"升清降浊"法针刺治疗脓毒症胃肠功能障碍:随机对照试验OA

Objective To observe the efficacy and safety of Shengqing Jiangzhuo(raising the clear and lowering the turbid)acupuncture method for sepsis-associated gastrointestinal dysfunction,and to preliminarily explore its mechanism.Methods Ninety-six patients with sepsis-associated gastrointestinal dysfunction were randomly divided into an observation group(48 cases,1 case dropped out)and a control group(48 cases,5 cases dropped out).The observation group was treated with Shengqing Jiangzhuo acupuncture method on the basis of conventional western medical treatment,with acupoints including bilateral Zusanli(ST36),Neiguan(PC6),and Taichong(LR3),once daily for 7 days.The control group was treated with sham acupuncture on the basis of conventional western medical treatment,with corresponding non-acupoints,once daily for 7 days.Acute gastrointestinal injury ultrasonography score(AGIUS)was assessed before treatment and after 1,3,and 7 days of treatment.Gastric residual volume(GRV)and incidence of feeding intolerance on days 1,3,and 7 after initiation of enteral nutrition,daily caloric intake on days 1 and 3,and time required to reach target caloric intake were recorded.Peripheral blood inflammatory indexes[interleukin(IL)-10,IL-6,tumor necrosis factor-α(TNF-α),IL-17A,systemic immune-inflammation index(SII),white blood cell count(WBC),and procalcitonin(PCT)]and sequential organ failure assessment(SOFA)score were measured before and after treatment.The 28-day mortality and adverse events were recorded.Results After 1 day of treatment,AGIUS in the observation group was lower than that before treatment(P<0.001).After 3 and 7 days of treatment,AGIUS in both groups were lower than those before treatment and after 1 day of treatment(P<0.001).After 7 days of treatment,AGIUS in the observation group was lower than that after 3 days of treatment(P<0.001).After 1,3,and 7 days of treatment,AGIUS in the observation group were lower than those in the control group(P<0.001).On days 3 and 7 after initiation of enteral nutrition,GRV in both groups was lower than that on day 1(P<0.001),and GRV on day 7 was lower than that on day 3(P<0.001);GRV in the observation group at all time points was lower than that in the control group(P<0.001).On days 1 and 3 after initiation of enteral nutrition,the incidence of feeding intolerance in the observation group was lower than that in the control group(P<0.001,P<0.01),and daily caloric intake was higher than that in the control group(P<0.05,P<0.01).The time required to reach target caloric intake in the observation group was shorter than that in the control group(P<0.05).After treatment,SOFA scores in both groups were lower than those before treatment(P<0.001),and SOFA score in the observation group was lower than that in the control group(P<0.001).There was no statistically significant difference in 28-day mortality between the two groups(P>0.05).After treatment,the levels of IL-6,TNF-α,IL-17A,SII,WBC,and PCT in the observation group were lower than those before treatment(P<0.05),and IL-10 level was higher than that before treatment(P<0.05);in the control group,IL-6 and WBC levels were lower than those before treatment(P<0.05),and IL-10 level was higher than that before treatment(P<0.05).After treatment,except for IL-10,other inflammatory indexes in the observation group were lower than those in the control group(P<0.01,P<0.05).No adverse events related to acupuncture treatment or operation occurred in either group.Conclusion Shengqing Jiangzhuo acupuncture method can improve gastrointestinal function in patients with sepsis-associated gastrointestinal dysfunction,reduce the risk of early feeding intolerance.Its mechanism may be related to alleviating inflammatory response.