针刺在改善重症病人经胃喂养耐受性及喂养效果的前期研究

Acupuncture in critically ill patients improves gastric feeding tolerance and effect: a preliminary study

目的:比较针刺与药物治疗改善重症病人早期肠内营养耐受性的效果。方法:两年间收住于我院ICU接受早期肠内营养病人随机分针刺组(ATG)和药物组(DTG),每组各20例。ATG每日上午行针刺治疗,DTG予甲氧氯普胺10 mg Q8h静脉注射。床旁超声测喂养开始前、针刺前及30 min后胃窦收缩频率(ACF),收缩幅度(ACA),计算胃窦运动指数(MI),记录胃残余量(GRV),实际喂养量,计算喂养达标百分比,监测前白蛋白水平(PAB)。结果:ATG第1天针刺30 min后MI及ACF较针刺前显著增加(P<0.05);组内比较第3天MI、ACF较第1天显著增长。DTG组内比较第3天与第1天MI及ACF无统计学差异,第3天ACF较第2天下降(P<0.05)。ATG第3天GRV的减少比DTG多(P<0.05)。ATG平均喂养增长率优于DT(P<0.05)。ATG喂养量与DTG无统计差异,PAB回升较DTG组更快。结论:针刺治疗能较迅速改善胃排空能力,与甲氧氯普胺相比作用更持久。

Objectives:In this study we evaluated whether acupuncture can improve gastric motility and feeding tolerance in comparison with standard promoting drugs in critically ill patients receiving early enteral nutrition(EEN).Methods:The patients who received EEN in our ICU were randomly divided into acupuncture treatment groups(ATG)and drug therapy groups(DTG).ATG was acupunctured in every morning,and DTG was given metoclopramide 10 mg Q8 h iv only.Measure ACF(Antral Contraction Frequency),ACA(Antral Contraction Amplitude)and Calculate MI(Motility Index)with ultrasonography before the beginning of daily feeding,30 minutes after acupuncture,and measure GRV(Gastric Residual Volume),actual feeding amount were monitored regularly.The percentage of daily target feeding was calculated and PAB(Prealbumin)was measured regularly.Results:There were 20 patients in each group.MI and ACF were significantly increased after acupuncture(P<0.01).Comparison in ATG,MI and ACF growth was statistically different the third day compared with the first day(P<0.05).But there was no significant difference in DTG.The average growth rate in ATG was better than DTG(P<0.05).The difference value between the first and the third day of GRV in ATG was more than that in DTG(P<0.05).In ATG the PAB was recovering faster than in DTG.Conclusion:The early enteral feeding combined with acupuncture has shown quicker and longer therapeutic effect on improving gastric motility than metoclopramide in critical ill patients.