耳穴压丸联合穴位针刺对重症机械通气患者预后的影响

Effects of Auricular Acuoints Pressing Pills Combined with Acupoint Acupuncture on Prognosis of Patients with Severe Mechanical Ventilation

目的探究耳穴压丸联合穴位针刺对重症机械通气患者预后的影响。方法回顾性收集2016年1月—2021年5月期间该院重症医学科收治的重症机械通气患者80例,依据干预方案的不同将其分为联合组38例和对照组42例,两组患者均在治疗原发病、控制感染的同时给予重症机械通气基础镇痛、镇静、排痰和常规药物治疗,对照组实施穴位针刺治疗,联合组在对照组基础上加用耳穴压丸,观察两组患者机械通气时间、重症监护病房(ICU)住院时间、呼吸机相关性肺炎(VAP)发生率和病死率,对比两组治疗前后心率(HR)、呼吸频率(RR)、平均动脉压(MAP)、血氧饱和度(SpO_(2))等基础生命体征,潮气量(Vt)、呼吸道峰压(Ppeak)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))等呼吸功能指标、白细胞计数(WBC)、超敏C反应蛋白(hs-CRP)、中性粒细胞百分比(NEUT%)和血肌酐(Cr)等生化指标,记录谵妄、低血压、心动过缓和胃肠道反应等并发症发生率。结果联合组机械通气时间、ICU住院时间和VAP发生率均低于对照组(P<0.05)。治疗前,两组HR、RR、MAP和SpO_(2)差异无统计学意义(P>0.05),治疗后联合组HR和RR低于对照组,MAP和SpO_(2)高于对照组(P<0.05)。治疗前两组Vt、Ppeak、PaO_(2)和PaCO_(2)差异无统计学意义(P>0.05),治疗后联合组Vt和PaO_(2)高于对照组,Ppeak和PaCO_(2)低于对照组(P<0.05)。治疗前两组WBC、hs-CRP、NEUT%和Cr差异无统计学意义(P>0.05),治疗后联合组WBC、hs-CRP、NEUT%和Cr均低于对照组(P<0.05)。联合组出现谵妄、低血压、心动过缓和胃肠道反应等并发症总发生率为8.11%(3/37),低于对照组28.21%(11/39)(P>0.05)。结论耳穴压丸联合穴位针刺治疗重症机械通气患者疗效较好,可缩短患者机械通气时间和ICU住院时间,降低VAP发生率,维持基础生命体征、呼吸功能和生化指标正常,降低并发症发生率,改善预后。

Objective To explore the effects of auricular acupoint pressing pills combined with acupoint acupuncture on prog-nosis of patients with severe mechanical ventilation.Methods Eighty patients with severe mechanical ventilation treated in department of critical care medicine of the hospital were retrospectively collected between January 2016 and May 2021,and they were divided into the combined group(38 cases)and the control group(42 cases)according to different intervention regimens.The patients in both groups were given basic analgesia,sedation,expectoration and conventional drug therapy for severe mechanical ventilation while treating the primary disease and controlling infection and the control group was given acupoint acupuncture therapy while the combined group was additionally given auricular acupoint pressing pills on the basis of the control group.The mechanical ventilation time,intensive care unit(ICU),incidence rate of ventilator-associated pneumonia(VAP)and mortality rate were observed in the two groups,and the basic vital signs such as heart rate(HR),respiratory rate(RR),mean arterial pressure(MAP)and oxygen saturation(SpO_(2)),respiratory function indicators of tidal volume(Vt),respiratory peak pressure(Ppeak),partial pres-sure of arterial oxygen(PaO_(2)),partial pressure of arterial carbon dioxide(PaCO_(2))and biochemical indicators such as white blood cell count(WBC),high-sensitivity C-reactive protein(hs-CRP),neutrophil percentage(NEUT%)and serum creatinine(Cr)were compared between the two groups before and after treatment.The incidence rates of complications such as delirium,hypoten-sion,bradycardia and gastrointestinal reactions were recorded.Results The mechanical ventilation time,ICU stay and incidence rate of VAP in the combined group were shorter than those in the control group(P<0.05).Before treatment,there were no significant differences in HR,RR,MAP or SpO_(2)between the two groups(P>0.05).After treatment,the values of HR and RR in the combined group were lower than those in the control group while the values of MAP and SpO_(2)were higher than those in the control group(P<0.05).There were no significant differences in the values of Vt,Ppeak,PaO_(2)and PaCO_(2)between the two groups before treatment(P>0.05).After treatment,the values of Vt and PaO_(2)in the combined group were higher than those in the control group while the values of Ppeak and PaCO_(2)were lower than those in the control group(P<0.05).Before treatment,there were no significant differences in WBC,hs-CRP,NEUT%or Cr between the two groups(P>0.05).But after treatment,the values of WBC,hs-CRP,NEUT%and Cr were lower in the combined group than those in the control group(P<0.05).The total inci-dence rate of complications of delirium,hypotension,bradycardia and gastrointestinal reaction in the combined group was 8.11%(3/37),which was lower than 28.21%(11/39)in the control group(P>0.05).Conclusion Auricular acupoint pressing pills combined with acupoint acupuncture has a good efficacy on patients with severe mechanical ventilation,and it can shorten the me-chanical ventilation time and ICU stay,reduce the incidence rate of VAP,maintain the normal basic vital signs,respiratory function and biochemical indicators,lower the incidence rates of complications and improve the prognosis.