电针对神经外科危重昏迷患者盲法留置鼻空肠管及肠内营养实施的影响

Effects of electroacupuncture on implementation of nasojejunal tube placement and enteral nutrition in neu- rosurgical patients in intensive care unit

目的观察电针对神经外科危重昏迷患者盲法留置鼻空肠营养管及肠内营养（EN）实施的影响。方法采用随机数字表法将79例神经外科危重昏迷患者分为电针组及常规组。2组患者均采用盲法插入鼻空肠管，电针组患者同时辅以电针刺激足三里、合谷等穴位。观察并记录2组患者鼻空肠管推进距离、插管24h和72h时置管成功率、EN热量达标率及并发症发生情况。结果电针组患者鼻空肠管在插管第24、48及72小时时的推进距离分别为（28．4±13．8）cm、（34．0±13．4）cm和（39．6±14．4）cm，较常规组的（18．1±15．5）cm、（23．0±16．1）cm和（29．6±17．0）cm均有明显增大（P〈0．05）。电针组患者插管第24，72小时时的置管成功率分别为76．9％和92．3％，均较常规组（分别为52．5％和75．0％）明显提高（P〈0．05）。电针组患者插管在72h内EN热量达标率为82．1％，较常规组（60．0％）明显提高（P〈0．05）。电针组需辅以肠外营养（PN）的患者比例为17．9％，较常规组（40．O％）明显下降（P〈0．05）。治疗期间电针组患者消化道出血、呕吐、腹胀等并发症发生率分别为15．4％，5．1％和7．7％，较常规组并发症发生率（分别为35．0％，20．O％和25．0％）均明显降低（P〈0．05）。结论电针穴位刺激能促进神经外科危重昏迷患者胃肠蠕动，提高盲法留置鼻空肠营养管的成功率，有利于早期肠内营养尽快实施，具有较好的临床应用价值。

Objective To investigate the effects of electroacupuncture （EA） on the implementation of blind nasojejunal （N J） tube placement and enteral nutrition （EN） in neurosurgical severe coma patients in intensive care unit （ICU）. Methods Seventy-nine neurosurgical severe coma patients admitted to ICU were randomly divided in- to conventional group （blind NJ tube placement, n = 40） and EA group （NJ placement and EA, n = 39）. EA was performed after NJ tube placement at bilateral acupoints Zusanli （ST36） and Hegu （L14） points using EA treatment instrument. The impelling distance of NJ tube were measured and the success rate of NJ tube placement were calculat- ed. The postoperative complications were observed. Results The difference of NJ tube impelling distances at the 24th, 48th, and 72th hours after surgery in EA group were significant longer than that in conventional group （P 〈 0.05 ）. The success rates of NJ tube placement at the 24th and 72nd hours after surgery in EA group were significant- ly better than that in conventional group （P 〈 0.05 ）. Their EN calories qualifiedness rate in 72 hours also increased significantly compared with conventional group and the proportion of patients assisted with parenteral nutrition de- creased （P 〈 0.05 ）. The postoperative complications including alimentary tract hemorrhage, vomiting, and abdomi- nal distension decreased remarkably in EA group compared with conventional group （P 〈 0.05）. Conclusions EA stimulation at aeupoints could promote the gastrointestinal peristalsis of neurosurgical severe coma patients and elevate the success rate of blind NJ tube placement, so it is beneficial for the implementation of early enteral nutrition （ EEN ）.