经皮电刺激足三里穴治疗对有机磷农药中毒患者胃肠道毒物的清除效果及安全性分析

A study on effect and safety of transcutaneous electrical stimulation at Zusanli acupoint for gastrointestinal poison elimination in patients with oral organophosphorus pesticide poisoning

目的：探讨经皮电刺激足三里穴治疗对有机磷农药中毒患者胃肠道内毒物的清除效果及其安全性。方法采用前瞻性研究方法，选择2013年9月至2015年2月河北省邢台市人民医院急诊科救治的首诊口服有机磷农药中毒患者62例，按照单纯随机抽样分组原则分为观察组和对照组，每组31例。两组患者均按照有机磷农药中毒诊疗规范给予综合治疗，观察组同时配合应用经皮电刺激双侧足三里穴位，每8 h 1次，每次30 min，直到排出黑便后停用。观察两组患者应用导泻剂后呕吐发生率、首次排便时间、排出黑便时间、每日排便次数、达到阿托品化时间、阿托品使用总量，胆碱酯酶（ChE）活性恢复至正常1/2时间、住院时间、治愈率和病死率；观察组行经皮穴位电刺激治疗前后血流动力学、脉搏血氧饱和度（SpO2）变化及治疗过程中有无不良事件发生。结果对照组应用导泻剂后呕吐发生率明显高于观察组〔32.2%（10/31）比9.7%（3/31），P＜0.05〕；观察组首次排便时间（h：9.3±3.6比11.6±5.2）、排出黑便时间（h：11.3±5.3比14.5±6.8）较对照组明显缩短（均P＜0.05）；而导泻期间每日排便次数则多于对照组（次/d：4.3±0.5比3.1±0.4，P＜0.01）；且观察组患者达到阿托品化时间（h：66.3±22.8比84.6±24.2）、阿托品使用总量（mg：66.3±22.8比84.6±24.2）和ChE活性恢复至正常1/2时间（d：6.1±2.4比8.3±3.9）均较对照组明显减少（均P＜0.01）。治疗终点时，观察组患者平均住院时间短于对照组（d：11.3±2.8比13.4±4.2，P＜0.05），治愈率高于对照组〔96.8%（30/31）比83.9%（26/31）， P＜0.05〕。观察组加用穴位电刺激治疗前后的血流动力学及SpO2变化不明显；治疗过程中未见不良反应发生。结论口服有机磷农药中毒的患者配合经皮电刺激足三里穴治疗，可降低导泻剂应用后呕吐发生率，增强导泻效果，促使胃肠道内毒物尽快排出，减少住院期间阿托品使用总量，缩短达到阿托品化时间，缩短患者住院时间，促进ChE活性的恢复，提高临床疗效。

Objective To investigate the effect and safety of transcutaneous electrical stimulation at Zusanli acupoint for elimination of gastrointestinal poison in patients with oral organophosphorus pesticide poisoning. Methods A prospective study was conducted, including 62 patients with oral organophosphorus pesticide poisoning from September 2013 to February 2015 in the Department of Emergency of Xingtai People＇s Hospital of Hebei Province. The patients were divided into a observation group and a control group （each, 31 cases） in accord with the principle of simple random sampling. All the patients in two groups were given comprehensive treatment according to the diagnosis and treatment of the guide for organic phosphorus pesticide poisoning. In addition, the transcutaneous electrical stimulation at bilateral Zusanli acupoints was carried out in the observation group, once therapeutic time 30 minutes and every 8 hours once, and stopped until the discharge of melena. The incidence of vomiting after application of cathartics, the first stool time, the time of melena discharge, daily defecation frequency, the time of reaching atropinization, the total amount of atropine used, the time of cholinesterase （ChE） activity returning to its 1/2 normal activity, the length of stay in hospital, cure rate and mortality were observed in both groups. The changes in hemodynamics and pulse blood oxygen saturation （SpO2） were observed before and after transcutaneous electrical acupoint stimulation, and the occurrence of adverse reactions in the therapeutic course were observed in the observation group.Results After application of cathartics, the incidence of vomiting in control group was significantly higher than that in the observation group [32.2% （10/31） vs. 9.7% （3/31）,P 〈 0.05]. In the observation group, the first stool time （hours： 9.3±3.6 vs. 11.6±5.2） and the time of melena discharge （hours： 11.3±5.3 vs. 14.5±6.8） were significantly shorter than those in the control group （both P 〈 0.05）; while the frequency of bowel movements during catharsis was higher than that of the control group （times/d： 4.3±0.5 vs. 3.1±0.4,P 〈 0.01）. In the observation group, the time reaching atropinization （hours： 66.3±22.8 vs. 84.6±24.2）, the total amount of atropine used （mg： 66.3±22.8 vs. 84.6±24.2）, and the time of ChE activity returning to its 1/2 normal range （days： 6.1±2.4 vs. 8.3±3.9） were significantly shorter than those in the control group （allP 〈 0.01）. At the end of treatment, the average length of stay in hospital was shorter （days： 11.3±2.8 vs. 13.4±4.2,P 〈 0.05） and the cure rate was higher [96.8% （30/31） vs. 83.9% （26/31）,P 〈 0.05] in the observation group than those in the control group; in observation group, the hemodynamics and SpO2 before and after acupoint electrical stimulation did not change significantly; in the course of treatment, no adverse reactions occurred.Conclusion The addition of transcutaneous electric stimulation at bilateral Zusanli acupoints in patients with oral organophosphorus pesticide poisoning has following advantages： lowering the incidence of vomiting during catharsis, enhancing the cathartic effect, promoting gastrointestinal poisoning discharge as soon as possible, reducing total atropine used during hospitalization, shortening the time reaching atropinization, shortening the duration of hospitalization, promoting the recovery of cholinesterase activity and elevating clinical therapeutic effects.