中国中西医结合急救杂志
中國中西醫結閤急救雜誌
중국중서의결합급구잡지
Chinese Journal of Integrated Traditional and Western Medicine in Intensive and Critical Care
2015年
6期
622-626
,共5页
高辉%解庆凡%郭文平%周爱民%赵麦良%郭会娥%王玉华%张延威
高輝%解慶凡%郭文平%週愛民%趙麥良%郭會娥%王玉華%張延威
고휘%해경범%곽문평%주애민%조맥량%곽회아%왕옥화%장연위
足三里%穴位%经皮穴位电刺激%有机磷农药中毒%治疗%安全性
足三裏%穴位%經皮穴位電刺激%有機燐農藥中毒%治療%安全性
족삼리%혈위%경피혈위전자격%유궤린농약중독%치료%안전성
Zusanli%Acupoint%Transcutaneous electrical acupoint stimulation%Organophosphorus pesticide poisoning%Treatment%Safety
目的：探讨经皮电刺激足三里穴治疗对有机磷农药中毒患者胃肠道内毒物的清除效果及其安全性。方法采用前瞻性研究方法，选择2013年9月至2015年2月河北省邢台市人民医院急诊科救治的首诊口服有机磷农药中毒患者62例，按照单纯随机抽样分组原则分为观察组和对照组，每组31例。两组患者均按照有机磷农药中毒诊疗规范给予综合治疗，观察组同时配合应用经皮电刺激双侧足三里穴位，每8 h 1次，每次30 min，直到排出黑便后停用。观察两组患者应用导泻剂后呕吐发生率、首次排便时间、排出黑便时间、每日排便次数、达到阿托品化时间、阿托品使用总量，胆碱酯酶（ChE）活性恢复至正常1/2时间、住院时间、治愈率和病死率；观察组行经皮穴位电刺激治疗前后血流动力学、脉搏血氧饱和度（SpO2）变化及治疗过程中有无不良事件发生。结果对照组应用导泻剂后呕吐发生率明显高于观察组〔32.2%（10/31）比9.7%（3/31），P＜0.05〕；观察组首次排便时间（h：9.3±3.6比11.6±5.2）、排出黑便时间（h：11.3±5.3比14.5±6.8）较对照组明显缩短（均P＜0.05）；而导泻期间每日排便次数则多于对照组（次/d：4.3±0.5比3.1±0.4，P＜0.01）；且观察组患者达到阿托品化时间（h：66.3±22.8比84.6±24.2）、阿托品使用总量（mg：66.3±22.8比84.6±24.2）和ChE活性恢复至正常1/2时间（d：6.1±2.4比8.3±3.9）均较对照组明显减少（均P＜0.01）。治疗终点时，观察组患者平均住院时间短于对照组（d：11.3±2.8比13.4±4.2，P＜0.05），治愈率高于对照组〔96.8%（30/31）比83.9%（26/31）， P＜0.05〕。观察组加用穴位电刺激治疗前后的血流动力学及SpO2变化不明显；治疗过程中未见不良反应发生。结论口服有机磷农药中毒的患者配合经皮电刺激足三里穴治疗，可降低导泻剂应用后呕吐发生率，增强导泻效果，促使胃肠道内毒物尽快排出，减少住院期间阿托品使用总量，缩短达到阿托品化时间，缩短患者住院时间，促进ChE活性的恢复，提高临床疗效。
目的：探討經皮電刺激足三裏穴治療對有機燐農藥中毒患者胃腸道內毒物的清除效果及其安全性。方法採用前瞻性研究方法，選擇2013年9月至2015年2月河北省邢檯市人民醫院急診科救治的首診口服有機燐農藥中毒患者62例，按照單純隨機抽樣分組原則分為觀察組和對照組，每組31例。兩組患者均按照有機燐農藥中毒診療規範給予綜閤治療，觀察組同時配閤應用經皮電刺激雙側足三裏穴位，每8 h 1次，每次30 min，直到排齣黑便後停用。觀察兩組患者應用導瀉劑後嘔吐髮生率、首次排便時間、排齣黑便時間、每日排便次數、達到阿託品化時間、阿託品使用總量，膽堿酯酶（ChE）活性恢複至正常1/2時間、住院時間、治愈率和病死率；觀察組行經皮穴位電刺激治療前後血流動力學、脈搏血氧飽和度（SpO2）變化及治療過程中有無不良事件髮生。結果對照組應用導瀉劑後嘔吐髮生率明顯高于觀察組〔32.2%（10/31）比9.7%（3/31），P＜0.05〕；觀察組首次排便時間（h：9.3±3.6比11.6±5.2）、排齣黑便時間（h：11.3±5.3比14.5±6.8）較對照組明顯縮短（均P＜0.05）；而導瀉期間每日排便次數則多于對照組（次/d：4.3±0.5比3.1±0.4，P＜0.01）；且觀察組患者達到阿託品化時間（h：66.3±22.8比84.6±24.2）、阿託品使用總量（mg：66.3±22.8比84.6±24.2）和ChE活性恢複至正常1/2時間（d：6.1±2.4比8.3±3.9）均較對照組明顯減少（均P＜0.01）。治療終點時，觀察組患者平均住院時間短于對照組（d：11.3±2.8比13.4±4.2，P＜0.05），治愈率高于對照組〔96.8%（30/31）比83.9%（26/31）， P＜0.05〕。觀察組加用穴位電刺激治療前後的血流動力學及SpO2變化不明顯；治療過程中未見不良反應髮生。結論口服有機燐農藥中毒的患者配閤經皮電刺激足三裏穴治療，可降低導瀉劑應用後嘔吐髮生率，增彊導瀉效果，促使胃腸道內毒物儘快排齣，減少住院期間阿託品使用總量，縮短達到阿託品化時間，縮短患者住院時間，促進ChE活性的恢複，提高臨床療效。
목적：탐토경피전자격족삼리혈치료대유궤린농약중독환자위장도내독물적청제효과급기안전성。방법채용전첨성연구방법，선택2013년9월지2015년2월하북성형태시인민의원급진과구치적수진구복유궤린농약중독환자62례，안조단순수궤추양분조원칙분위관찰조화대조조，매조31례。량조환자균안조유궤린농약중독진료규범급여종합치료，관찰조동시배합응용경피전자격쌍측족삼리혈위，매8 h 1차，매차30 min，직도배출흑편후정용。관찰량조환자응용도사제후구토발생솔、수차배편시간、배출흑편시간、매일배편차수、체도아탁품화시간、아탁품사용총량，담감지매（ChE）활성회복지정상1/2시간、주원시간、치유솔화병사솔；관찰조행경피혈위전자격치료전후혈류동역학、맥박혈양포화도（SpO2）변화급치료과정중유무불량사건발생。결과대조조응용도사제후구토발생솔명현고우관찰조〔32.2%（10/31）비9.7%（3/31），P＜0.05〕；관찰조수차배편시간（h：9.3±3.6비11.6±5.2）、배출흑편시간（h：11.3±5.3비14.5±6.8）교대조조명현축단（균P＜0.05）；이도사기간매일배편차수칙다우대조조（차/d：4.3±0.5비3.1±0.4，P＜0.01）；차관찰조환자체도아탁품화시간（h：66.3±22.8비84.6±24.2）、아탁품사용총량（mg：66.3±22.8비84.6±24.2）화ChE활성회복지정상1/2시간（d：6.1±2.4비8.3±3.9）균교대조조명현감소（균P＜0.01）。치료종점시，관찰조환자평균주원시간단우대조조（d：11.3±2.8비13.4±4.2，P＜0.05），치유솔고우대조조〔96.8%（30/31）비83.9%（26/31）， P＜0.05〕。관찰조가용혈위전자격치료전후적혈류동역학급SpO2변화불명현；치료과정중미견불량반응발생。결론구복유궤린농약중독적환자배합경피전자격족삼리혈치료，가강저도사제응용후구토발생솔，증강도사효과，촉사위장도내독물진쾌배출，감소주원기간아탁품사용총량，축단체도아탁품화시간，축단환자주원시간，촉진ChE활성적회복，제고림상료효。
