电针干预重症急性胰腺炎伴麻痹性肠梗阻：随机对照研究

Electroacupuncture for severe acute pancreatitis accompanied with paralytic ileus:a randomized controlled trial

目的:观察电针干预与常规治疗对重症急性胰腺炎伴麻痹性肠梗阻患者腹胀腹痛等临床症状的疗效差异。方法:采取前瞻性实效性随机对照研究,将140例重症急性胰腺炎伴麻痹性肠梗阻患者随机分为电针组和常规治疗组,每组70例。常规治疗组采用常规治疗的方法,包括重症监护、胃肠减压、禁食、补充血容量、抑酸、维持内环境稳定、预防感染、抑制胰腺外分泌等。电针组在常规治疗的基础上,电针针刺足三里、支沟,留针30min,每日1次,共治疗5d。观察两组患者治疗前与治疗期间每天的自觉腹胀与腹痛症状严重程度评分变化及转手术或ICU人数。结果:(1)首次电针干预后,电针组患者腹痛与腹胀症状严重程度评分均明显改善,且优于常规治疗组(均P<0.05),此后每日腹痛与腹胀症状严重程度评分缓解均优于常规治疗组,差异有统计学意义(均P<0.05);(2)两组在中转手术或ICU治疗人数方面差异无统计学意义(P>0.05)。结论:电针刺激足三里、支沟能够改善重症急性胰腺炎伴麻痹性肠梗阻患者临床腹部痛胀症状,且电针治疗安全,可以配合中西医结合内科治疗方案被推广与运用在重症急性胰腺炎疾病治疗中。

Objective To observe the clinical efficacy differences between electroacupuncture （EA） and regular treatment for severe acute pancreatitis accompanied with paralytic ileus. Methods This was a prospective prag- matic randomized controlled trial. A total of 140 cases of severe acute pancreatitis accompanied with paralytic ileus were randomly assigned into an EA group and a regular treatment group, 70 cases in each one. The patients in the regular treatment group were treated with regular treatment, including intensive care, gastrointestinal decompres- sion, fasting, blood capacity supplement, acid suppression treatment, internal environment maintenance, infection prevention, inhibition of pancreatic exocrine secretion, etc. Based on the regular treatment, patients in the EA group were treated with EA at Zusanli （ST 36） and Zhigou （TE 6）, 30 min for each treatment, once a day for totally 5 days. The VAS-based abdominal distension severity scale and abdominal pain severity scale were compared before and during treatment in the two groups, moreover, the number of patients who transferred to surgery or ICU was compared. Results （1） After the 1st EA, the abdominal pain and distension severity scales were both improved in the EA group, which were superior to those of the regular treatment group （all P〈0.05）; afterwards, the abdominal distension and pain severity scales of each day in the EA group were all significantly superior to those of the regular treatment group （all P〈0.05）. （2） The number of patients who transferred to surgery or ICU was not significantly different between the two groups （P〉0.05）. Conclusion EA at Zusanli （ST 36） and Zhigou （TE 6） can significantly reduce the abdominal distension and pain severity scales in patients of severe acute pancreatitis accompanied with paralytic ileus, indicating positive clinical significance; in addition, EA is safe and can he recommended to the treatment of severe acute panereatitis in combination with treatment plan of integrated Chinese and western medicine.