Effect of early enteral nutrition with recovery acupuncture on acute gastrointestinal injury in sepsis
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摘要: 目的 探讨早期肠内营养配合复元针法治疗脓毒症急性胃肠损伤(AGI)的疗效。方法 选择2018年1月—2022年1月收治的195例脓毒症AGI患者为研究对象，采用随机数字表法将其分为观察组(n=65)、早期肠内营养组(n=65)及复元针法组(n=65)。所有患者入院后给予常规处理，早期肠内营养组给予早期肠内营养支持干预，复元针法组给予复元针法干预，观察组采用早期肠内营养配合复元针法进行干预，对比3组干预前后的腹内压、腹围、肠鸣音，自开通肠内营养至肠内营养达标时间、入住重症监护室(ICU)时间及住院总时间，干预前后的急性生理与慢性健康评分Ⅱ(APACHEⅡ)、AGI分级，对比3组干预前后的血清转铁蛋白(TF)、血清总蛋白(ALB)、血红蛋白(Hb)、前清蛋白(PA)的表达水平。结果 观察组的腹内压均低于早期肠内营养组和复元针法组，观察组的肠鸣音均多于早期肠内营养组和复元针法组，差异有统计学意义(P＜0.05)。观察组的营养达标时间、入住ICU时间及住院总时间均短于早期肠内营养组和复元针法组，差异有统计学意义(P＜0.05)。干预后观察组的APACHEⅡ评分及AGI评分均低于早期肠内营养组和复元针法组，差异有统计学意义(P＜0.05)。干预后观察组的TF、ALB、Hb及PA均高于早期肠内营养组和复元针法组，差异有统计学意义(P＜0.05)。干预后早期肠内营养组的ALB、Hb及PA均高于复元针法组，差异有统计学意义(P＜0.05)。结论 早期肠内营养联合复元针法能改善脓毒症AGI患者的腹部症状，促进患者康复，改善机体整体状态及营养状况。Abstract: Objective To investigate the efficacy of enteral nutrition with acupuncture on acute gastrointestinal injury(AGI) in sepsisMethods One hundred and ninety-five patients with septic acute gastrointestinal injury treated from January 2018 to January 2022 were randomly divided into observation group(n=65), early enteral nutrition group(n=65) andcompound injection group (n=65). All patients were routinely treated after hospital admission. The early enteral nutrition group was treated with the early enteral nutrition support intervention, the injection group was treated with the injection intervention, and the observation group was administrated with early enteral nutrition with compound injection. Intra-abdominal pressure, abdominal circumference, and bowel sounds in the three groups, comparing the time from the opening of enteral nutrition to the enteral nutrition standard, the time of admission to the intensive care unit(ICU) and the total hospitalization time of the three groups, comparing the acute physiological and chronic health score(APACHEⅡ) and AGI grade before and after the three groups, the expression levels of serum transferrin(TF), total serum protein(ALB), hemoglobin(Hb) and provalant(PA) were compared before and after the intervention of the three groups.Results The intraabdominal pressure was lower than the early enteral nutrition group and the compound element acupuncture group, and the intestinal sounds were pronounced than the early observation group(P < 0.05). The observation group, the time of ICU stay and the total time of hospitalization were shorter than the early enteral nutrition group, which was statistically significant(P < 0.05). The APACHEⅡ score and AGI score of the observation group were lower than that of the early enteral nutrition group, which was significant(P < 0.05). The TF, ALB, Hb and PA in the postintervention observation group were all higher than those in the early enteral nutrition group, with a statistically significant difference(P < 0.05). ALB, Hb and PA were higher in the early enteral nutrition group than in the complicated acupuncture group, which was significant(P < 0.05).Conclusion early enteral nutrition combined with recovery acupuncture can improve the abdominal symptoms, promote the rehabilitation and improve the overall body and nutritional status of patients with gastrointestinal injury in sepsis.
