中医针刺治疗重症患者胃肠功能障碍的应用效果

摘要
图/表
参考文献(27)
相关文章 (15)

全文: PDF (637 KB) HTML (1 KB)
输出: BibTeX | EndNote (RIS)

摘要目的探讨中医针刺治疗重症患者胃肠功能障碍的应用效果。方法选取2020 年11 月至2023 年8 月在兰州市第一人民医院重症医学科住院的142 例重症伴有胃肠功能障碍患者作为研究对象，根据患者及家属意愿将其分为针刺组和常规组，每组各71 例。针刺组在原发疾病治疗的基础上，通过相关穴位进行中医针刺治疗；常规组在治疗原发病的基础上，给予莫沙必利进行治疗。比较两组患者治疗前及治疗期间的胃排空时间（GET）、胃窦收缩频率（ACF）、胃窦运动指数（MI）、肠蠕动情况，并比较两组患者的通便时间、住ICU 时间、住院总费用及死亡率。结果两组患者治疗7 d 的GET 短于本组治疗5 d，治疗5 d 的GET 短于本组治疗3 d，治疗3 d 的GET 短于本组治疗前，差异有统计学意义（P＜0.05）；针刺组治疗3、5、7 d 的GET 均短于常规组，差异有统计学意义（P＜0.05）。两组患者治疗7 d 的ACF 快于本组治疗5 d，治疗5 d 的ACF 快于本组治疗3 d，治疗3 d 的ACF 快于本组治疗前，差异有统计学意义（P＜0.05）；针刺组治疗3、5、7 d 的ACF 均快于常规组，差异有统计学意义（P＜0.05）。两组患者治疗7 d 的MI 高于本组治疗5 d，治疗5 d 的MI 高于本组治疗3 d，差异有统计学意义（P＜0.05）；针刺组治疗3 d 的MI 高于本组治疗前，差异有统计学意义（P＜0.05）；针刺组治疗3、5、7 d 的MI 均高于常规组，差异有统计学意义（P＜0.05）。两组患者治疗7 d 的肠蠕动快于本组治疗5 d，治疗5 d 的肠蠕动快于本组治疗3 d，差异有统计学意义（P＜0.05）；针刺组治疗3 d 的肠蠕动快于本组治疗1 d，治疗1 d 的肠蠕动快于本组治疗前，差异有统计学意义（P＜0.05）；针刺组治疗1、3、5、7 d 的肠蠕动均快于常规组，差异有统计学意义（P＜0.05）。针刺组的通便时间短于常规组，住院总费用少于常规组，针刺组治疗后第10～42 天的死亡率低于常规组，差异有统计学意义（P＜0.05）。结论莫沙必利治疗重症患者胃肠功能障碍有一定疗效，但通过内关、合谷、中脘、天枢、气海、足三里、丰隆、三阴交穴位等穴位进行中医针刺治疗来促进重症患者胃肠功能障碍的疗效明确，通过中医针刺治疗重症患者胃肠功能障碍较莫沙必利治疗的获益更大，能缩短胃排空时间，增加胃窦运动幅度及肠蠕动，提高MI，更早改善胃肠功能障碍，减少住院总费用，改善患者预后。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章

