| 虞意华.针灸对老年重症肺炎患者胃肠功能及胃肠激素的影响[J].浙江中西医结合杂志,2015,25(10): |
| 针灸对老年重症肺炎患者胃肠功能及胃肠激素的影响 |
| Effects of acupuncture on gastrointestinal function and gastrointestinal hormone in elderly patients with severe pneumonia |
| 投稿时间：2015-01-14 修订日期：2015-07-31 |
| DOI： |
| 中文关键词: 重症肺炎 胃肠功能；针灸；胃肠激素；胃动素；胃泌素；老年 |
| 英文关键词:Severe pneumonia gastrointestinal function Acupuncture Gastrointestinal hormone Motilin Gastrin elderly |
| 基金项目:浙江省中医药管理局项目(2010ZA002)； |
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| 中文摘要: |
| 【】 目的 评价针灸对老年重症肺炎患者胃肠功能恢复及胃肠激素的调节作用及其可能机制。方法 选择本院重症医学科(ICU)收治的重症肺炎患者64例,按随机数字表法分为对照组(31 例)和针灸组(33 例),两组均给予抗感染常规治疗,针灸组在常规治疗基础上行针灸,每日1 次,疗程5天。于治疗前、治疗3 d、7 d 观察两组患者临床症状、血清胃动素(MOT)、胃泌素(GAS)水平、胃残留量(GRV)、腹腔内压力(IAP)和急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分,并进行胃肠功能障碍疗效评价。结果 针灸组患者临床胃肠道症状对照组明显改善(P ＜0.05)；两组治疗后MOT增高,GAS降低,治疗7 d GRV 减少、IAP下降与对照组同期比较差异有统计学意义(P ＜0.05)；胃肠功能障碍疗效评分显示显效、有效及总有效率均明显高于对照组(显效率：36.4% 比19.4%,有效率：27.3% 比22.6%,总有效率：63.7% 比42.0%,均P ＜0.05)；两组血清MOT水平(pg/L)增高,GAS 水平(pg/L)下降、胃残余量(ml)明显减少,腹腔内压力(mmhg)、APACHEⅡ评分(分)、均明显降低,而且针灸组在上述指标的改善程度明显优于对照组,以治疗7 d 变化更显著(增加MOT水平378.40±130.55比306.51±121.36,GAS水平下降70.23±33.16比118.06±114.96,胃残留量：79.70±70.02 比118.06±114.96,腹腔内压力：9.36±4.34比12.39±5.77,APACHEⅡ评分：16.88±4.71比19.61±4.53,P ＜0.05或P ＜0.01)。结论 针灸能够有效地改善老年重症肺炎患者的胃肠道临床症状,显著减少胃储留及腹腔内压力水平,增加血清MOT水平,降低GAS水平、降低APACHEⅡ评分,显著提高治疗老年重症肺炎患者胃肠功能障碍治疗的有效性,其改善胃肠功能机制可能与通过调节胃肠激素水平有关。 |
| 英文摘要: |
| Objective To study the regulation of gastrointestinal function and possible mechanism of acupuncture in elderly patients with severe pneumonia. Methods Sixty-four patients with severe pneumonia in our Intensiv Care Unit（ICU）were selected，and they were randomly divided into control group（ group A，31 cases） and group acupuncture（group B，33 cases）. Conventional treatment was given to the two groups，additionally，in group B，Acupuncture was applied once a day for 5 days. Before the treatment and 3 days and 7 days after treatment，the changes of clinical symptoms，Gastrointestinal Hormone level， gastric residual volume (GRV)，intra-abdominal pressure（IAP），acute physiology and chronic health evaluation Ⅱ（APACHE Ⅱ）score，MODS severity score，gastrointestinal symptom scores were observed，and the therapeutic effect of gastrointestinal dysfunction was evaluated in the two groups. Results The improvement of clinical symptoms of group B was significantly better than that of group A，after treatment，the Gastrointestinal symptom scores of the two groups were lower，on the 7th day，the score in group B compared with that of the same time in group A had statistical significant difference（P ＜0.05）；the gastrointestinal dysfunction score showed marked effectiveness，and the total effective rate were obviously higher in group B than those in group A（ marked effectiveness: 36.4% vs.19.4%，effectiveness：27.3% vs.22.6%，the total effective rate : 63.7% vs.42.0%，all P ＜0.05）； the serum levels of MOT increased, GAS was decreased, GRV and IAP were decreased, APACHE Ⅱ score of the two groups were decreased，and the improvement degree of above indexes in group B were better than those in group A, the changes of MOT(pg / L),GAS(pg / L), GRV(ml), IAP（mmhg）, APACHEⅡ score (points) for 7 days in the group B were more significant (level of MOT : 378.40±130.55 vs.306.51±121.36, level of GAS（pg/l） : 70.23±33.16 vs.118.06±114.96, GRV（ml）:, 79.70±70.02 vs.118.06±114.96,IAP: 9.36±4.34 vs.12.39±5.77，APACHEⅡ score: 16.88±4.71 vs.19.61±4.53, P <0.05 or P <0.01). Conclusion Acupuncture can effectively improve gastrointestinal function in elderly patients with severe pneumonia, the mechanism may be through its regulation of gastrointestinal hormone levels. |
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