四磨汤加味方联合针刺治疗对AECOPD伴Ⅱ型呼吸衰竭无创通气后合并腹胀患者胃肠动力的影响

Effects of modified Simo Decoction combined with acupuncture on gastrointestinal motility in AECOPD patients with typeⅡrespiratory failure complicated with abdominal distension after non-invasive ventilation

目的观察四磨汤加味方联合针刺治疗慢性阻塞性肺疾病急性加重期(AECOPD)伴Ⅱ型呼吸衰竭患者经无创通气治疗后并发腹胀的效果及对胃肠动力的影响。方法选择2020年1月—2021年6月上海市宝山区中西医结合医院收治的AECOPD伴Ⅱ型呼吸衰竭无创通气后合并腹胀患者132例,按照随机数字表法分为对照组和观察组各66例。对照组患者予以枸橼酸莫沙必利片口服,观察组患者在对照组治疗基础上予以四磨汤加味方联合针刺治疗,连续治疗1周。比较治疗后2组患者的腹围、腹压、胃肠动力学指标[胃动素(MTL)、生长抑素(SS)、胃泌素(GAS)]、腹胀程度、腹胀消失时间、肛门排气时间、肠鸣音恢复时间、排便时间、呼吸机使用总时间、每日呼吸机使用时间及总疗效。结果治疗后,观察组的腹围、腹压均显著小于对照组(P均<0.05),MTL、GAS水平均显著高于对照组(P均<0.05),血清SS水平均显著低于对照组(P均<0.05),腹胀程度明显轻于对照组(P<0.05),腹胀消失时间、肛门排气时间、肠鸣音恢复时间、排便时间、呼吸机使用总时间、每日呼吸机使用时间均显著短于对照组(P均<0.05)。观察组的总有效率为96.97%(64/66),显著高于对照组的86.36%(57/66),差异有统计学意义(P<0.05)。结论四磨汤加味方联合针刺治疗可明显减轻AECOPD伴Ⅱ型呼吸衰竭患者经无创通气治疗后腹胀,调节胃肠激素水平,增强胃肠动力,促进胃肠功能恢复,缩短无创通气时间。

Objective It is to observe the treatment effect of modified Simo Decoction combined with acupuncture in the treatment of patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)with typeⅡrespiratory failure complicated with abdominal distension after non-invasive ventilation and its effect on gastrointestinal motility.Methods A total of 132 patients with AECOPD and typeⅡrespiratory failure complicated with abdominal distension after non-invasive ventilation who were admitted to Shanghai Baoshan District Hospital of Integrated Traditional Chinese and Western Medicine from January 2020 to June 2021 were selected and divided into the control group and the observation group according to the random number table method,66 cases in each group.The patients in the control group were given mosapride citrate tablets orally,while the patients in the observation group were treated with modified Simo Decoction plus acupuncture on the basis of the treatment in the control group,both groups were continuously treated for 1 week.The abdominal circumference,abdominal pressure,gastrointestinal kinetic indexes[motilin(MTL),somatostatin(SS),gastrin(GAS)],degree of abdominal distension,disappearance time of abdominal distension,anal exhaust time,bowel sound recovery time,defecation time,total ventilator use time,daily ventilator use time and total curative effect were compared between the two groups after treatment.Results After treatment,the abdominal circumference and abdominal pressure of the observation group were significantly lower than those of the control group(all P<0.05),the levels of MTL and GAS were significantly higher than those of the control group(all P<0.05),and the serum SS level was significantly lower than that of the control group(P<0.05),the degree of abdominal distension was significantly lighter than that of the control group(P<0.05),the disappearance time of abdominal distention,anal exhaust time,bowel sound recovery time,defecation time,total ventilator use time,and daily ventilator use time were significantly shorter than those of the control group(all P<0.05).The total effective rate of the observation group was 96.97%(64/66),which was significantly higher than that 86.36%(57/66)of the control group,the difference was significant(P<0.05).Conclusion Modified Simo Decoction combined with acupuncture can significantly reduce abdominal distension after non-invasive ventilation,regulate the level of gastrointestinal hormones,enhance gastrointestinal motility,promote the recovery of gastrointestinal function,and shorten the time of non-invasive ventilation in patients with AECOPD and typeⅡrespiratory failure.