Xing Xi, Jiang Ronglin, Lei Shu, Xu Qiqi, Zhu Meifei, Zhi Yihui, Xia Guoliann, Huang Liquan, Mao Shihao, Chen Zheqi, Feng Dandan
Department of Intensive Care Unit, the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine, Hangzhou 310006, Zhejiang, China. Corresponding author: Jiang Ronglin, Email:
Zhonghua Wei Zhong Bing Ji Jiu Yi Xue. 2021 Jan;33(1):95-99. doi: 10.3760/cma.j.cn121430-20200804-00562.
To evaluate the therapeutic effect of electroacupuncture on acute gastrointestinal injury (AGI) in patients with severe traumatic brain injury (sTBI).
A prospective randomized controlled trial was conducted. 126 consecutively hospitalized patients with AGI after sTBI admitted to intensive care unit (ICU) of the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine from January 2018 to December 2019 were enrolled. The patients were divided into observation group and control group by random number table. All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days, including the treatments of primary diseases, indwelling nasogastric tube to extract gastric contents every 6 hours to determine gastric residual volume (GRV). When vital signs were basically stable, enteral nutrition (EN) was implemented and EN feeding amount and speed were adjusted according to GRV. On the basis of conventional western medicine treatment, the observation group was treated with electroacupuncture at Zusanli, Tianshu, Shangjuxu, Xiajuxu and Zhongwan, once in the morning and once in the evening, 30 minutes each time. The gastrointestinal function parameters including intra-abdominal pressure (IAP), serum diamine oxidase (DAO) and gastrointestinal failure (GIF) scores were observed before treatment and at day 3 and day 7 of treatment. The incidence of ICU hospital-acquired pneumonia (HAP-ICU), duration of mechanical ventilation (MV), length of ICU stay, 28-day mortality and adverse reactions of electroacupuncture were also observed in the two groups. Kaplan-Meier method was used for 28-day survival analysis.
During the 7-day treatment and observation, 26 cases of 126 patients withdrew from the study, and 100 cases were actually enrolled, 50 cases in the observation group and 50 cases in the control group. IAP and DAO at day 3 of treatment in both groups were significantly lower than those before treatment [control group: IAP (cmHO, 1 cmHO = 0.098 kPa) was 13.75±2.76 vs. 18.11±3.97, DAO (U/L) was 129.88±24.81 vs. 158.01±22.64; observation group: IAP (cmHO) was 13.56±2.19 vs. 18.50±3.54, DAO (U/L) was 129.11±29.32 vs. 159.36±28.65; all P < 0.01]. The gastrointestinal function parameters of the two groups improved gradually with the extension of treatment time, and the IAP, DAO and GIF scores at day 7 of treatment in the observation group were significantly lower than those in the control group [IAP (cmHO): 11.28±3.61 vs. 12.68±3.23, DAO (U/L): 49.69±17.56 vs. 57.27±20.15, GIF score: 2.02±0.74 vs. 2.40±0.70, all P < 0.05). The duration of MV and the length of ICU stay in the observation group were significantly shorter than those in the control group [duration of MV (days): 15.72±4.60 vs. 18.08±4.54, length of ICU stay (days): 16.76±4.68 vs. 19.26±5.42, both P < 0.05], and the incidence of ICU-HAP and 28-day mortality were significantly lowered (12.0% vs. 30.0%, 22.0% vs. 32.0%, both P < 0.05). Survival analysis showed that the 28-day cumulative survival rate in the observation group was significantly higher than that in the control group (86.4% vs. 76.1%; Log-Rank test: χ = 37.954, P < 0.001). The patients in the observation group had no significant adverse reaction of electroacupuncture treatment.
Electroacupuncture at corresponding acupoints can effectively improve gastrointestinal function in patients with AGI after sTBI, which is beneficial to shortening the length of ICU stay, promoting the recovery of the patients, and reducing the 28-day mortality.
评估电针治疗重型颅脑损伤（sTBI）患者急性胃肠损伤（AGI）的疗效。
进行一项前瞻性随机对照试验。选取2018年1月至2019年12月在浙江中医药大学附属第一医院重症监护病房（ICU）连续住院的126例sTBI后发生AGI的患者。通过随机数字表将患者分为观察组和对照组。两组患者均连续7天接受西医常规治疗，包括治疗原发性疾病，每6小时留置鼻胃管抽取胃内容物以测定胃残余量（GRV）。当生命体征基本稳定时，实施肠内营养（EN），并根据GRV调整EN喂养量和速度。在西医常规治疗基础上，观察组采用电针足三里、天枢、上巨虚、下巨虚和中脘穴，每日早晚各1次，每次30分钟。观察治疗前及治疗第3天、第7天的胃肠功能参数，包括腹内压（IAP）、血清二胺氧化酶（DAO）和胃肠功能衰竭（GIF）评分。同时观察两组患者ICU获得性肺炎（HAP-ICU）发生率、机械通气时间（MV）、ICU住院时间、28天死亡率及电针不良反应。采用Kaplan-Meier法进行28天生存分析。
在7天的治疗观察期间，126例患者中有26例退出研究，实际纳入100例，观察组50例，对照组50例。两组治疗第3天时IAP和DAO均显著低于治疗前[对照组：IAP（cmH₂O，1 cmH₂O = 0.098 kPa）为13.75±2.76 vs. 18.11±3.97，DAO（U/L）为129.88±24.81 vs. 158.01±22.64；观察组：IAP（cmH₂O）为13.56±2.19 vs. 18.50±3.54，DAO（U/L）为129.11±29.32 vs. 159.36±28.65；均P < 0.01]。两组胃肠功能参数随治疗时间延长逐渐改善，观察组治疗第7天时IAP、DAO和GIF评分均显著低于对照组[IAP（cmH₂O）：11.28±3.61 vs. 12.68±3.23，DAO（U/L）：49.69±17.56 vs. 57.27±20.15，GIF评分：2.02±0.74 vs. 2.40±0.70，均P < 0.05]。观察组MV时间和ICU住院时间均显著短于对照组[MV时间（天）：15.72±4.60 vs. 18.08±4.54，ICU住院时间（天）：16.76±4.68 vs. 19.26±5.42，均P < 0.05]，且ICU-HAP发生率和28天死亡率均显著降低（12.0% vs. 30.0%，22.0% vs. 32.0%，均P < 0.05）。生存分析显示，观察组28天累积生存率显著高于对照组（86.4% vs. 76.1%；Log-Rank检验：χ² = 37.954，P < 0.001）。观察组患者电针治疗无明显不良反应。
针刺相应穴位可有效改善sTBI后AGI患者的胃肠功能，有利于缩短ICU住院时间，促进患者康复，降低28天死亡率。