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Key words:
- early enteral nutrition /
- recovery acupuncture /
- sepsis /
- acute gastrointestinal injury
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表 1 3组腹内压、腹围、肠鸣音的比较
X±S 组别 例数 腹内压/mmHga) 腹围/cm 肠鸣音/(次·min-1) 干预前 干预后 干预前 干预后 干预前 干预后 观察组 65 12.95±1.96 4.13±0.891) 108.85±9.53 95.24±6.621) 1.19±0.18 3.96±0.981) 早期肠内营养组 65 12.63±2.05 5.86±1.051) 107.85±8.96 97.06±5.991) 1.21±0.22 3.48±0.631) 复元针法组 65 12.84±2.14 5.63±1.141) 110.52±11.40 97.42±8.231) 1.22±0.31 3.45±0.511) F/P 1.052/0.335 9.591/＜0.001 0.424/0.646 1.952/0.081 1.521/0.109 8.942/0.007 t1/P1 0.910/0.365 10.133/＜0.001 0.616/0.539 1.644/0.103 0.567/0.572 3.322/0.001 t2/P2 0.240/0.811 6.560/＜0.001 0.711/0.479 1.305/0.196 0.529/0.598 2.920/0.005 t3/P3 0.448/0.655 0.939/0.351 1.165/0.248 0.224/0.824 0.166/0.868 0.234/0.816 注：a)1 mmHg=0.133 kPa。
t1/P1：观察组与早期肠内营养组比较；t2/P2：观察组与复元针法组比较；t3/P3：复元针法组与早期肠内营养组比较。与干预前比较，1)P＜0.05。
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表 2 3组营养达标时间、入住ICU时间及住院总时间的比较
d，X±S 组别 例数 营养达标时间 入住ICU时间 住院总时间 观察组 65 4.89±0.69 4.70±1.35 12.93±1.72 早期肠内营养组 65 5.46±0.74 5.49±1.24 15.27±1.68 复元针法组 65 5.39±0.87 5.41±1.53 14.92±2.45 F/P 7.992/0.009 12.525/＜0.001 16.445/＜0.001 t1/P1 4.542/＜0.001 3.475/0.001 7.847/＜0.001 t2/P2 2.848/0.006 2.201/0.031 4.204/＜0.001 t3/P3 0.388/0.699 0.257/0.798 0.745/0.459 t1/P1：观察组与早期肠内营养组比较；t2/P2：观察组与复元针法组比较；t3/P3：复元针法组与早期肠内营养组比较。
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表 3 3组APACHEⅡ及AGI评分的比较
分，X±S 组别 例数 APACHEⅡ评分 AGI评分 干预前 干预后 干预前 干预后 观察组 65 22.96±4.24 11.06±2.051) 2.95±0.42 1.29±0.141) 早期肠内营养组 65 21.91±5.74 14.96±1.971) 2.89±0.52 1.48±0.191) 复元针法组 65 22.13±4.22 14.52±3.111) 2.94±0.51 1.46±0.211) F/P 1.483/0.145 16.431/＜0.001 1.005/0.137 13.552/＜0.001 t1/P1 1.186/0.238 11.059/＜0.001 0.724/0.471 6.491/＜0.001 t2/P2 0.878/0.383 5.875/＜0.001 0.096/0.924 4.260/＜0.001 t3/P3 0.195/0.846 0.756/0.452 0.434/0.665 0.447/0.656 t1/P1：观察组与早期肠内营养组比较；t2/P2：观察组与复元针法组比较；t3/P3：复元针法组与早期肠内营养组比较。与干预前比较，1)P＜0.05。
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表 4 3组血清营养指标的比较
