平胃散加减联合经皮神经肌肉电刺激治疗重症骨创伤患者ICU获得性衰弱临床研究

Clinical Study on Modified Pingwei Powder Combined with Percutaneous Nerve Muscle Electrical Stimulation for Severe Patients with Orthopedic Trauma with ICU-Acquired Weakness

目的:观察平胃散加减联合经皮神经肌肉电刺激治疗重症骨创伤患者重症监护病房获得性衰弱(ICU-AW)的疗效。方法:观察92例重症骨创伤ICU-AW患者,按随机数字表法分为对照组及观察组各46例。对照组在常规治疗的基础上指导患者进行康复功能锻炼,观察组在对照组基础上给予平胃散加减联合经皮神经肌肉电刺激。2组均连续治疗2周。比较2组临床疗效及并发症发生率,比较2组治疗前后日常生活能力Barthel指数(BI)评分、住ICU时间、机械通气天数、住院总天数、医学研究理事会(MRC)评分、急性生理功能与慢性健康状况评分系统Ⅱ(APACHE Ⅱ)评分、血清肿瘤坏死因子-α (TNF-α)水平的变化。结果:观察组、对照组的总有效率分别为95.65%、80.43%,2组临床疗效比较,差异有统计学意义(P<0.05)。治疗后,观察组日常生活活动能力BI等级改善优于对照组(P<0.05)。治疗后,观察组的住ICU时间、机械通气天数、住院总天数均短于对照组(P<0.05)。2组不同时间点MRC评分在时间因素、组间因素和时点交互因素方面比较,差异有统计学意义(P<0.05)。治疗3 d、治疗7 d后,2组MRC评分均较治疗前升高(P<0.05),观察组MRC评分高于对照组(P<0.05)。2组不同时间点APACHE Ⅱ评分在时间因素、组间因素和时点交互因素方面比较,差异有统计学意义(P<0.05)。治疗3 d、7 d后,2组APACHE Ⅱ评分均较治疗前下降(P<0.05),观察组APACHE Ⅱ评分低于对照组(P<0.05)。治疗14 d,2组TNF-α水平均较治疗前下降(P<0.05),观察组TNF-α水平低于对照组(P<0.05)。治疗期间,观察组并发症发生率为4.35%,对照组为13.04%,2组并发症发生率比较,差异无统计学意义(P>0.05)。结论:平胃散加减联合经皮神经肌肉电刺激治疗重症骨创伤ICU-AW的疗效较好,可提升日常生活能力、肢体肌力,缩短病程,抑制血清TNF-α水平,减轻机体的炎症状态。

Objective:To observe the curative effect of modified Pingwei Powder combined with percutaneous nerve muscle electrical stimulation on severe patients with orthopedic trauma with intensive care unit-acquired weakness(ICU-AW).Methods:A total of 92 ICU-AW patients with severe orthopedic trauma were observed and divided into the control group and the observation group according to the random number table method,with 46 cases in each group. On the basis of routine treatment,the control groupwas given guidance for patients to perform rehabilitation functional exercises, and the observation groupreceived modified Pingwei Powder combined with percutaneous nerve muscle electrical stimulation on thebasis of the control group. Both groups were treated for two weeks continuously. The clinical effects andincidence of complications were compared between the two groups. The changes in Barthel Index (BI)scores,ICU stay time,mechanical ventilation days,total hospitalization days,Medical Research Council(MRC) scores, Acute Physiological and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) scores, and levels oftumor necrosis factor- α (TNF- α) in serum were compared between the two groups before and aftertreatment. Results:The total effective rates in the observation group and the control group were 95.65%and 80.43% respectively,the difference being significant (P<0.05). After treatment,the improvement indaily living activity (BI) level in the observation group was better than that in the control group (P<0.05).After treatment,the observation group had shorter ICU stay time,mechanical ventilation days,and totalhospitalization days than those in the control group (P<0.05). In terms of time factors,inter group factors,and time point interaction factors,the difference in MRC scores between the two groups at different timepoints was significant (P<0.05). After treatment for three days and seven days,the MRC scores in the twogroups were increased when compared with those before treatment (P<0.05),and the MRC score in theobservation group was higher than that in the control group (P<0.05). The APACHE Ⅱ scores in the twogroups were compared in terms of time factors,inter group factors,and time point interaction factors atdifferent time points,and the difference was significant (P<0.05). After three and seven days of treatment,the APACHEⅡ scores in the two groups were reduced when compared with those before treatment (P<0.05),and the APACHEⅡscores in the observation group were lower than those in the control group (P<0.05). After 14 days of treatment, the TNF- α levels in the two groups were decreased when comparedwith those before treatment (P<0.05),and the TNF-α level in the observation group was lower than that inthe control group (P<0.05). During the treatment period,the incidence of complications was 4.35% in theobservation group,and 13.04% in the control group. There was no significant difference in the incidence ofcomplications between the two groups (P>0.05). Conclusion: Modified Pingwei Powder combined withpercutaneous nerve muscle electrical stimulation has a good therapeutic effect on severe orthopedic traumawith ICU-AW,which can improve daily living ability and limb muscle strength,shorten the disease course,inhibit serum TNF- α levels,and reduce the body's inflammatory state.