Ma Liu-Yi, Liu Qian-Qian, Wu Lei, Gao Min, Yin Ze-Yu
Department of Emergency, Hebei Cangzhou Hospital of Integrated Traditional Chinese and Western Medicine, Cangzhou 061000, Hebei Province, China.
Zhen Ci Yan Jiu. 2021 Apr 25;46(4):312-7. doi: 10.13702/j.1000-0607.200463.
To observe the effect of electroacupuncture (EA) of Zusanli(ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis (SAP).
A total of 68 SAP patients (hospitalized from January of 2018 to December of 2019 in Cangzhou Hospital of Integrated Medicine) were randomly divided into control and EA groups (=34 cases in each group). All patients of the two groups received the same early enteral nutrition treatment through nasojejunal tube. EA (5-15 Hz, 1-5 mA) was applied to bilateral ST36 and CV12 for 20 min, twice a day for 7 days. The incidence of feeding intolerance (abdominal distension, vomiting, diarrhea, constipation, gastrointestinal bleeding), time to reach energy target, intraperitoneal pressure and the number of borborygmus in 1 min were recorded. The contents of plasma high sensitivity -C reactive protein (hs-CRP), IL-6 and endotoxin were measured using Latex immunoturbidimetric method, chemiluminescence and Tachypiens Amebocyte Lysate Azo substrate color development method, respectively, and the contents of urinary lactulose and mannitol detected using high-performance liquid chromatography. The total protein and albumin levels in the blood were measured for assessing the patients' nutrition status, and acute physiology and chronic health evaluation scoring system (APACHE-Ⅱ) score was determined for assessing the severity of disease.
Compared with the control group, the incidence of abdominal distension, vomiting and constipation, intolerance rate to feeding, time to reach the energy target, intraperitoneal pressure on day 7, inflammatory indexes, hs-CRP, IL-6, endotoxin, urine L/M on day 4 and 7, and the APACHE Ⅱ score on day 7 were significantly lower (<0.01), and the number of borborygmus in 1 min on day 4 and 7 after the treatment was significantly higher in the EA group (<0.01). In comparison with pretreatment, the abdominal pressure and plasma endotoxin level on day 4 and 7, hs-CRP, IL-6 and L/M ratio on day 1, 4 and 7, as well as APACHE Ⅱ score on day 7 after the treatment were significantly decreased in the two groups (<0.01), and the number of borborygmus on day 4 and 7, and the total protein and albumin on day 7 significantly increased in both the control and EA groups (<0.01).
EA of ST36 and CV12 can shorten the time to reach the energy target, reduce inflammatory response, improve the intestinal mucosal barrier function, and thus reduce the incidence of feeding intolerance in SAP patients.
观察电针足三里（ST36）和中脘（CV12）对重症急性胰腺炎（SAP）患者肠内营养喂养不耐受的影响。
选取68例SAP患者（2018年1月至2019年12月在沧州市中西医结合医院住院），随机分为对照组和电针组（每组34例）。两组患者均通过鼻空肠管接受相同的早期肠内营养治疗。电针（5 - 15Hz，1 - 5mA）双侧ST36和CV12，每次20分钟，每日2次，共7天。记录喂养不耐受的发生率（腹胀、呕吐、腹泻、便秘、胃肠道出血）、达到能量目标的时间、腹腔内压力及1分钟肠鸣音次数。分别采用乳胶免疫比浊法、化学发光法和鲎试剂偶氮基质显色法测定血浆高敏C反应蛋白（hs-CRP）、IL-6和内毒素含量，采用高效液相色谱法检测尿乳果糖和甘露醇含量。检测血液中总蛋白和白蛋白水平以评估患者营养状况，采用急性生理与慢性健康评价系统（APACHE-Ⅱ）评分评估疾病严重程度。
与对照组相比，电针组腹胀、呕吐及便秘的发生率、喂养不耐受率、达到能量目标的时间、第7天腹腔内压力、炎症指标hs-CRP、IL-6、内毒素、第4天和第7天尿L/M比值以及第7天APACHEⅡ评分均显著降低（<0.01），治疗后第4天和第7天1分钟肠鸣音次数显著增多（<0.01）。与治疗前比较，两组治疗后第4天和第7天腹腔压力和血浆内毒素水平、第1天、第4天和第7天hs-CRP、IL-6及L/M比值以及第7天APACHEⅡ评分均显著降低（<0.01），对照组和电针组治疗后第4天和第7天肠鸣音次数、第7天总蛋白和白蛋白均显著升高（<0.01）。
电针ST36和CV12可缩短达到能量目标的时间，减轻炎症反应，改善肠黏膜屏障功能，从而降低SAP患者喂养不耐受的发生率。