Objective To investigate the effect and safety of transcutaneous electrical stimulation at Zusanli acupoint for elimination of gastrointestinal poison in patients with oral organophosphorus pesticide poisoning. Methods A prospective study was conducted, including 62 patients with oral organophosphorus pesticide poisoning from September 2013 to February 2015 in the Department of Emergency of Xingtai People's Hospital of Hebei Province. The patients were divided into a observation group and a control group (each, 31 cases) in accord with the principle of simple random sampling. All the patients in two groups were given comprehensive treatment according to the diagnosis and treatment of the guide for organic phosphorus pesticide poisoning. In addition, the transcutaneous electrical stimulation at bilateral Zusanli acupoints was carried out in the observation group, once therapeutic time 30 minutes and every 8 hours once, and stopped until the discharge of melena. The incidence of vomiting after application of cathartics, the first stool time, the time of melena discharge, daily defecation frequency, the time of reaching atropinization, the total amount of atropine used, the time of cholinesterase (ChE) activity returning to its 1/2 normal activity, the length of stay in hospital, cure rate and mortality were observed in both groups. The changes in hemodynamics and pulse blood oxygen saturation (SpO2) were observed before and after transcutaneous electrical acupoint stimulation, and the occurrence of adverse reactions in the therapeutic course were observed in the observation group.Results After application of cathartics, the incidence of vomiting in control group was significantly higher than that in the observation group [32.2% (10/31) vs. 9.7% (3/31),P < 0.05]. In the observation group, the first stool time (hours: 9.3±3.6 vs. 11.6±5.2) and the time of melena discharge (hours: 11.3±5.3 vs. 14.5±6.8) were significantly shorter than those in the control group (both P < 0.05); while the frequency of bowel movements during catharsis was higher than that of the control group (times/d: 4.3±0.5 vs. 3.1±0.4,P < 0.01). In the observation group, the time reaching atropinization (hours: 66.3±22.8 vs. 84.6±24.2), the total amount of atropine used (mg: 66.3±22.8 vs. 84.6±24.2), and the time of ChE activity returning to its 1/2 normal range (days: 6.1±2.4 vs. 8.3±3.9) were significantly shorter than those in the control group (allP < 0.01). At the end of treatment, the average length of stay in hospital was shorter (days: 11.3±2.8 vs. 13.4±4.2,P < 0.05) and the cure rate was higher [96.8% (30/31) vs. 83.9% (26/31),P < 0.05] in the observation group than those in the control group; in observation group, the hemodynamics and SpO2 before and after acupoint electrical stimulation did not change significantly; in the course of treatment, no adverse reactions occurred.Conclusion The addition of transcutaneous electric stimulation at bilateral Zusanli acupoints in patients with oral organophosphorus pesticide poisoning has following advantages: lowering the incidence of vomiting during catharsis, enhancing the cathartic effect, promoting gastrointestinal poisoning discharge as soon as possible, reducing total atropine used during hospitalization, shortening the time reaching atropinization, shortening the duration of hospitalization, promoting the recovery of cholinesterase activity and elevating clinical therapeutic effects.
