摘要
目的探讨针灸对危重症患者肠内营养(EN)误吸、胃肠功能及炎症指标的影响。方法选取2021年1月至2022年12月浙江省温州市中心医院重症医学科危重症患者106例,按照随机数字表法将其分为针灸组和对照组,各53例。对照组入院24~48 h内给予EN支持,若出现喂养不耐受情况,可给予甲氧氯普胺肌注,10 mg/次,2次/d,持续24~48 h。针灸组在对照组基础上行针灸干预,艾灸选穴足三里、中脘,悬灸,2次/d,15 min/次;针刺选穴取双侧足三里、三阴交、内关、中脘、上巨虚、下巨虚、天枢及气海,温针灸选穴取足三里或中脘。直刺穴位,得气后留针30 min,1次/d。两组均干预1周。比较两组干预前后急性胃肠功能损伤(AGI)分级、炎症指标[白细胞介素(IL)-6、IL-1β、肿瘤坏死因子-α(TNF-α)]、营养指标[白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)]水平;统计EN并发症情况、甲氧氯普胺用量。结果干预1周后,两组AGI分级均较干预前降低,且针灸组低于对照组,差异有统计学意义(P<0.05)。干预1周后,两组血清IL-6、IL-1β、TNF-α水平均较干预前降低,且针灸组低于对照组,差异有统计学意义(P<0.05)。干预1周后,两组血清Alb、PA、Hb水平均较干预前升高,且针灸组高于对照组,差异有统计学意义(P<0.05)。针灸组误吸、腹泻、腹胀发生率低于对照组,差异有统计学意义(P<0.05)。针灸组甲氧氯普胺用量低于对照组,差异有高度统计学意义(P<0.01)。结论针灸用于危重症患者EN支持可显著改善胃肠功能及营养状况,减轻炎症反应,减少误吸等并发症。
Objective To investigate the effects of acupuncture and moxibustion on enteral nutrition(EN)aspiration,gastrointestinal function,and inflammatory indexes in critically ill patients.Methods A total of 106 critically ill patients from the Department of Critical Care Medicine,Wenzhou Central Hospital of Zhejiang Province from January 2021 to December 2022 were selected and they were divided into acupuncture and moxibustion group and control group according to random number table method,with 53 cases in each group.The control group was given EN support within 24 to 48 h after admission.If there was feeding intolerance,Metoclopramide could be given intramural injection,10 mg/time,twice a day,for 24 to 48 h.The acupuncture and moxibustion group was treated on the basis of the control group,and moxibustion was selected at zúsānlǐand zhōngwǎn,hanging moxibustion,twice a day,15 min/times;acupuncture was selected at two sides of zúsānlǐ,sānyīnjiāo,nèiguān,zhōngwǎn,shàngjùxū,xiàjùxū,tiānshū,and qìhǎi,warming needle moxibustion was selected at zúsānlǐ,or zhōngwǎn.Puncture the acupoint directly and leave the needle for 30 min after arrival of qi,once a day.Both groups were treated for one week.The acute gastrointestinal injury(AGI)grade,inflammatory indexes(interleukin[IL]-6,IL-1β,tumor necrosis factor-α[TNF-α]),and nutritional indexes(albumin[Alb],prealbumin[PA],hemoglobin[Hb])of the two groups were compared before and after intervention.EN complications and Metoclopramide dosage were analyzed.Results After one week of intervention,AGI grading in both groups was lower than that before intervention,and that in acupuncture and moxibustion group was lower than that in control group,the differences were statistically significant(P<0.05).After one week of intervention,serum IL-6,IL-1β,and TNF-αlevels in two groups were lower than those before intervention,and those in the acupuncture group were lower than those in the control group,the differences were statistically significant(P<0.05).After one week of intervention,serum Alb,PA,and Hb levels in two groups were higher than those before intervention,and those in the acupuncture group was higher than those in the control group,the differences were statistically significant(P<0.05).The incidences of aspiration,diarrhea,and abdominal distension in acupuncture and moxibustion group were lower than that in control group,and the differences were statistically significant(P<0.05).The dosage of Metoclopramide in acupuncture and moxibustion group was lower than that in control group,and the difference was highly statistically significant(P<0.01).Conclusion Acupuncture and moxibustion for EN support in critically ill patients can significantly improve gastrointestinal function and nutritional status,reduce inflammatory response,and reduce complications such as aspiration.
作者
孔文伟
诸葛伶俐
张奕秉
KONG Wenwei;ZHUGE Lingli;ZHANG Yibing(Department of Critical Care Medicine,Wenzhou Central Hospital,Zhejiang Province,Wenzhou325000,China;Department of Gastroenterology,Wenzhou Central Hospital,Zhejiang Province,Wenzhou325000,China)
出处
《中国医药导报》
CAS
2023年第30期160-163,共4页
China Medical Herald
基金
浙江省卫生健康科技计划项目(2022KY1203)
浙江省温州市基础性科研项目(Y20201004)。
关键词
针灸
危重症
肠内营养
Acupuncture and moxibustion
Critical illness
Enteral nutrition
