补阳还五汤联合针刺疗法对重症监护病房获得性肌无力肢体运动功能及免疫功能影响

Effect of Buyang Huanwu Decoction(补阳还五汤)Combined with Acupuncture Therapy on Limb Motor Function and Immune Function in Patients with Intensive Care Unit-Acquired Weakness

目的探讨补阳还五汤联合针刺疗法对重症监护病房获得性肌无力(ICU-AW)患者肢体运动功能及免疫功能影响。方法将2017年6月—2018年6月医院ICU住院收治的72例ICU-AW患者随机分为对照组和研究组,每组36例。入院后均给予常规ICU治疗措施,并由高年资医师完成病情评估,选择康复治疗的运动方式。对照组在上述基础上给予中药补阳还五汤口服,每日1剂,连服10 d;研究组加用针刺疗法治疗,每日1次,连续治疗10 d。检测免疫功能[肿瘤坏死因子-α(TNF-α)、白介素-6(IL-6)]变化,应用英国医学研究委员会(MRC)量表评估肢体运动功能,应用改良Barthel指数评分(MBI)评估日常活动能力,应用生物电阻抗(Biospace公司,韩国)检测全身肌肉含量,并记录患者机械通气时间、ICU住院时间以及总住院时间。结果与治疗前比较,两组血清TNF-α、IL-6水平显著降低(P<0.01),MRC评分、MBI评分显著升高(P<0.01),ASM/Ht2显著升高(P<0.01);与对照组比较,研究组TNF-α、IL-6水平显著较低(P<0.01),MRC评分、MBI评分显著较高(P<0.01),ASM/Ht2显著较高(P<0.01),机械通气时间、ICU住院时间、总住院时间显著较短(P<0.01)。结论补阳还五汤联合针刺疗法可改善ICU-AW患者肢体运动功能和日常生活能力,缩短机械通气时间、ICU住院时间、总住院时间,可能与抑制TNF-α、IL-6表达来调节免疫功能有关。

Objective To investigate the effects of Buyang Huanwu Decoction(补阳还五汤) combined with acupuncture on limb motor function and immune function in patients with intensive care unit-acquired weakness(ICU-AW). Methods Seventy-six patients with ICU-AW admitted to ICU from June 2017 to June 2018 were randomly divided into control group and study group, 36 cases in each group. Routine ICU treatment was given after admission. Senior physicians completed the condition assessment and selected the exercise mode of rehabilitation treatment. The control group received Buyang Huanwu Decoction orally, one dose a day for 10 days, while the study group was treated with acupuncture once a day for 10 days. Changes of immune function(TNF-α, IL-6) and limb motor function were assessed by the British Medical Research Council(MRC). The daily activity was assessed by the modified Barthel index score(MBI), body muscle content was measured by bioelectrical impedance(Biospace, Korea), and mechanical ventilation time, ICU hospitalization time and total hospitalization were recorded. Results Compared with those before treatment, the levels of TNF-α and IL-6 in serum of the two groups decreased significantly(P<0.01). The scores of MRC and MBI increased significantly(P<0.01) and ASM/Ht2 decreased significantly(P<0.01). Compared with those of the control group, the levels of TNF-α and IL-6 in the study group were significantly lower(P<0.01). The scores of MRC and MBI were significantly higher(P<0.01), the ASM/Ht2 was significantly lower(P<0.01), the duration of mechanical ventilation and the hospitalization time of ICU were significantly lower(P<0.01). The length of hospital stay was significantly shorter(P<0.01). Conclusion Buyang Huanwu Decoction combined with acupuncture therapy can improve limb motor function and daily living ability of ICU-AW patients, shorten mechanical ventilation time, ICU hospitalization time and total hospitalization time, which may be related to suppressing the expressions of TNF-α and IL-6 to regulate immune function.