针灸,2008,28(11):813-816.
[11]中华医学会重症医学分会.中国严重脓毒症/脓毒性休克治疗指南(2014)[J].中华内科杂志,2015,54(6):557-581.
[12]李娟,李曙平,吴娜.胃肠功能障碍和衰竭对老年危重病患者临床预后的影响[J].现代中西医结合杂志,2012,21(1):25-26,34.
[13]Knaus WA,Draper EA,Wagner DP,et al.APACHEⅡ:a severity of disease classification system[J].Critic Care Med,1985,13(10):818-829.
[14]王强,唐才喜,冯斌,等.早期通便、引流治疗重症急性胰腺炎腹腔高压的效果观察[J].临床肝胆病杂志,2017,33(1):106-109.
[15]王濯,沈梅芬.监测胃残余量在危重症患者肠内营养中应用效果的系统评价[J].护士进修杂志,2016,31(5):406-409.
[16]李小寒,尚少梅.基础护理学[M].北京:人民卫生出版社,2006:209-210.
[17]施泽宏,郭力.严重烧伤后胃肠功能障碍与多器官功能障碍综合征[J].医学临床研究,2004,21(5):510-514.
[18]杨红臣.探讨大黄对休克后胃肠功能障碍的治疗及对多器官功能障碍综合征的防治作用[J].世界最新医学信息文摘(电子版),2013,13(11):69-70.
[19]金水芳,江荣林.脓毒症胃肠功能障碍的研究新进展[J].浙江临床医学,2015,17(5):836-838.
[20]吕金胜,何凤慈,齐震东,等.大黄素对动物离体回肠收缩作用的影响[J].中国药业,2000,9(11):25.
[21]周咏梅,朱早兰,卢小芹,等.中医护理技术在危重症病人胃肠功能障碍治疗中的应用[J].全科护理,2013,11(31):2912-2913.
[22]胡大朝.危重患者急性胃肠功能障碍与衰竭的病因及诊治[J].中国社区医师(医学专业),2012,14(9):7-8.
[23]张志伟,徐艳萍.中药早期干预重症患者胃肠功能障碍的疗效观察[J].中国中医药科技,2018,25(6):909-910.
[24]董军,张淑文,段美丽,等.通腑颗粒对多器官功能障碍综合征胃肠功能障碍患者病情严重程度的影响[J].中国中西医结合急救杂志,2006,13(6):327-330.
[25]韩澎.华佗夹脊穴按摩法治疗新生儿胃肠功能障碍的临床观察[J].护理研究(下旬版),2007,(11):3050.
[26]章珍明,范志勇.浅谈从夹脊穴论治胃肠神经官能症[J].陕西中医,2008,29(3):334-335.
[27]严振国.常用穴位解剖基础[M].上海:上海中医药大学出版社,1990:116-118.
[28]李殿宁,许志泉.背俞穴和华佗夹脊穴的“穴树”机理探讨[J].南京中医学院学报,1994,10(6):32-34.
[29]沙德花,买文菊,郑贵芝,等.电针治疗带状疱疹后遗神经痛87例临床分析[J].现代医药卫生,2014,30(2):287.
[30]费新明.以华佗夹脊穴为主针刺治疗呃逆36例临床观察[J].甘肃中医学院学报,2009,26(2):39-41.