电针刺激迷走神经对神经外科术后合并呼吸机相关性肺炎患者的临床疗效观察

Clinical observation of electroacupuneture vagus nerve for neurosurgical postoperative combined ventilator - associated pneumonia in patients

目的观察运用电针刺激迷走神经对神经外科术后呼吸机相关性肺炎（VAP）患者的临床疗效。方法采用前瞻眭单盲随机对照研究方法，选取2016—04—2016—07本院重症医学科收治的45例神经外科术后合并VAP患者为研究对象。按随机数字表编码法将患者分为常规组（n=23）和电针组（n=22），常规组根据中华医学会制定的《呼吸机相关性肺炎诊断、预防和治疗指南（2013），给予抗菌药物治疗、支持治疗及物理治疗等。电针组在对照组的基础上，电针刺激下肢迷走神经每天2次，每次30rain。两组均连续治疗7d。记录两组患者治疗前和治疗后3、7d急性生理学与慢性健康状况评分系统Ⅱ（APACHEⅡ）评分，记录两组患者治疗前和治疗后3、7d时WBC、PCT、IL-6、CRP等。结果与常规组比较，电针组在3、7dAPACHEⅡ评分显著降低（P〈0．05）。与常规组比较，电针组在7d时PCT、IL-6、WBC较常规组下降更加显著（P〈0．05），而在0、3d时PCT、IL-6、WBC等炎症因子比较差异无统计学意义（P〉0．05）。而CRP在所有时间段两组比较差异无统计学意义（P〉0．05）。结论运用电针连续刺激VAP患者迷走神经，可明显改善患者临床表现，降低炎症因子水平，从而缩短病程，有利于患者术后恢复。电针刺激可作为重要补充方法运用在VAP综合治疗中。

Objective To investigate the efficacy of electroacupuncture vagus nerve stimulation in the treatment of ventilator - associated pneumonia （VAP） in neurosurgical postoperative. Methods A total of 45 patients neurosurgical postoperative related VAP in our hospital were investigated. The 45 patients were randomly divided into control group （n = 23） and electro - acupuncture group （n = 22）. Patients in the control group were given treatment by antimicrobial and support therapy, physical therapy according to the clinical practice guideline for diagnosis, prevention and management of VAP in 2013. Electroacupuncture group were given electroacupuncture vagus nerve stimulation base on the method of the control group. The basis of electroacupuncture lower limb the vagus nerve, twice a day at a time for 30 min. After treatment, the APACHE Ⅱ ratings, WBC, PCT, IL - 6, CRP were compared between the two group. Results The APACHE Ⅱ ratings of electroacupuncture group was significantly decreased than control group in the 3, 7 d. The inflammatory factors （PCT, IL - 6, WBC） electroacupuncture group were significantly decreased than control group after treatment 7 d. No significantly difference in the two groups about （PCT, IL - 6, WBC） in the 0, 3 d. And CRP in all periods, two groups had no significant difference （P 〉 0.05）. Conclusion Electroacupuncture vagus nerve stimulation can significantly improve the clinical efficacy of patients, lower levels of inflammatory factors, can be used as an important supplementary method used in the comprehensive treatment of VAP.