X±S 组别 例数 TF/(g·L-1) ALB/(g·L-1) Hb/(g·L-1) PA/(mg·L-1) 干预前 干预后 干预前 干预后 干预前 干预后 干预前 干预后 观察组 65 1.27±0.28 2.39±0.461) 27.52±3.85 38.89±4.391) 104.42±12.43 128.87±11.751) 102.54±13.10 205.52±18.531) 早期肠内营养组 65 1.30±0.21 1.85±0.381) 27.21±4.06 32.63±4.331) 102.83±11.52 117.59±9.731) 104.27±11.63 172.68±17.261) 复元针法组 65 1.31±0.23 1.69±0.521) 27.01±4.45 29.74±5.021) 104.41±9.34 107.93±10.051) 106.42±10.75 159.85±9.521) F/P 0.852/0.551 9.472/0.004 0.741/0.442 8.524/0.006 1.421/0.094 12.442/＜0.001 1.331/0.081 12.442/＜0.001 t1/P1 0.691/0.491 7.297/＜0.001 0.447/0.656 8.185/＜0.001 0.756/0.451 5.961/＜0.001 0.796/0.427 10.455/＜0.001 t2/P2 0.698/0.487 6.377/＜0.001 0.548/0.585 8.678/＜0.001 0.004/0.997 8.565/＜0.001 1.448/0.152 13.865/＜0.001 t3/P3 0.203/0.840 1.571/0.121 0.210/0.834 2.757/0.007 0.674/0.503 4.368/＜0.001 0.859/0.393 4.117/＜0.001 t1/P1：观察组与早期肠内营养组比较；t2/P2：观察组与复元针法组比较；t3/P3：复元针法组与早期肠内营养组比较。与干预前比较，1)P＜0.05。
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[1] 黄昆鹏, 张进祥. 脓毒症的定义、诊断与早期干预——不可分割的三要素[J]. 临床急诊杂志, 2021, 22(3): 221-226. doi: 10.13201/j.issn.1009-5918.2021.03.015
[2] 丁陈玲, 陈剑潇, 皋源. 病原微生物分子检测技术在脓毒症诊断与预后评估中的临床价值[J]. 临床急诊杂志, 2022, 23(1): 76-80. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC202201017.htm
[3] 古丽菲热·塔依尔, 杨春波, 李祥, 等. 脓毒症肠道损伤模型中NLRP3炎症小体活化介导炎症反应及细胞凋亡[J]. 中华危重病急救医学, 2021, 33(7): 855-860. doi: 10.3760/cma.j.cn121430-20210323-00725
[4] 李弘毅, 翟瑞卿, 梁火燕, 等. 基于16S rDNA测序分析脓毒症大鼠早期肠道微生态的变化[J]. 中华危重病急救医学, 2022, 34(1): 28-34. https://www.cnki.com.cn/Article/CJFDTOTAL-HJKZ202111040.htm
[5] 王仲, 魏捷, 朱华栋, 等. 中国脓毒症早期预防与阻断急诊专家共识[J]. 临床急诊杂志, 2020, 21(7): 517-529. doi: 10.13201/j.issn.1009-5918.2020.07.001
[6] 杨广, 李健, 常卫东. 活血法治疗脓毒症肠功能障碍的理论探讨[J]. 中国中西医结合消化杂志, 2017, 25(12): 986-989. http://zxpw.cbpt.cnki.net/WKD2/WebPublication/paperDigest.aspx?paperID=079f0bf6-37c9-4390-83ec-4e4b4bdd44b3
[7] 刘晏, 殷于磊, 乐琦琦, 等. 理中复元方结合针刺法治疗脾虚痰瘀型慢性萎缩性胃炎[J]. 中成药, 2017, 39(9): 1799-1807. https://www.cnki.com.cn/Article/CJFDTOTAL-ZCYA201709008.htm
[8] 韦志友. 复元针法治疗脓毒症患者急性胃肠损伤的临床观察[D]. 北京: 北京中医药大学, 2017.
[9] 曹钰, 柴艳芬, 邓颖, 等. 中国脓毒症/脓毒性休克急诊治疗指南(2018)[J]. 临床急诊杂志, 2018, 19(9): 567-588. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZLC201809001.htm
[10] Rembacken B, Hassan C, Riemann JF, et al. Quality in screening colonoscopy: position statement of the European Society of Gastrointestinal Endoscopy(ESGE)[J]. Endoscopy, 2012, 44(10): 957-968.
