电针对呼吸衰竭机械通气患者影响的临床研究
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摘要
目的观察电针对呼吸衰竭机械通气患者的影响。方法选择需气管插管的呼吸衰竭患者117例,随机分为实验组与对照组。两组均予基础治疗。实验组患者在此基础上加用电针,取足三里、三阴交、丰隆、内关、神门、天枢、定喘(均为双侧取穴),肺俞、膻中、关元、脾俞、肾俞、中脘(均为单侧取穴)。得气后行平补平泻手法,后予电针治疗。对照组仅予基础治疗。持续治疗5 d,并随访至14 d。观察并记录实验组患者电针前后浅快呼吸指数、CO_2分压、血氧指数(PaO_2/FiO_2)、潮气量变化,并将两组患者5 d内脱机成功率、丙泊酚日使用量、胃肠障碍发生率、营养达标率,14 d内脱机成功率、谵妄发生率、ICU停留时间、死亡率进行比较。结果针灸前后患者浅快呼吸指数、CO_2分压、PaO_2/FiO_2、潮气量均较前改善(P<0.05)。实验组患者较对照组丙泊酚日使用量、胃肠障碍发生率、营养达标率改善、脱机成功率、谵妄发生率、ICU停留时间、死亡率得到改善,但差异无统计学意义(P>0.05)。结论针灸是一项有前景的治疗,电针后患者即刻临床症状得到改善,中长期疗效尚需进一步验证。
Objective: To observe the clinical effects of electroacupuncture on the respiratory failure patients with mechanical ventilation. Methods: 117 patients were randomly divided into the experimental group(n = 60)and the control group(n = 57). Both groups received conventional treatment,and the experimental group also received electroacupuncture. The treatment lasted 5 days and were followed up for 14 days. The rapid respiratory index,PaCO2,PaO2/Fi O2 and tidal volume were observed in experimental group. The weaning rate of mechanical respirators in 5 days,propofol daily usage,AGI,the rate of nutritional achievement,the weaning rate of mechanical respirators in 14 days,delirium rate,ICU stay time and mortality rate in two groups were observed. Results: The rapid respiratory index,PaCO2,PaO2/FiO2 and tidal volume were improved in the experimental group(P < 0.05).Propofol daily usage,AGI,the rate of nutritional achievement,the weaning rate of mechanical respirators,delirium rate,ICU stay time and mortality rate were improved,but the difference were not statistically significant(P > 0.05).Conclusion: Electro-acupuncture is a promising treatment. The immediate clinical symptoms after electroacupuncture were improved. Furter value needs more research.
Objective: To observe the clinical effects of electroacupuncture on the respiratory failure patients with mechanical ventilation. Methods: 117 patients were randomly divided into the experimental group(n = 60)and the control group(n = 57). Both groups received conventional treatment,and the experimental group also received electroacupuncture. The treatment lasted 5 days and were followed up for 14 days. The rapid respiratory index,PaCO2,PaO2/Fi O2 and tidal volume were observed in experimental group. The weaning rate of mechanical respirators in 5 days,propofol daily usage,AGI,the rate of nutritional achievement,the weaning rate of mechanical respirators in 14 days,delirium rate,ICU stay time and mortality rate in two groups were observed. Results: The rapid respiratory index,PaCO2,PaO2/FiO2 and tidal volume were improved in the experimental group(P < 0.05).Propofol daily usage,AGI,the rate of nutritional achievement,the weaning rate of mechanical respirators,delirium rate,ICU stay time and mortality rate were improved,but the difference were not statistically significant(P > 0.05).Conclusion: Electro-acupuncture is a promising treatment. The immediate clinical symptoms after electroacupuncture were improved. Furter value needs more research.
引文
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[12]梁宜,周杰,孙晶,等.方剑乔教授电针镇痛临床运用心悟[J].上海针灸杂志,2016,35(12):1387-1389.
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[14]Reintam Blaser A,Jakob SM,Starkopf J.Gastrointestinal failure in the ICU[J].Curr Opin Crit Care,2016,22(2):128-141.
[15]全爱君,蔡国锋,刘凯,等.针刺治疗重症肺炎合并胃肠功能障碍疗效观察[J].上海针灸杂志,2017,36(3):287-290.
