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[早期穴位电刺激对感染性休克患者下肢肌力的影响]

[Effect of early acupoint electrical stimulation on lower limb muscle strength in patients with septic shock].

作者信息

Wang Shuang-le, Zhu Jin, Zhao Zhi-Gang, Liu Huan, Ni Hai-Bin, Hu Xing-Xing

机构信息

Third Clinical Medical College of Nanjing University of Chinese Medicine, Nanjing 210023, Jiangsu Province, China.

Department of Emergency and Critical Medicine, Affiliated Hospital of Integrated Traditional Chinese and Western Medicine, Nanjing University of Chinese Medicine.

出版信息

Zhongguo Zhen Jiu. 2020 Nov 12;40(11):1173-7. doi: 10.13703/j.0255-2930.20191022-0005.

Abstract

OBJECTIVE

To observe the effect of early acupoint electrical stimulation on the decline of lower limbs muscle strength in patients with intensive care unit-acquired weakness (ICU-AW) caused by septic shock.

METHODS

A total of 58 patients with ICU-AW caused by septic shock were randomly divided into an observation group (28 cases, 1 case dropped off ) and a control group (30 cases, 2 cases dropped off ). Patients in both groups received routine basic treatment. In the observation group, acupoint electric stimulation therapy was added at Huantiao (GB 30), Futu (ST 32), Zusanli (ST 36), Xuanzhong (GB 39) and Taichong (LR 3). Unilateral point with electrodes were applied, the SDZ-Ⅱ electronic instrument (discontinuous wave, frequency in 2 Hz, strength in 5 mA) was connected and changed to the other side after 30 min of unilateral treatment.The treatment was given 2 times daily, continued for 7 d or until the medical research council (MRC) score being 54 points or more. The changes of lower limb muscle strength MRC score, modified Rankin scale (MRS) score, bilateral quadriceps thickness and gastrocnemius pinnate angle of both groups were observed before treatment and on discharge. The time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge were compared between the two groups. The MRS scores of the two groups were followed up 28 d after discharge.

RESULTS

The MRC scores of lower limb muscle strength in the two groups on discharge were higher than those before treatment (<0.05), and the MRS scores on discharge and 28 d after discharge in the two groups were lower than those before treatment (<0.05). The MRC scores of lower limb muscle strength on discharge in the observation group were higher than thoes in the control group (<0.05), and the MRS scores on discharge and 28 d after discharge in the observation group were lower than those in the control group (<0.05). On discharge, bilateral quadriceps thickness and gastrocnemius pinnate angle in the two groups were increased compared with those before treatment (<0.05), and thoese in the observation group was higher than the control group (<0.05). There was no significant difference between the two groups in the time of admission to ICU, time of hospitalization, mortality during hospitalization, and mortality 28 d after discharge (>0.05).

CONCLUSION

Early acupoint electrical stimulation can improve the lower extremity muscle decline in patients with ICU-AW caused by septic shock.

摘要

目的

观察早期穴位电刺激对脓毒性休克所致重症监护病房获得性肌无力(ICU-AW)患者下肢肌肉力量下降的影响。

方法

将58例脓毒性休克所致ICU-AW患者随机分为观察组(28例,脱落1例)和对照组(30例,脱落2例)。两组患者均接受常规基础治疗。观察组在环跳(GB 30)、伏兔(ST 32)、足三里(ST 36)、悬钟(GB 39)和太冲(LR 3)穴位加用电刺激疗法。采用单侧电极穴位,连接SDZ-Ⅱ型电子仪器(间断波,频率2 Hz,强度5 mA),单侧治疗30 min后换至另一侧。每日治疗2次,持续7 d或直至医学研究委员会(MRC)评分达到54分及以上。观察两组患者治疗前及出院时下肢肌肉力量MRC评分、改良Rankin量表(MRS)评分、双侧股四头肌厚度和腓肠肌羽状角的变化。比较两组患者入住ICU时间、住院时间、住院期间死亡率及出院后28 d死亡率。对两组患者出院后28 d进行MRS评分随访。

结果

两组患者出院时下肢肌肉力量MRC评分均高于治疗前(P<0.05),两组患者出院时及出院后28 d的MRS评分均低于治疗前(P<0.05)。观察组患者出院时下肢肌肉力量MRC评分高于对照组(P<0.05),观察组患者出院时及出院后28 d的MRS评分低于对照组(P<0.05)。出院时,两组患者双侧股四头肌厚度和腓肠肌羽状角均较治疗前增加(P<0.05),且观察组高于对照组(P<0.05)。两组患者入住ICU时间、住院时间、住院期间死亡率及出院后28 d死亡率比较,差异无统计学意义(P>0.05)。

结论

早期穴位电刺激可改善脓毒性休克所致ICU-AW患者的下肢肌肉衰退。

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