中华麻醉学杂志
中華痳醉學雜誌
중화마취학잡지
CHINESE JOURNAL OF ANESTHESIOLOGY
2013年
5期
626-629
,共4页
电针%穴,足三里%穴,尺泽%内素素血症%呼吸窘迫综合征,成人
電針%穴,足三裏%穴,呎澤%內素素血癥%呼吸窘迫綜閤徵,成人
전침%혈,족삼리%혈,척택%내소소혈증%호흡군박종합정,성인
Electroacupuncture%POINT ST36(ZUSANLI)%POINT LU5 (CHIZE)%Endotoxemia%Respiratory distress syndrome,adult
目的 评价电针足三里穴和尺泽穴对脓毒症患者急性肺损伤的影响.方法 脓毒症并发急性肺损伤/急性呼吸窘迫综合征患者60例,性别不限,年龄43 ～ 78岁,体重49 ～ 89 kg,急性病生理学和慢性健康评价-Ⅱ评分(APACHE-Ⅱ评分)16 ～ 23分,氧合指数125～256 mm Hg.采用随机数字表法,将患者分为3组(n=20):常规治疗组(S组)、常规治疗+电针非穴位组(SNE组)和常规治疗+电针穴位组(SE组).S组给予常规治疗,SE组在常规治疗基础上,电针刺激足三里和尺泽穴,参数:疏密波(2/50 Hz)波宽300 μs,刺激电流由0开始,以0.1 mA的梯度逐渐增大,逐渐达到患者能耐受的最大水平,然后维持刺激强度在此水平,持续刺激30 min,1次/d,连续5d.SNE组常规治疗基础上,电针刺激非穴位,电针刺激参数同SE组.于电针刺激前(T1)、电针刺激结束后3 d(T2)及5 d(T3)时取动脉血样,行血气分析,计算氧合指数,行APACHE-Ⅱ评分.T1、T3时取静脉血样和行肺泡灌洗,取支气管肺泡灌洗液(BALF),采用ELISA法测定血清及BALF中TNF-α和IL-10的浓度.记录电针刺激结束后5d内器官功能障碍综合征的发生情况和生死情况.结果 与T1时比较,T2、T3时3组氧合指数均升高,APACHE-Ⅱ评分降低,L时3组血清和BALF TNF-α浓度降低,IL-10浓度升高(P＜0.05或0.01)；与T2时比较,T3时3组氧合指数均升高,APACHE-Ⅱ评分降低(P＜0.05)；与S组比较,SE组T2、T3时氧合指数升高,T3时APACHE-Ⅱ评分降低,血清和BALF中TNF-α浓度降低,IL-10浓度升高(P ＜0.05或0.01),SNE组上述指标差异无统计学意义(P＞0.05).3组器官功能障碍综合征发生率和生存率差异无统计学意义(P＞0.05).结论 电针刺足三里和尺泽穴有助于减轻脓毒症患者急性肺损伤,其机制可能与调节促炎因子/抗炎因子平衡,抑制炎症反应有关.
目的 評價電針足三裏穴和呎澤穴對膿毒癥患者急性肺損傷的影響.方法 膿毒癥併髮急性肺損傷/急性呼吸窘迫綜閤徵患者60例,性彆不限,年齡43 ～ 78歲,體重49 ～ 89 kg,急性病生理學和慢性健康評價-Ⅱ評分(APACHE-Ⅱ評分)16 ～ 23分,氧閤指數125～256 mm Hg.採用隨機數字錶法,將患者分為3組(n=20):常規治療組(S組)、常規治療+電針非穴位組(SNE組)和常規治療+電針穴位組(SE組).S組給予常規治療,SE組在常規治療基礎上,電針刺激足三裏和呎澤穴,參數:疏密波(2/50 Hz)波寬300 μs,刺激電流由0開始,以0.1 mA的梯度逐漸增大,逐漸達到患者能耐受的最大水平,然後維持刺激彊度在此水平,持續刺激30 min,1次/d,連續5d.SNE組常規治療基礎上,電針刺激非穴位,電針刺激參數同SE組.于電針刺激前(T1)、電針刺激結束後3 d(T2)及5 d(T3)時取動脈血樣,行血氣分析,計算氧閤指數,行APACHE-Ⅱ評分.T1、T3時取靜脈血樣和行肺泡灌洗,取支氣管肺泡灌洗液(BALF),採用ELISA法測定血清及BALF中TNF-α和IL-10的濃度.記錄電針刺激結束後5d內器官功能障礙綜閤徵的髮生情況和生死情況.結果 與T1時比較,T2、T3時3組氧閤指數均升高,APACHE-Ⅱ評分降低,L時3組血清和BALF TNF-α濃度降低,IL-10濃度升高(P＜0.05或0.01)；與T2時比較,T3時3組氧閤指數均升高,APACHE-Ⅱ評分降低(P＜0.05)；與S組比較,SE組T2、T3時氧閤指數升高,T3時APACHE-Ⅱ評分降低,血清和BALF中TNF-α濃度降低,IL-10濃度升高(P ＜0.05或0.01),SNE組上述指標差異無統計學意義(P＞0.05).3組器官功能障礙綜閤徵髮生率和生存率差異無統計學意義(P＞0.05).結論 電針刺足三裏和呎澤穴有助于減輕膿毒癥患者急性肺損傷,其機製可能與調節促炎因子/抗炎因子平衡,抑製炎癥反應有關.