关键词 ： , 重症患者, 胃肠功能障碍, 中医针刺治疗, 胃窦运动指数

Abstract：

Objective To explore the effect of traditional Chinese medicine acupuncture on gastrointestinal dysfunction in severe patients.Methods A total of 142 severe patients with gastrointestinal dysfunction hospitalized in the Department of Critical Care Medicine,the First People's Hospital of Lanzhou City from November 2020 to August 2023 were selected as the research objects.According to the wishes of patients and their families,they were divided into an acupuncture group and a conventional group,with 71 cases in each group.On the basis of the treatment of primary diseases,the acupuncture group was treated with traditional Chinese medicine acupuncture at relevant acupoints.The conventional group was treated with Mosapride on the basis of the treatment of the primary disease.The gastric emptying time (GET),antral contraction frequency (ACF),antral motility index (MI) and intestinal peristalsis before and during treatment were compared between the two groups,and the defecation time,length of ICU stay,total hospitalization cost and mortality were compared between the two groups.Results The GET after 7 days of treatment in the two groups were shorter than those after 5 days of treatment,the GET after 5 days of treatment in the two groups were shorter than those after 3 days of treatment,and the GET after 3 days of treatment in the two groups were shorter than those before treatment,and the differences were statistically significant(P＜0.05).The GET at 3,5 and 7 days of treatment in the acupuncture group were shorter than those in the conventional group,and the differences were statistically significant (P＜0.05).The ACF of the two groups after 7 days of treatment were faster than those after 5 days of treatment,the ACF after 5 days of treatment were faster than those after 3 days of treatment,and the ACF after 3 days of treatment were faster than those before treatment,and the differences were statistically significant(P＜0.05).The ACF of the acupuncture group at 3,5 and 7 days of treatment were faster than those of the conventional group,and the differences were statistically significant (P＜0.05).The MI of the two groups after 7 days of treatment were higher than those after 5 days of treatment,and the MI of the two groups after 5 days of treatment were higher than those after 3 days of treatment,and the differences were statistically significant (P ＜0.05).The MI of the acupuncture group after 3 days of treatment was higher than that before treatment,and the difference was statistically significant (P＜0.05).The MI of the acupuncture group were higher than those of the conventional group at 3,5 and 7 days after treatment,and the differences were statistically significant(P＜0.05).The intestinal peristalsis of the two groups after 7 days of treatment were faster than those after 5 days of treatment,and the intestinal peristalsis of the two groups after 5 days of treatment was faster than those after 3 days of treatment,and the differences were statistically significant (P＜0.05).The intestinal peristalsis of the acupuncture group after 3 days of treatment was faster than that after 1 day of treatment,and the intestinal peristalsis of the acupuncture group after 1 day of treatment was faster than that before treatment,and the differences were statistically significant (P＜0.05).After 1,3,5 and 7 days of treatment,the intestinal peristalsis of the acupuncture group were faster than those of the conventional group,and the differences were statistically significant(P＜0.05).The defecation time of the acupuncture group was shorter than that of the conventional group,the total hospitalization cost was less than that of the conventional group,and the mortality rate of the acupuncture group was lower than that of the conventional group on the 10th to 42nd day after treatment,and the differences were statistically significant (P ＜0.05).Conclusion Mosapride has a certain effect on gastrointestinal dysfunction in severe patients,but traditional Chinese medicine acupuncture treatment through Neiguan,Hegu,Zhongwan,Tianshu,Qihai,Zusanli,Fenglong,Sanyinjiao and other acupoints has a definite effect on gastrointestinal dysfunction in severe patients.The benefits of traditional Chinese medicine acupuncture treatment for gastrointestinal dysfunction in severe patients are greater than Mosapride treatment.It can shorten the gastric emptying time,increase the amplitude of gastric antrum movement and intestinal peristalsis,improve MI,improve gastrointestinal dysfunction earlier,reduce the total cost of hospitalization,and improve the prognosis of patients.

Key words： Severe patients Gastrointestinal dysfunction Traditional Chinese medicine acupuncture treatment Antral motility index

基金资助:

甘肃省兰州市人才创新创业项目（2019-RC-67）。

通讯作者: 杨继若（1966-），男，甘肃兰州人，甘肃省名中医，二级主任医师，擅长中医针灸治疗脑血管疾病、胃肠功能紊乱、视神经萎缩、动眼神经麻痹等。

作者简介: 班丽红（1985-），女，广西河池人，硕士，主要从事重症监护治疗救治工作及相关临床研究。

引用本文:

班丽红;王延震;黄焕源; 王筱; 李斌; 杨继若. 中医针刺治疗重症患者胃肠功能障碍的应用效果[J]. 中国当代医药, 2024, 31(14): 72-77.
BAN Lihong1 WANG Yanzhen1 HUANG Huanyuan2 WANG Xiao1 LI Bin3 YANG Jiruo4. Application effect of traditional Chinese medicine acupuncture on gastrointestinal dysfunction in severe patients. 中国当代医药, 2024, 31(14): 72-77.

链接本文:

https://www.dangdaiyiyao.com/CN/ 或 https://www.dangdaiyiyao.com/CN/Y2024/V31/I14/72

