经皮穴位电刺激在改善重症脑血管病患者营养和胃动力及预后中的应用

卢乐苗; 田昕

doi:10.16766/j.cnki.issn.1674-4152.002426

经皮穴位电刺激在改善重症脑血管病患者营养和胃动力及预后中的应用

doi: 10.16766/j.cnki.issn.1674-4152.002426

卢乐苗¹,
田昕^2, ,

1.
丽水市中心医院针灸科，浙江丽水 323000
2.
丽水市中心医院重症医学科

基金项目:

浙江省中医药科技计划项目 2020ZB299

浙江省丽水市公益性技术应用研究计划项目 2019GYX19

详细信息

通讯作者:
田昕，E-mail：zjlstx@126.com

中图分类号: R743 R245.97
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出版历程
- 收稿日期: 2021-11-10
- 网络出版日期: 2022-08-20

Application of transcutaneous electrical acupoint stimulation in improving nutrition, gastric motility and prognosis of patients with severe cerebrovascular disease

LU Le-miao¹,
TIAN Xin^{2
, ,}

1.
Department of Acupuncture and Moxibustion, Lishui Central Hospital, Lishui, Zhejiang 323000, China

摘要

摘要: 目的探究早期经皮穴位电刺激(TEAS)在改善重症脑血管病(SCVD)患者营养状态、胃动力及预后情况的作用，为临床推广应用提供参考。方法采取完全随机双盲对照的临床实验方法，选取2018年1月1日—2020年12月31日丽水市中心医院收治的重症脑血管病患者80例为研究对象，采用随机数字表法分为常规治疗组(40例)和早期TEAS组(40例)，对比2组患者的营养指标[血红蛋白(HGB)、白蛋白(ALB)、总蛋白(TP)及血糖(GLU)]、胃内日残留总量、ICU入住时间、日常生活能力(ADL)及美国国立卫生研究院卒中量表(NIHSS)评分。结果 2组患者HGB、GLU比较，不存在组间、时间及交互效应(均P>0.05)，各时间点2组差异无统计学意义(均P>0.05)；2组患者TP、ALB及胃内日残留总量存在组间效应(均P < 0.05)，早期TEAS组营养及胃动力改善更显著(均P < 0.05)，存在时间效应(均P < 0.05)，分组与时间存在交互效应(均P < 0.05)；早期TEAS组ICU入住时间为(16.80±6.69)d，显著短于常规治疗组的(13.05±6.06)d；治疗14 d后早期TEAS组患者的ADL评分和NIHSS评分均显著改善(均P < 0.05)。结论早期TEAS治疗可有效改善SCVD患者营养状态、胃动力及预后，可在患者发病早期介入治疗，具有安全有效且经济易行的特点，有较大的临床推广应用价值。
- 重症脑血管病 /
- 经皮穴位电刺激 /
- 胃动力 /
- 营养状态 /
- 预后
Abstract: Objective To explore the role of early transcutaneous electrical acupoint stimulation (TEAS) in improving the nutritional status, gastric motility and prognosis of patients with severe cerebrovascular disease (SCVD), so as to provide references for clinical application. Methods A completely randomized double-blind controlled clinical trial method was adopted, and 80 patients with SCVD admitted to Lishui Central Hospital from January 1, 2018 to December 31, 2020 were selected as the research objects, and they were randomly divided into the conventional treatment group (40 cases) and the early TEAS group (40 cases). The nutritional indexes [hemoglobin (HGB), albumin (ALB), total protein (TP) and blood glucose(GLU)], total intragastric residues, ICU stay time, activity of daily living (ADL) and NIHSS scores were compared between the two groups were compared. Results There were no intergroup, time and interaction effects between the two groups of patients with HGB and GLU indicators (all P>0.05), there was no significant difference between the two groups at each time point (all P>0.05). There were inter group effects on TP, ALB and total daily residues in the stomach(all P < 0.05). In the early TEAS group, the improvement of nutrition and gastric motility was more significant (all P < 0.05), there was time effect (all P < 0.05), and there was interaction effect between grouping and time (all P < 0.05). The ICU stay time in the early TEAS group was (16.80±6.69) d, which was significantly shorter than that in the routine treatment group [(13.05±6.06) d]. After 14 days of treatment, the ADL score and NIHSS score of patients in the early TEAS group were significantly improved (all P < 0.05). Conclusion Early TEAS treatment can effectively improve the nutritional status, gastric motility and prognosis of SCVD patients, and can be used for interventional therapy at the early stage of the disease. It is safe, effective, economical and easy to implement, and has great clinical application value.
- Severe cerebrovascular disease /
- Transcutaneous electrical acupoint stimulation /
- Gastric motility /
- Nutritional status /
- Prognosis

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表 1 2组重症脑血管病患者一般资料比较

Table 1. Comparison of general data of patients with severe cerebrovascular disease in two groups

