老年脓毒症胃肠功能障碍的中医证素分布及其针刺疗效观察

Distribution of TCM Syndrome Elements of Gastrointestinal Dysfunction in Senile Sepsis and Observation of Acupuncture Effect

目的:探讨针刺对于老年脓毒症合并胃肠功能障碍的临床疗效,探讨针刺治疗对于不同证型的缓解程度。方法:选取2018年8月至2019年8月北京老年医院收治的老年脓毒症胃肠功能障碍患者80例作为研究对象,记录一般资料、四诊信息,填写病例调查表,根据证型不同,在常规治疗基础上联合针刺治疗。记录中医症状评分的改善情况、胃肠功能相关参数及实验室指标的缓解程度,进而评价针刺治疗的效果,以及各证型间效果的差异。结果:纳入的80例老年脓毒症胃肠功能障碍患者中,以热证、痰证、瘀证等实证为多见。接受针刺治疗后APACHEⅡ,以及WBC,hs-CRP等炎性反应因子均有显著的改善(P<0.05),此外与治疗前比较,IFABP、肠鸣音次数、腹内压、中医症状积分等等亦有显著统计学意义。对于不同证型的分层分析,显示热证与痰证,针刺治疗效果明显。结论:针刺治疗可以老年脓毒症胃肠功能障碍,尤其是对于中医辨证属热证、痰证者临床症状改善更为明显。针刺或可作为该疾病的潜在治疗方式,值得进行大样本的深入研究、评价。

Objective:To explore the clinical effect of acupuncture on senile sepsis with gastrointestinal dysfunction,and explore the degree of relief of acupuncture treatment for different syndromes.Methods:A total of 80 elderly sepsis patients with gastrointestinal dysfunction admitted to Beijing Geriatric Hospital from August 2018 to August 2019 were selected,general information,four-diagnosis information were recorded,and the Case Report Forms were filled.According to different syndromes,acupuncture treatment on the basis of conventional treatment were given.The improvement of TCM symptom scores,gastrointestinal function related parameters and the degree of remission of laboratory indicators were recorded and then the effect of acupuncture treatment and the difference of effect among various syndrome were evaluated.Results:Among the 80 elderly sepsis patients with gastrointestinal dysfunction,the heat syndrome,phlegm syndrome,and blood stasis syndrome are more common.After acupuncture treatment,APACHEⅡ,WBC,hs-CRP and other inflammatory response factors were significantly improved(P<0.05).In addition,compared with before treatment,the improvement of IFABP,bowel sounds,intra-abdominal pressure,TCM symptoms scores and so on are also statistically significant.For the stratified analysis of different syndromes,it showed that acupuncture had better effect on the heat syndrome and phlegm syndromes.Conclusion:Acupuncture can treat gastrointestinal dysfunction in elderly sepsis,especially for those with heat syndrome and phlegm syndrome based on TCM differentiation.Acupuncture may be used as a potential treatment for the disease,and it is worthy of in-depth study and evaluation of large samples.