大黄超声电导靶位透入疗法对脓毒症患者胃肠功能障碍恢复的效果观察

The effect of Rhubarb ultrasonic electroconductive targeted dialysis therapy on the recovery of gastrointestinal dysfunction in sepsis patients:an observational study

目的探讨大黄超声电导靶位透入疗法对脓毒症患者胃肠功能的影响。方法选取2021年10月至2023年6月在广州中医药大学第二附属医院诊治的88例住院脓毒症患者作为研究对象,采用简单随机法将患者分为治疗组和对照组。两组患者均给予抗感染、液体复苏、营养支持、血糖管理、预防应激性溃疡等常规治疗,治疗组在常规治疗基础上选取神阙穴、中脘穴,给予超声电导靶位透入大黄疗法。主要观察指标为两组患者治疗前和治疗后3 d、7 d的肠鸣音次数;次要观察指标为两组患者胃潴留情况、血清C-反应蛋白(CRP)、降钙素原(PCT)、急性生理学与慢性健康状况评分Ⅱ(APACHEⅡ)、首次排便时间、机械通气时间、重症监护病房(ICU)住院时间、住院费用及28 d再入院率。于治疗前及治疗后3 d、7 d每隔4 h评估并记录1次胃潴留情况取平均值,于治疗前和治疗后7 d评定CRP、PCT、APACHEⅡ评分,并电话随访28 d再入院情况。结果最终治疗组44例和对照组有43例完成干预。两组治疗前肠鸣音次数和胃潴留量比较差异无统计学意义,随时间延长,两组肠鸣音次数逐渐增多,胃潴留量逐渐减少,治疗组治疗后3 d和7 d肠鸣音次数均较对照组明显增多〔次/min:治疗3 d为4.49(4.23,4.74)比3.07(2.80,3.33),治疗7 d为4.79(4.49,5.10)比3.36(3.06,3.66),均P<0.01〕,胃潴留量均较对照组明显减少〔mL:治疗3 d为20.93(9.22,32.64)比53.52(41.16,65.88),治疗后7 d为3.72(0.17,7.28)比31.59(24.87,38.31),均P<0.01〕;治疗组患者首次排便时间较对照组明显缩短(h:25.67±9.99比33.64±11.30,P<0.01);治疗后7 d,治疗组CRP、PCT、APACHEⅡ评分均较对照组明显降低〔CRP(mg/L):45.97(35.68,56.26)比77.30(57.20,97.38),PCT(μg/L):0.94(0.56,1.31)比2.73(1.36,4.09),APACHEⅡ评分(分):24.11±7.01比28.06±9.25,均P<0.05〕,机械通气时间、ICU住院时间均较对照组明显缩短〔机械通气时间(h):107.05±70.76比168.83±136.62,ICU住院时间(d):7.58±3.72比9.70±5.15,均P<0.05〕,住院费用和28 d再入院率均较对照组明显降低〔住院费用(元):80337.89±36483.72比109100.24±87080.84,28 d再入院率:9.1%(4/44)比27.9%(12/43),均P<0.05〕。结论大黄超声电导靶位透入疗法是一种安全、简单、有效的中医外治特色疗法,可为脓毒症患者胃肠功能保护提供一种新的依据。

Objective To explore the effect of Rhubarb ultrasonic electrical conduction target penetration therapy on the gastrointestinal function of sepsis patients.Methods A total of 88 cases of inpatient sepsis patients diagnosed and treated at the Second Affiliated Hospital of Guangzhou University of Chinese Medicine from October 2021 to June 2023 were selected as the participants and the patients were divided into the treatment group and the control group by a simple random method.Both groups were given routine treatments such as anti-infection,fluid resuscitation,nutritional support,blood sugar management,and prevention of stress ulcers,while the treatment group was treated with ultrasonic conductance target penetration Rhubarb therapy at Shenque point and Zhongwan point on the basis of the control group.The main observational indexes were the number of bowel sounds in the two groups before treatment and after 3 days,and 7 days of treatment.The secondary observational indexes were gastric retention,serum C-reactive protein(CRP),procalcitonin(PCT),acute physiology and chronic health evaluationⅡ(APACHEⅡ),the first defecation time,time to mechanical ventilation,length of stay in the intensive care unit(ICU),hospitalization cost,and 28 days readmission rate of the two groups.The gastric retention was evaluated and recorded every 4 hours before treatment and 3 days and 7 days after treatment,CRP and APACHEⅡscore were evaluated before treatment and 7 days after treatment,the 28-day readmission was followed up by telephone.Results A total of 44 cases in the treatment group and 43 cases in the control group completed the intervention.The difference between the bowel sounds and the amount of gastric retention of the two groups was not statistically significant before treatment,with the prolongation of time,the bowel sounds of the two groups gradually increased and the amount of gastric retention gradually decreased,and the number of bowel sounds in the treatment group increased significantly compared to the control group 3 days and 7 days after treatment[beats/minute:4.49(4.23,4.74)vs.3.07(2.80,3.33)3rd day of and 4.79(4.49,5.10)vs.3.36(3.06,3.66)on the 7th day of treatment,both P<0.01],and the amount of gastric retention was significantly reduced compared with the control group[mL:20.93(9.22,32.64)vs.53.52(41.16,65.88)for 3rd day of and 3.72(0.17,7.28)vs.31.59(24.87,38.31)on the 7th day of treatment,both P<0.01].The first defecation time was significantly shorter in the treatment group than in the control group(hours:25.67±9.99 vs.33.64±11.30,P<0.01).After 7 days treatment,the CRP,PCT,and APACHEⅡscore were significantly reduced in the treatment group compared to those in the control group[CRP(mg/L):45.97(35.68,56.26)vs.77.30(57.20,97.38),PCT(μg/L):0.94(0.56,1.31)vs.2.73(1.36,4.09),APACHEⅡscore:24.11±7.01 vs.28.06±9.25,all P<0.05],the mechanical ventilation time and ICU length of stay were significantly shortened[mechanical ventilation time(hours):107.05±70.76 vs.168.83±136.62,ICU stay time(days):7.58±3.72 vs.9.70±5.15,both P<0.05],the hospitalization cost and 28-day readmission rate were significantly reduced[hospitalization cost(yuan):80337.89±36483.72 vs.109100.24±87080.84,28-day readmission rate:9.1%(4/44)vs.27.9%(12/43),both P<0.05].Conclusion Rhubarb ultrasonic conductive target penetration therapy is a safe,simple,and effective characteristic therapy of external Chinese medicine that can provide a new basis for the protection of gastrointestinal function in patients with sepsis.