组别	例数	性别[例(%)]		年龄(x±s, 岁)	疾病类型[例(%)]		GCS评分(x±s, 分)	APACHE-Ⅱ评分(x±s, 分)
组别	例数	男性	女性	年龄(x±s, 岁)	脑出血	脑梗死	GCS评分(x±s, 分)	APACHE-Ⅱ评分(x±s, 分)
常规治疗组	40	25(62.5)	15(37.5)	56.55±9.74	27(67.5)	13(32.5)	5.90±1.26	19.13±3.78
早期TEAS组	40	27(67.5)	13(32.5)	57.15±8.97	30(75.0)	10(25.0)	5.43±1.48	18.75±3.84
统计量		0.220^a		0.287^b	0.549^a		1.545^b	0.440^b
P值		0.639		0.775	0.459		0.126	0.661
注：^a为χ²值，^b为t值。APACHE-Ⅱ评分为急性生理与慢性健康评分(acute physiology and chronic health evaluation)。

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表 2 2组重症脑血管病患者营养状况指标比较(x±s)

Table 2. Comparison of nutritional status indicators in patients with severe cerebrovascular disease in two groups (x±s)

组别	例数	HGB(g/L)			TP(%)
组别	例数	第1天	第7天	第14天	第1天	第7天	第14天
常规治疗组	40	106.13±19.15	107.25±16.29	109.40±14.99	56.57±7.90	59.41±7.79	65.10±7.44^ab
早期TEAS组	40	105.43±16.03	108.03±20.32	110.58±12.53	55.36±8.42	62.77±6.93^a	70.70±7.21^ab
t值		0.177	0.188	0.380	0.661	2.036	3.417
P值		0.860	0.851	0.705	0.510	0.045	0.001

组别	例数	ALB(mg/L)			GLU(mg/L)
组别	例数	第1天	第7天	第14天	第1天	第7天	第14天
常规治疗组	40	31.74±4.65	33.07±4.56	34.66±4.08^a	7.69±1.51	7.74±1.60	7.78±1.37
早期TEAS组	40	32.06±4.42	34.66±4.11^a	38.65±4.87^ab	7.60±1.63	7.65±1.46	7.73±1.54
t值		0.313	1.631	3.970	0.261	0.239	0.161
P值		0.755	0.107	< 0.001	0.795	0.811	0.872
注：2组间HGB比较，F_组间=0.029，P=0.866，F_时间=1.490，P=0.228，F_交互=0.082，P=0.922；2组间TP比较，F_组间=6.476，P=0.013，F_时间=50.792，P < 0.001，F_交互=4.263，P=0.016；2组间ALB比较，F_组间=13.246，P < 0.001，F_时间=21.679，P < 0.001，F_交互=3.293，P=0.040；2组间GLU比较，F_组间=0.066，P=0.798，F_时间=0.300，P=0.725，F_交互=0.009，P=0.988。同组内同一指标，与第1天比较, ^aP < 0.05;与第7天比较, ^bP < 0.05。

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表 3 2组重症脑血管病患者胃内日残留总量比较(x±s, mL)

Table 3. Comparison of the total daily residual volume in the stomach of patients with severe cerebrovascular disease in the two groups (x±s, mL)

组别	例数	治疗前	治疗后1 d	治疗后2 d	治疗后3 d	治疗后4 d	治疗后5 d	治疗后6 d	治疗后7 d
常规治疗组	40	709.20±50.98	651.63±87.90	582.45±95.08	520.53±84.58	489.65±75.04	430.98±64.28	302.80±42.84	211.23±40.31
早期TEAS组	40	686.55±64.44	419.28±92.93	309.25±96.52	226.10±63.81	199.93±42.41	165.25±51.84	110.48±42.03	68.18±17.62
t值		1.743	11.488	12.753	17.576	21.258	20.352	20.268	20.564
P值		0.085	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001	< 0.001
注：F_组间=9.055，P=0.005，F_时间=34.192，P < 0.001，F_交互=11.115，P < 0.001。早期治疗组组内F=17.823，P < 0.001, 早期TEAS组组内F=11.762，P < 0.001。

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表 4 2组重症脑血管病患者预后功能比较(x±s)

Table 4. Comparison of prognostic function of patients with severe cerebrovascular disease in two groups (x±s)

组别	例数	ICU入住时间(d)	ADL评分(分)		NIHSS评分(分)
组别	例数	ICU入住时间(d)	入院当天	治疗后14 d	入院当天	治疗后14 d
常规治疗组	40	16.80±6.69	2.15±0.58	2.30±0.88	31.73±2.97	30.13±5.97
早期TEAS组	40	13.05±6.06	2.03±0.62	2.93±0.89^a	31.48±3.38	18.03±6.57^a
t值		2.626	0.932	3.156	0.351	8.623
P值		0.010	0.354	0.002	0.726	< 0.001
注：与同组入院当天比较，^aP < 0.05。

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