针刺对危重症病人胃肠及免疫功能作用的临床研究

Clinical study on effects of acupuncture for gastrointestinal and immune function of critically ill patients

目的:观察针刺治疗对危重症病人胃肠和免疫功能的改善作用。方法:将机械通气的危重症病人107例随机分常规组、针刺组和电针组。针刺组和电针组病人分别给予普通针刺和电针刺激足三里、上巨虚等穴位。观察并记录三组病人每天营养液的喂养量,早期肠内营养(EEN)、全肠内营养(TEN)、加用肠外营养(PN)病人的比例,以及每天用于营养支持的费用。同时观察并记录两组病人营养支持期间消化道并发症的发生情况。在病人入院时、入院第4和第7天分别检测外周血淋巴细胞计数(TLC)、免疫球蛋白、补体和淋巴细胞亚群。结果:电针组病人于入院第2天起每天喂养量较常规组均有明显增多(P<0.05)。电针组病人TEN比例较常规组明显增多;电针组加用PN的比例较常规组明显减少;电针组病人每天用于营养支持的费用明显低于常规组,呕吐、腹胀和胃潴留的发生亦较常规组有明显减少(P<0.05)。入院第7天,电针组病人TLC较常规组明显增多,CD4和CD4/CD8比值明显升高;IgG、IgA和C3浓度较常规组明显升高(P<0.05)。结论:针刺能促进危重症病人胃肠功能的恢复,有利于EN的有效实施,能改善危重症病人的多项免疫指标。

Objective ： To observe whether acupuncture treatment has positive impact on gastroin- testinal and immune function of critically ill patients. Methods： 107 cases of critically ill patients re- quiring mechanical ventilation admitted in ICU of Jiaxing First Hospital were randomly divided into 3 groups： conventional group, common acupuncture group, and electro-acupuncture group. Zusanli, Shangjuxu and some other acupuncture points were used. Daily feeding amount of nutrient fluid, propor- tions of early enteral nutrition （ EEN）, total enteral nutrition （TEN） and parenteral nutrition （PN） sup- plementation, as well as daily cost of nutritional support were observed and recorded for all three groups of patients. The gastrointestinal bleeding, vomiting and other complications during nutritional support were also observed. Peripheral blood lymphocyte count （TLC）, immunoglobulin, complement and lym- phocyte subsets were determined at 0, 4, 7 days after admission. Results ： Patients of electro-acupunc- ture group had significantly higher daily feeding amount than that of conventional group. The electro-acu- puncture group had significantly higher proportion of TEN, lower rate of PN support, and lower total cost for daily nutritional support（ P 〈 0.05 ）. Incidence of vomiting, abdominal distention and gastric retention also decreased significantly in electro-acupuncture group. TLC, CIM, CIM/CD8 ratio, IgG, IgA and C3 increased significantly in electro-acupuncture group. Conclusion： Acupuncture especially electro-acu- puncture is conducive to promote gastrointestinal function recovery for critically ill patients, beneficial for effective implementation of enteral nutrition support, and advantageous in improving multiple immune in- dicators.