Application of gastrointestinal pacing therapy in patients with chronic obstructive pulmonary disease complicated with gastrointestinal dysfunction
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摘要: 目的 探讨胃肠起搏治疗在慢性阻塞性肺疾病(COPD)合并胃肠功能紊乱患者中的应用疗效。方法 选取2020年9月—2021年9月盐城市第三人民医院收治的COPD合并胃肠功能紊乱患者80例作为研究对象，按照随机数表法分为胃肠起搏组、中药汤剂组、穴位按摩组和对照组，每组各20例，并予以对应治疗，疗程均为14 d。分别检测4组患者治疗前后肺功能、动脉血气分析、免疫功能及促胃液素水平，记录患者治疗前后COPD评估测试量表(CAT)评分、呼吸困难指数(mMRC)评分、6分钟步行试验(6MWT)距离、生活质量(QOL)评分及消化道症状积分，并统计4组患者临床疗效。结果 胃肠起搏组患者治疗后第1秒末用力呼气量(FEV1)、第1秒末用力呼气量与用力肺活量比值(FEV1/FVC)均稍高于其他3组(P>0.05)；4组患者治疗后酸碱度(pH)、血氧饱和度(SPO2)、氧分压(PO2)、二氧化碳分压(PCO2)均差异无统计学意义(P>0.05)；胃肠起搏组患者治疗后CD3+、CD4+均明显高于其他3组(P< 0.05)，CD8+明显低于其他3组(P< 0.05)；胃肠起搏组患者治疗14 d后促胃液素水平均明显低于其他3组(P< 0.05)；胃肠起搏组患者治疗后CAT及mMRC评分均明显低于其他3组(P< 0.05)；胃肠起搏组患者治疗后6MWT距离明显长于其他3组(P< 0.05)，QOL评分明显低于其他3组(P< 0.05)；胃肠起搏组患者治疗4、7、14 d后消化道积分均明显低于其他3组(P< 0.05)；4组患者间临床疗效比较，胃肠起搏组稍高于其他3组(P>0.05)。结论 胃肠起搏治疗能有效缓解COPD合并胃肠功能紊乱患者胃肠道症状，提高患者运动耐力及免疫力，且可在一定程度上改善患者肺功能。Abstract: Objective To explore the efficacy of gastrointestinal pacing treatment in patients with chronic obstructive pulmonary disease(COPD) combined with gastrointestinal dysfunction.Methods A total of 80 patients with COPD and gastrointestinal dysfunction admitted from September 2020 to September 2021 were selected as the study subjects. They were divided into gastrointestinal pacing group, TCM decoction group, acupuncture massage group and control group, with 20 cases in each group. The corresponding treatment was given, and the course was 14 days. Lung function, arterial blood gas analysis, immune function and gastrin levels were examined before and after treatment in the four groups. The COPD assessment test scale(CAT) score, respiratory difficulty index(mMRC) score, 6-minute walk trial(6MWT) distance, quality of life(QOL) score, and digestive tract symptoms score were recorded before and after treatment in the four groups. The clinical effects of the four groups of patients were also counted.Results After treatment, forced expiratory volume at the end of the first second(FEV1), ratio of forced expiratory volume to forced vital capacity at the end of first second(FEV1/FVC) in the gastrointestinal pacing group were slightly higher than the other three groups(P>0.05); There were no significant differences in acid(pH), blood oxygen saturation(SPO2), oxygen pressure(PO2) and carbon dioxide pressure(PCO2) in the four groups, respectively(P>0.05); Patients in the gastrointestinal pacing group had significantly higher CD3+and CD4+compared with the other three groups(P< 0.05) and CD8+was significantly lower than the other three groups(P< 0.05); Patients in the gastrointestinal pacing group had significantly lower gastrin levels after 14 d than in the other three groups(P< 0.05); Both the CAT and mMRC scores were significantly lower than those in the other three groups(P< 0.05); The 6MWT distance in the gastrointestinal pacing group was significantly longer than the other three groups(P< 0.05); The QOL score was significantly lower than that in the other three groups(P< 0.05); Patients in the gastrointestinal pacing group had significantly lower GI integration after 4 d, 7 d, 14 d than the other three groups(P< 0.05); Comparison of clinical efficacy between the four groups, the gastrointestinal pacing group was slightly higher than the other three groups(P>0.05).Conclusion Gastrointestinal pacing treatment can effectively relieve gastrointestinal symptoms in patients with COPD combined with gastrointestinal dysfunction, improve patients' exercise endurance and immunity, and can improve the patient's lung function to some extent.