[1]	Reintam Blaser A，Preiser JC，Fruhwald S，et al.Working Group on Gastrointestinal Function within the Section of Metabolism，Endocrinology and Nutrition（MEN Section）of ESICM.Gastrointestinal dysfunction in the critically ill：a systematic scoping review and research agenda proposed by the Section of Metabolism，Endocrinology and Nutrition of the European Society of Intensive Care Medicine[J].Crit Care，2020，24（1）：224.
[2]	Asrani VM，Brown A，Huang W，et al.Gastrointestinal dysfunction in critical illness：a review of scoring tools[J].JPEN J Parenter Enteral Nutr，2020，44（2）：182-196.
[3]	Reintam Blaser A，Padar M，M，et al.Development of the Gastrointestinal Dysfunction Score（GIDS）for critically ill patients-A prospective multicenter observational study（iSOFA study）[J].Clin Nutr，2021，40（8）：4932-4940.
[4]	卢荣，杨继若.腹针治疗腹部术后胃肠功能紊乱的疗效观察[J].甘肃科技，2017，33（3）：116-117.
[5]	贾刘云，崔琳.中医针刺疗法联合常规西药治疗危重症患者胃肠功能障碍的疗效分析[J].深圳中西医结合杂志，2022，32（12）：27-30.
[6]	徐畅，梁建峰，李智勇，等.老年脓毒症胃肠功能障碍的中医证素分布及其针刺疗效观察[J].世界中医药，2020，15（16）：2499-2502.
[7]	张俭，黄竞，常卫东，等.针刺疗法治疗脓毒症临床疗效和安全性的Meta 分析[C]//世界中医药学会联合会老年医学专业委员会、中国中西医结合学会慢病防治与管理专业委员会2019 学术年会论文摘要集.2019：124.
[8]	罗马委员会.功能性胃肠病罗马Ⅲ诊断标准[J].胃肠病学，2006，11（12）：761-765.
[9]	管向东，陈德昌，严静，等.中国重症医学专科资质培训教材[M].北京：人民卫生出版社，2019：3.
[10]	Cubillos J，Tse C，Chan VW，et al.Bedside ultrasound assessment of gastric content：an observational study[J].Can J Anaesth，2012，59（4）：416-423.
[11]	Corriero A，Gadaleta RM，Puntillo F，et al.The central role of the gut in intensive care[J].Crit Care，2022，26（1）：379.
[12]	李洪祥，王育珊.重症患者急性胃肠功能障碍诊断与治疗的进展[J].当代医学，2019，25（24）：1-5.
[13]	孙仁华，刘景全，邵自强.重症患者胃肠功能障碍：当前聚焦点[J].浙江医学，2021，43（23）：2501-2504，2516.
[14]	Piton G，Belon F，Cypriani B，et al.Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality[J].Crit Care Med，2013，41（9）：2169-2176.
[15]	Reintam Blaser A，Malbrain ML，Starkopf J，et al.Gastrointestinal function in intensive care patients：terminology，definitions and management.Recommendations of the ESICM WorkingGrouponAbdominalProblems[J].IntensiveCareMed，2012，38（3）：384-394.
[16]	Reintam A，Parm P，Kitus R，et al.Gastrointestinal failure score in critically ill patients：a prospective observational study[J].Crit Care，2008，12（4）：R90.
[17]	张茹，邬媛，宏欣，等.急性呼吸衰竭患者发生胃肠功能障碍的危险因素及预测模型的构建分析[J].疑难病杂志，2023，22（7）：725-729，734.
[18]	卢璐，孙建华.针灸治疗术后胃肠功能障碍的临床研究进展[J].中医报，2012，27（3）：380-381.
[19]	陈小微.针灸内关、合谷、足三里穴在COPD 合并消化不良中的治疗价值探讨[J].内蒙古中医药，2021，40（1）：94-96.
[20]	陈怀.脐疗加灸特定穴位（足三里，三阴交）调治老年性功能性便秘的疗效观察[J].中文科技期刊数据库（文摘版）医药卫生，2021（12）：278-279.
[21]	张东宁，周洲，周桂超，等.加速康复外科理念结合中医针刺治疗腹腔镜胃癌根治术患者胃肠功能障碍[J].中国临床研究，2021，34（3）：362-365.
[22]	陈剑明，刘清泉，黄坡，等.中医通腑泄热法治疗脓毒症胃肠功能障碍的系统评价与Meta 分析[J].西部中医药，2022，35（2）：67-73.
[23]	毕翠，杨秀梅，刘洋，等.中药穴位贴敷联合推拿对腹腔镜子宫肌瘤剔除术后气虚血瘀证患者胃肠功能的影响[J].西部中医药，2023，36（9）：124-127.
[24]	张志谦，梁云云.足三里穴位注射治疗胃大部分切除术后胃功能性排空障碍的临床效果[J].中国当代医药，2023，30（11）：56-58，63.
[25]	兰国，孙亭立.电针治疗联合心理疏导在胰十二指肠切除术后胃排空障碍中的应用[J].中国当代医药，2022，29（6）：45-47，51.
[26]	Ban L，Pu Y，Huang H，et al.Acupuncture Enhances Gastrointestinal Motility and Improves Autonomic Nervous Function in Patients with Septic Gastrointestinal Dysfunction[J].Comput MathMethodsMed，2022，2022：1653290.
[27]	朱广辉，李杰，田启航，等.中医“胃气”理论指导下多角度治疗胃癌[J].辽宁中医药大学学报，2020，22（8）：36-39.