CAJ | 학술논문

目的观察电针对神经外科危重昏迷患者盲法留置鼻空肠营养管及肠内营养(EN)实施的影响.方法采用随机数字表法将79例神经外科危重昏迷患者分为电针组及常规组.2组患者均采用盲法插入鼻空肠管,电针组患者同时辅以电针刺激足三里、合谷等穴位.观察并记录2组患者鼻空肠管推进距离、插管24 h和72 h时置管成功率、EN热量达标率及并发症发生情况.结果电针组患者鼻空肠管在插管第24、48及72小时时的推进距离分别为(28.4±13.8)cm、(34.0±13.4)cm和(39.6±14.4)cm,较常规组的(18.1±15.5)cm、(23.0±16.1)cm和(29.6±17.0)cm均有明显增大(P＜0.05).电针组患者插管第24,72小时时的置管成功率分别为76.9％和92.3％,均较常规组(分别为52.5％和75.0％)明显提高(P＜0.05).电针组患者插管在72 h内EN热量达标率为82.1％,较常规组(60.0％)明显提高(P＜0.05).电针组需辅以肠外营养(PN)的患者比例为17.9％,较常规组(40.0％)明显下降(P＜0.05).治疗期间电针组患者消化道出血、呕吐、腹胀等并发症发生率分别为15.4％,5.1％和7.7％,较常规组并发症发生率(分别为35.0％,20.0％和25.0％)均明显降低(P＜0.05).结论电针穴位刺激能促进神经外科危重昏迷患者胃肠蠕动,提高盲法留置鼻空肠营养管的成功率,有利于早期肠内营养尽快实施,具有较好的临床应用价值.
목적 관찰전침대신경외과위중혼미환자맹법류치비공장영양관급장내영양(EN)실시적영향.방법 채용수궤수자표법장79례신경외과위중혼미환자분위전침조급상규조.2조환자균채용맹법삽입비공장관,전침조환자동시보이전침자격족삼리、합곡등혈위.관찰병기록2조환자비공장관추진거리、삽관24 h화72 h시치관성공솔、EN열량체표솔급병발증발생정황.결과 전침조환자비공장관재삽관제24、48급72소시시적추진거리분별위(28.4±13.8)cm、(34.0±13.4)cm화(39.6±14.4)cm,교상규조적(18.1±15.5)cm、(23.0±16.1)cm화(29.6±17.0)cm균유명현증대(P＜0.05).전침조환자삽관제24,72소시시적치관성공솔분별위76.9％화92.3％,균교상규조(분별위52.5％화75.0％)명현제고(P＜0.05).전침조환자삽관재72 h내EN열량체표솔위82.1％,교상규조(60.0％)명현제고(P＜0.05).전침조수보이장외영양(PN)적환자비례위17.9％,교상규조(40.0％)명현하강(P＜0.05).치료기간전침조환자소화도출혈、구토、복창등병발증발생솔분별위15.4％,5.1％화7.7％,교상규조병발증발생솔(분별위35.0％,20.0％화25.0％)균명현강저(P＜0.05).결론 전침혈위자격능촉진신경외과위중혼미환자위장연동,제고맹법류치비공장영양관적성공솔,유리우조기장내영양진쾌실시,구유교호적림상응용개치.
Objective To investigate the effects of electroacupuncture (EA) on the implementation of blind nasojejunal (NJ) tube placement and enteral nutrition (EN) in neurosurgical severe coma patients in intensive care unit (ICU).Methods Seventy-nine neurosurgical severe coma patients admitted to ICU were randomly divided into conventional group (blind NJ tube placement,n =40) and EA group (NJ placement and EA,n =39).EA was performed after NJ tube placement at bilateral acupoints Zusanli (ST36) and Hegu (L14) points using EA treatment instrument.The impelling distance of NJ tube were measured and the success rate of NJ tube placement were calculated.The postoperative complications were observed.Results The difference of NJ tube impelling distances at the 24th,48th,and 72th hours after surgery in EA group were significant longer than that in conventional group (P ＜ 0.05).The success rates of NJ tube placement at the 24th and 72nd hours after surgery in EA group were significantly better than that in conventional group (P ＜ 0.05).Their EN calories qualifiedness rate in 72 hours also increased significantly compared with conventional group and the proportion of patients assisted with parenteral nutrition decreased (P ＜0.05).The postoperative complications including alimentary tract hemorrhage,vomiting,and abdominal distension decreased remarkably in EA group compared with conventional group (P ＜ 0.05).Conclusions EA stimulation at acupoints could promote the gastrointestinal peristalsis of neurosurgical severe coma patients and elevate the success rate of blind NJ tube placement,so it is beneficial for the implementation of early enteral nutrition (EEN).