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表 1 4组患者治疗前后肺功能指标比较
X±S 指标 胃肠起搏组
(n=20)穴位按摩组
(n=20)中药汤剂组
(n=20)对照组
(n=20)F P FEV1/L 治疗前 1.54±0.31 1.52±0.36 1.55±0.34 1.52±0.33 6.768 0.934 治疗后 1.74±0.40 1.67±0.38 1.68±0.33 1.59±0.37 9.335 0.416 FEV1/FVC/% 治疗前 52.15±10.62 52.21±10.45 52.43±10.73 52.13±9.78 7.346 0.885 治疗后 58.91±11.15 56.85±10.85 55.95±10.91 54.85±10.61 10.215 0.337 
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表 2 4组患者治疗前后动脉血气分析指标比较
X±S 指标 胃肠起搏组
(n=20)穴位按摩组
(n=20)中药汤剂组
(n=20)对照组
(n=20)F P pH 治疗前 7.33±0.06 7.35±0.04 7.36±0.06 7.36±0.05 0.249 0.967 治疗后 7.40±0.03 7.39±0.05 7.39±0.04 7.38±0.04 0.865 0.910 SPO2/% 治疗前 92.38±4.61 91.28±5.23 91.94±4.87 92.01±4.37 1.013 0.906 治疗后 96.48±2.091) 96.54±1.771) 95.69±2.031) 96.20±2.211) 1.034 0.818 PO2/kPa 治疗前 10.25±1.87 10.53±1.77 10.24±1.85 10.92±2.07 1.125 0.875 治疗后 11.27±1.85 11.51±2.13 11.13±1.65 11.11±1.03 1.561 0.845 PCO2/kPa 治疗前 7.88±1.91 7.69±1.85 7.50±1.94 7.49±2.01 1.432 0.863 治疗后 6.73±1.87 6.63±1.71 6.43±1.75 7.21±2.05 1.659 0.421 与同组治疗前比较，1)P < 0.05。
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表 3 4组患者治疗前后免疫功能比较
%，X±S 指标 胃肠起搏组
(n=20)穴位按摩组
(n=20)中药汤剂组
(n=20)对照组
(n=20)F P CD3+ 治疗前 52.57±6.17 52.94±6.23 52.25±6.21 52.40±6.13 0.636 0.915 治疗后 61.48±7.851) 57.34±7.111) 57.56±7.261) 55.39±6.961) 4.694 0.011 CD4+ 治疗前 28.88±5.77 29.07±5.85 28.32±5.73 28.42±5.81 1.312 0.871 治疗后 37.73±6.121) 32.33±6.031) 32.97±5.871) 31.42±5.941) 5.653 < 0.001 CD8+ 治疗前 35.25±5.41 35.22±5.36 35.31±5.39 35.23±5.32 1.266 0.895 治疗后 22.52±3.331) 25.41±3.611) 25.26±3.851) 28.35±3.791) 5.967 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 4 4组患者治疗前后CAT及mMRC评分比较
分，X±S 指标 胃肠起搏组
(n=20)穴位按摩组
(n=20)中药汤剂组
(n=20)对照组
(n=20)F P CAT评分 治疗前 30.69±4.11 30.60±4.23 30.70±4.15 30.55±4.07 0.815 0.803 治疗后 24.85±3.611) 27.19±3.521) 27.10±3.571) 28.10±3.351) 4.329 0.018 mMRC评分 治疗前 2.85±0.81 2.85±0.76 2.90±0.79 2.80±0.77 0.893 0.772 治疗后 1.75±0.431) 2.25±0.551) 2.30±0.611) 2.35±0.641) 5.135 0.007 与同组治疗前比较，1)P < 0.05。
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表 5 4组患者治疗前后6MWT距离及QOL评分比较
X±S 指标 胃肠起搏组
(n=20)穴位按摩组
(n=20)中药汤剂组
(n=20)对照组
(n=20)F P 6MWT距离/m 治疗前 250.95±31.27 252.75±33.67 248.20±32.15 250.85±32.31 0.245 0.707 治疗后 286.45±35.341) 269.80±34.711) 273.90±34.151) 262.05±33.961) 3.652 0.024 QOL评分/分 治疗前 94.55±10.25 94.50±9.96 94.70±10.12 94.60±10.08 0.353 0.632 治疗后 71.05±8.131) 81.80±8.691) 81.40±8.731) 86.05±9.161) 6.125 < 0.001 与同组治疗前比较，1)P < 0.05。
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表 6 4组患者临床疗效比较
例(%) 组别 例数 显效 有效 无效 总有效 胃肠起搏组 20 9(45.00) 9(45.00) 2(10.00) 18(90.00) 穴位按摩组 20 3(15.00) 11(55.00) 6(30.00) 14(70.00) 中药汤剂组 20 6(30.00) 10(50.00) 4(20.00) 16(80.00) 对照组 20 1(5.00) 11(55.00) 8(40.00) 12(60.00) χ2 5.333 P 0.149
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