摘要
目的探讨中医耳穴贴压治疗对脓毒症心肌抑制患者的心肌保护作用及其可能机制。方法选择2017年12月—2018年12月成都市第一人民医院重症医学科收治的脓毒症心肌抑制患者44例,随机分为观察组(21例)及对照组(23例),对照组严格按照“2014中国严重脓毒症/脓毒性休克治疗指南”中推荐的方法进行治疗,观察组在对照组治疗基础上给予耳穴贴压刺激神门、交感、心等穴位,检测2组患者治疗第1天、第5天、第7天血清心肌肌钙蛋白T(cTnT)、肌酸激酶同工酶(CK-MB)、B型尿钠肽(BNP)、白细胞介素-6(IL-6)、降钙素原(PCT)水平及左室射血分数(LVEF),评估并比较2组患者治疗第1天、第5天、第7天脓毒症序贯器官衰竭评分(SOFA评分)、重症监护室疼痛观察工具法(CPOT)评分。结果治疗第7天,2组患者血清cTnT、CK-MB、BNP、IL-6、PCT水平及SOFA评分均较治疗第1天明显降低(P均<0.05),LVEF均较治疗第1天明显升高(P<0.05);2组患者治疗第7天血清cTnT、CK-MB水平比较差异均无统计学意义(P均>0.05);观察组患者治疗第7天血清BNP、IL-6、PCT水平及SOFA评分均明显低于同期对照组(P均<0.05),治疗第5天及第7天的LVEF均明显高于同期对照组(P均<0.05)。治疗第1天及第5天,2组患者CPOT评分治疗前后组内、组间比较差异均无统计学意义(P均>0.05);治疗第7天,观察组耳穴贴压后的CPOT评分明显低于耳穴贴压前及同时间点对照组(P均<0.05),对照组治疗前后CPOT评分比较差异无统计学意义(P>0.05)。结论耳穴贴压刺激相应耳穴有保护脓毒症心肌抑制患者心肌作用,可改善心脏功能,机制可能与激活机体胆碱能抗炎通路,从而降低机体炎症因子水平有关。
Objective It is to investigate the myocardial protective effect and possible mechanism of auricular acupoint pressing in patients with myocardial depression induced by severe sepsis.Methods Forty-four patients with sepsis myocardial depression treated in the department of critical medicine,Chengdu First People’s Hospital from December 2017 to December 2018 were randomly divided into observation group(21 cases)and control group(23 cases).The control group was treated strictly according to the recommended scheme of“Guidelines for Treatment of Severe Sepsis and Septic Shock in China 2014”.On the basis of the treatment of the control group,the observation group was treated with auricular acupoint pressing stimulation at Shenmen,Jiaogan and Xin,etc.The levels of serum troponin T(cTnT),creatine kinase isoenzyme(CK-MB),B-type natriuretic peptide(BNP),and interleukin-6(IL-6),procalcitonin(PCT),and left ventricular ejection fraction(LVEF)were detected on the 1st,5th,and 7th days of treatment in the two groups,and the scores of sequential organ failure assessment(SOFA),Critical Care Pain Observation Tool(CPOT)were evaluated and compared on the 1st,5th,and 7th days of treatment in the two groups.Results There was no significant difference in serum cTnT and CK-MB levels between the 2 groups of patients on the 7th day of treatment(all P>0.05);the levels of serum BNP,IL-6,PCT and SOFA scores on the 7th day of treatment were significantly lower while the LVEF on the 5th and 7th days of treatment was significantly higher in the observation group than those in the control group at the same period(P<0.05).On the first day and the 5th day of treatment,there was no significant difference in CPOT score between the two groups before and after treatment(P>0.05).On the 7th day of treatment,the CPOT score of the observation group after auricular acupressure was significantly lower than that before ear pressure and in the control group at the same time point(P<0.05),there was no significant difference in CPOT score between the contr
作者
杨梁
彭晓峰
曾剑
余萍
YANG liang;PENG Xiaofeng;ZENG jian;YU ping(Chengdu First People’s Hospital, Chengdu 610000,Sichuan,China)
出处
《现代中西医结合杂志》
CAS
2020年第10期1058-1062,共5页
Modern Journal of Integrated Traditional Chinese and Western Medicine
基金
四川省医学科研青年创新课题计划项目(Q17016)。
关键词
脓毒症
心肌抑制
耳穴贴压
胆碱能抗炎通路
sepsis
myocardial depression
auricular acupoint pressing
cholinergic anti-inflammatory pathway
