针刺法联合西医常规治疗改善ICU术后谵妄的临床疗效观察

Observation on the clinical efficacy of acupuncture combined with conventional Western medicine treatment in reducing ICU postoperative delirium

目的观察针刺法联合西医常规治疗对ICU术后谵妄(postoperative delirium,POD)的临床疗效。方法选取自2021年1月至2022年6月在湖南中医药大学附属第二中西医结合医院接受全麻插管手术后在ICU治疗的60例患者为研究对象,采用随机数字表法分为对照组和观察组,每组30例。对照组予以西医常规治疗,观察组在对照组的基础上加用穴位针刺治疗,穴位取百会、印堂、水沟、神庭、四神聪、中极、后溪、神门、内关,每次30 min,连续3 d。比较两组患者术后谵妄的发生率、镇痛镇静药物使用剂量、血清中枢神经特异性蛋白(S100-β)、神经元特异性烯醇化酶(neuron-specific enolase,NSE)、多巴胺(dopamine,DA)、前列腺素E_(2)(prostaglandin E_(2),PGE_(2))水平,并记录两组治疗期间的不良反应。结果观察组POD的发生率为3.33%,低于对照组的26.67%(P<0.05);观察组组内比较,药物使用剂量较同期针刺治疗前减少(P<0.05);治疗后两组间比较,观察组药物使用剂量、S100-β、NSE、DA、PGE_(2)水平均低于周期对照组(P<0.05)。两组均未发现明显不明反应。结论针刺法联合西医常规治疗可以减少ICU患者术后谵妄的发生率,减少镇痛镇静药物剂量,其机制可能与减少中枢兴奋、改善脑损伤及调节疼痛递质相关。

Objective To observe the clinical efficacy of acupuncture combined with conventional Western medicine treatment on postoperative delirium(POD)in ICU patients.Methods Sixty patients who underwent general anesthesia with tracheal intubation followed by ICU treatment at the Second Integrated Chinese and Western Medicine Hospital Affiliated to Hunan University of Chinese Medicine from January 2021 to June 2022 were selected as the study subjects and were divided into control group and observation group by the random number table method,with 30 patients in each group.The control group received conventional Western medicine treatment,while the observation group was additionally treated with acupuncture at specific acupoints,including Baihui(GV 20),Yintang(EX-HN 3),Shuigou(GV 26),Shenting(GV 24),Sishencong(EX-HN 1),Zhongji(CV 3),Houxi(SI 3),Shenmen(HT 7),and Neiguan(PC 6),which lasted for 30 min each time for three consecutive days.The incidence of POD,dosage of analgesic and sedative drugs,levels of central nervous system specific protein(S100-β),neuron-specific enolase(NSE),dopamine(DA),and prostaglandin E_(2)(PGE_(2))in serum were compared between the two groups,and adverse reactions during treatment were recorded.Results The incidence of POD was 3.33%in the observation group,which was lower than 26.67%in the control group(P<0.05).Within the observation group,the drug dosage was lower than that before acupuncture treatment(P<0.05).After treatment,the drug dosage,levels of S100-β,NSE,DA,and PGE_(2) in the observation group were lower than those in the control group(P<0.05).No obvious unidentified reactions were observed in either group.Conclusion Acupuncture combined with conventional Western medicine treatment can reduce the incidence of POD and the dosage of analgesic and sedative drugs in ICU patients.The mechanism may be related to reducing central excitability and brain injury,as well as regulating pain transmitters.