[11] 中国中西医结合学会急救医学专业委员会, 《中国中西医结合急救杂志》编辑委员会. 脓毒症中西医结合诊治专家共识[J]. 中华危重病急救医学, 2013, 25(4): 194-197. https://www.cnki.com.cn/Article/CJFDTOTAL-ZGZX202003003.htm
[12] 张淑香, 王淑玲, 曹允芳, 等. 膀胱灌注量对重症患者经膀胱腹内压测量的影响[J]. 中华护理杂志, 2012, 47(9): 806-807. https://www.cnki.com.cn/Article/CJFDTOTAL-ZHHL201209015.htm
[13] 郑志华, 周广军. 化瘀解毒汤对脓毒症患者血清炎症因子水平和APACHE Ⅱ评分的影响[J]. 中国中医急症, 2021, 30(11): 1984-1986. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ202111025.htm
[14] 刘丹蕾, 许卓谦, 瞿长春, 等. 早期胃肠康复治疗机械通气的脓毒症伴急性胃肠损伤患者的有效性和安全性: 34例前瞻性、随机对照、先导试验[J]. 南方医科大学学报, 2019, 39(11): 1298-1304. https://www.cnki.com.cn/Article/CJFDTOTAL-DYJD201911007.htm
[15] Barichello T, Sayana P, Giridharan VV, et al. Long-Term Cognitive Outcomes After Sepsis: a Translational Systematic Review[J]. Mol Neurobiol, 2019, 56(1): 186-251.
[16] 吴建华, 汪晓波, 倪步烤, 等. 早期肠内肠外营养在脓毒症疾病转归中的作用[J]. 浙江临床医学, 2019, 21(9): 1253-1255.
[17] 肖春红, 张再重, 宋京翔, 等. 营养支持治疗在慢性危重症治疗中的作用[J]. 中华胃肠外科杂志, 2019, 22(11): 1016-1020.
[18] 梁群, 薛鸿征, 冯文佳. 不同营养支持途径对脓毒症患者的影响综述[J]. 解放军医学院学报, 2021, 42(10): 1110-1113. https://www.cnki.com.cn/Article/CJFDTOTAL-JYJX202110019.htm
[19] 项丹. 持续异丙肾上腺素输注对脓毒症早期大鼠脑的保护作用[D]. 广州: 南方医科大学, 2015.
[20] 张先进, 刘敏, 林新锋, 等. 调胃承气汤对脓毒症胃肠损伤患者胃肠功能及免疫状态的影响[J]. 中国医药导报, 2020, 17(25): 119-124. https://www.cnki.com.cn/Article/CJFDTOTAL-YYCY202025031.htm
[21] 吴国琳, 余国友. 余国友主任医师论治急危重症并发胃肠功能衰竭经验[J]. 中国中医急症, 2015, 24(1): 85-87. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYJZ201501029.htm
[22] 刘清泉, 李雁, 寇兰俊. 多脏器功能失常综合征中医病因病机及治法探讨[J]. 北京中医药大学学报, 2000, 23(3): 57-58. https://www.cnki.com.cn/Article/CJFDTOTAL-JZYB200003024.htm
[23] 虞意华, 金肖青, 俞迈红, 等. 针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究[J]. 中华中医药学刊, 2015, 33(8): 1953-1956. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYHS201508053.htm
[24] Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM Working Group on Abdominal Problems[J]. Intensive Care Med, 2012, 38(3): 384-394.
[25] 北京中医医院. 金正王乐亭[M]. 北京: 北京出版社, 1984: 32-41.
[26] 司红利, 赵甜, 相花花. 自拟扶阳复元汤联合通督调神针法对缺血性中风恢复期老年患者脑血流动力学指标及神经功能相关因子水平的影响[J]. 辽宁医学杂志, 2022, 36(1): 90-93. https://www.cnki.com.cn/Article/CJFDTOTAL-LNYX202201030.htm
[27] 吴富东, 王世军, 王晓燕, 等. 电针足三里穴对正常大鼠微循环的调节作用及穴位脏腑相关性研究[J]. 中医杂志, 2010, 51(12): 1101-1103. https://www.cnki.com.cn/Article/CJFDTOTAL-ZZYZ201012024.htm
[28] 罗彪. 针刺足三里、中脘穴治疗重症急性胰腺炎伴肠麻痹的临床观察[D]. 成都: 成都中医药大学, 2018.
[29] 沈菁. 从针刺十二经穴对胃、肠、心三脏功能的影响探讨腧穴效应的特异性规律[D]. 长沙: 湖南中医药大学, 2008.
[30] 徐运瑜. 针刺天枢穴配合背部走罐治疗功能性便秘61例[J]. 浙江中医药大学学报, 2014, 38(6): 803-804. https://www.cnki.com.cn/Article/CJFDTOTAL-BHON201406040.htm
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