[16]虞意华,金肖青,俞迈红,等.针灸对老年重症肺炎患者胃肠功能及胃肠激素的影响[J].浙江中西医结合杂志,2015,25(10):901-904.
[17]Wang J,Peng ZY,Zhou WH,et al.A National Multicenter survey on management of pain,Agitation,and Delirium in intensive care units in China[J].Chinese Medical Journal,2017,130(10):1182-1188.
[18]Lam WL,Yeung WF,Wong MK,et al.Combined electroacupuncture and auricular acu-puncture for postoperative pain after abdominal surgery for gynecological diseases:study protocol for a randomized controlled trial[J].Trials,2018,19(1):8.
[19]叶忠亮,傅志华,蔡云,等.电针对机械通气患者镇静作用的临床观察[J].中国中医急症,2013,22(6):1026-1027.
[2]Feng J,Wang X,Li X,et al.Acupuncture for chronic obstructive pulmonary disease(COPD):A multicenter,randomized,sham-controlled trial[J].Medicine(Baltimore),2016,95(40):40-45.
[3]Zhou F,Wu HJ,Zhai JP,et al.Who are the users of a traditional Chinese sanfu acupoint herbal patching therapy in China:A cross-sectional survey[J].Medicine(Baltimore),2016,95(49):e5414.
[4]Pai HJ,Azevedo RS,Braga AL,et al.A randomized,controlled,crossover study in patients with mild and moderate asthma undergoing treatment with traditional Chinese acupuncture[J].Clinics(Sao Paulo),2015,70(10):663-669.
[5]慢性阻塞性肺疾病急性加重(AECOPD)诊治专家组.慢性阻塞性肺疾病急性加重(AECOPD)诊治中国专家共识(2017年更新版)[J].国际呼吸杂志,2017,37(14):1041-1057.
[6]中华医学会呼吸病学分会.中国成人社区获得性肺炎诊断和治疗指南(2016年版)[J].中华结核和呼吸杂志,2016,39(4):253-279.
[7]中华医学会呼吸病学分会.哮喘学组支气管哮喘防治指南(2016年版)[J].中华结核和呼吸杂志,2016,39(9):675-697.
[8]中国国家标准化管理委员会.腧穴名称与定位[M].北京:中国标准出版社,2006.
[9]Annika,Reintam Blaser,Manu LNG,et al.Gastrointestinal function in intensive care patients:terminology,definitions and management.Recommendations of the ESICM Working Group on Abdominal Problems[J].Intensive care medicine,2012,38(3):384-394.
[10]Barr J,Fraser GL,Puntillo K,et al.Clinical practice guidelines for the management of pain,agitation,and delirium in adult patients in the intensive care unit[J].Crit Care Med,2013,41(1):263-306.
[11]叶聿隶,萧雪峰,耿赟,等.针灸辅助治疗呼吸机脱机的理论思考与实践[J].中国中医急症,2016,25(2):368-370.
[12]梁宜,周杰,孙晶,等.方剑乔教授电针镇痛临床运用心悟[J].上海针灸杂志,2016,35(12):1387-1389.
[13]张晓梅,肖培新,尹婷.姜良铎教授辨治呼吸衰竭经验[J].中国中医急症.2014,23(10):1845-1846.
[14]Reintam Blaser A,Jakob SM,Starkopf J.Gastrointestinal failure in the ICU[J].Curr Opin Crit Care,2016,22(2):128-141.
[15]全爱君,蔡国锋,刘凯,等.针刺治疗重症肺炎合并胃肠功能障碍疗效观察[J].上海针灸杂志,2017,36(3):287-290.
[16]虞意华,金肖青,俞迈红,等.针灸对老年重症肺炎患者胃肠功能及胃肠激素的影响[J].浙江中西医结合杂志,2015,25(10):901-904.
[17]Wang J,Peng ZY,Zhou WH,et al.A National Multicenter survey on management of pain,Agitation,and Delirium in intensive care units in China[J].Chinese Medical Journal,2017,130(10):1182-1188.
[18]Lam WL,Yeung WF,Wong MK,et al.Combined electroacupuncture and auricular acu-puncture for postoperative pain after abdominal surgery for gynecological diseases:study protocol for a randomized controlled trial[J].Trials,2018,19(1):8.
[19]叶忠亮,傅志华,蔡云,等.电针对机械通气患者镇静作用的临床观察[J].中国中医急症,2013,22(6):1026-1027.