목적 평개전침족삼리혈화척택혈대농독증환자급성폐손상적영향.방법 농독증병발급성폐손상/급성호흡군박종합정환자60례,성별불한,년령43 ～ 78세,체중49 ～ 89 kg,급성병생이학화만성건강평개-Ⅱ평분(APACHE-Ⅱ평분)16 ～ 23분,양합지수125～256 mm Hg.채용수궤수자표법,장환자분위3조(n=20):상규치료조(S조)、상규치료+전침비혈위조(SNE조)화상규치료+전침혈위조(SE조).S조급여상규치료,SE조재상규치료기출상,전침자격족삼리화척택혈,삼수:소밀파(2/50 Hz)파관300 μs,자격전류유0개시,이0.1 mA적제도축점증대,축점체도환자능내수적최대수평,연후유지자격강도재차수평,지속자격30 min,1차/d,련속5d.SNE조상규치료기출상,전침자격비혈위,전침자격삼수동SE조.우전침자격전(T1)、전침자격결속후3 d(T2)급5 d(T3)시취동맥혈양,행혈기분석,계산양합지수,행APACHE-Ⅱ평분.T1、T3시취정맥혈양화행폐포관세,취지기관폐포관세액(BALF),채용ELISA법측정혈청급BALF중TNF-α화IL-10적농도.기록전침자격결속후5d내기관공능장애종합정적발생정황화생사정황.결과 여T1시비교,T2、T3시3조양합지수균승고,APACHE-Ⅱ평분강저,L시3조혈청화BALF TNF-α농도강저,IL-10농도승고(P＜0.05혹0.01)；여T2시비교,T3시3조양합지수균승고,APACHE-Ⅱ평분강저(P＜0.05)；여S조비교,SE조T2、T3시양합지수승고,T3시APACHE-Ⅱ평분강저,혈청화BALF중TNF-α농도강저,IL-10농도승고(P ＜0.05혹0.01),SNE조상술지표차이무통계학의의(P＞0.05).3조기관공능장애종합정발생솔화생존솔차이무통계학의의(P＞0.05).결론 전침자족삼리화척택혈유조우감경농독증환자급성폐손상,기궤제가능여조절촉염인자/항염인자평형,억제염증반응유관.
Objective To evaluate the effects of electroacupuncture (EA) at Zusanli and Chize on sepsisinduced acute lung injury (ALI) in patients.Methods Sixty patients with sepsis-induced ALI/respiratory distress syndrome,aged 43-78 yr,weighing 49-89 kg,with their APACHE-Ⅱ scores of 16-23 and oxygenation index of 125-256 mm Hg,were randomly divided into 3 groups (n =20 each):conventional therapy group (group S),conventional therapy + acupuncture at non-acupoint group (group SNE) and conventional therapy + acupuncture at acupoint group (group SE).Bilateral Huantiao and Chize points were stimulated with electric stimulator (frequency 2/50 Hz,wave length 300μs,starting at a voltage of 0 and increasing by 0.1 mA every time until the maximal tolerance level was reached) for 30 min once a day for 5 days based on the conventional therapy in group SE.In group SNE,EA was performed at the non-acupoint based on the conventional therapy and the parameters of EA were same as those previously mentioned in group SE.Before EA stimulation (T1) and at 3 and 5 days after the end of EA stimulation (T2-3),arterial blood samples were taken for blood gas analysis,oxygenation index (OI) was calculated,and APACHE-Ⅱ] scores were assessed.Venous blood samples were collected at T1 and T3 for detection of TNF-α and IL-10 concentrations in the broncho-alveolar lavage fluid (BALF) and serum (by ELISA).Results Compared with the baseline value at T1,OI was significantly increased and APACHE-Ⅱ scores were decreased at T2 and T3,and TNF-α concentrations in the BALF and serum were decreased and IL-10 concentrations in the BALF and serum were increased at T3 in the three groups (P ＜ 0.05 or 0.01).The OI was significantly higher and APACHE-Ⅱ scores were lower at T3 than at T2 in the three groups (P ＜ 0.05).Compared with group S,the OI was significantly increased at T2 and T3,APACHE-Ⅱ scores and TNF-α concentrations in the BALF and serum were decreased at T3,and IL-10 concentrations in the BALF and serum were increased at T3 in group SE (P ＜0.05 or 0.01),and no significant changes were found in the parameters mentioned above in group SNE (P ＞0.05).There were no significant differences in the incidence and survival rate of multiple organ dysfunction syndrome among the three groups (P ＞ 0.05).Conclusion EA at Zusanli and Chize is helpful in mitigating sepsisinduced ALI in patients,and regulation of the balance between proinflammatory factors and anti-inflammatory factors and inhibition of inflammatory responses may be involved in the mechanism.
