【摘要】 目的 比较电针穴位联合整肠生胶囊与单纯西医治疗对胃肠功能障碍的脓毒症患者早期肠内营养耐受性作用。方法 将63例脓毒症胃肠功能障碍患者随机分为对照组（21例）、整肠生组（20例）、观察组（22例）。对照组采用限制性液体复苏、抗感染、维持血流动力学等常规西医治疗，于血流动力学趋于稳定、血管活性药物减量时即可开通肠内营养。整肠生组在对照组治疗基础上予以整肠生胶囊口服，2颗/次，3次/d。观察组在整肠生组治疗基础上，自肠内营养开通时于曲池、天枢、中脘、足三里、下脘、上巨虚、水分、气海穴位电针治疗，将治疗仪每一个电极分别连接穴位上的银针，采用疏密波、频率为20 Hz，电流强度为0.1～1 mA,2次/d,30 min/次，治疗至肠内营养达标后3 d。记录患者自开通肠内营养至肠内营养达标的总时间，并比较三组患者治疗前后急性胃肠损伤（AGI）分级、入住重症加强护理病房（ICU）时间、腹内压（IAP）、肠鸣音恢复、机械通气（MV）时间、院内获得性肺炎（HAP）感染率及住院时间。结果 观察组肠内营养达标时间（4.3±0.9）d，短于对照组（5.3±1.1）d及整肠生组（5.1±1.0）d(P<0.05)，观察组入住ICU时间（13.7±1.3）d、MV时间（6.2±3.9）d、住院时间（19.6±1.2）d，短于对照组入住ICU时间（15.1±2.4）d、MV时间（9.8±4.3）d、住院时间（21.2±1.8）d及整肠生ICU入住时间（15.0±1.7）d、MV时间（9.7±4.5）d(P<0.05)。观察组发生HAP感染率低于对照组和整肠生组（P<0.05）。观察组治疗后肠鸣音恢复时间、IAP降低和AGI分级改善情况明显优于对照组（P<0.05）。结论 电针联合整肠生治疗能降低腹内压，促进胃肠功能恢复，改善脓毒症患者早期肠内营养耐受性，从而缩短肠内营养达标时间及住院时间，疗效优于单纯西医治疗。更多还原

【Abstract】 Objective To compare the therapeutic effect of electroacupuncture points combined with Bacillus Licheniformis capsules with conventional western medicine alone on early enteral nutrition tolerance in patients with sepsis. Method Sixty-three patients with sepsis were randomly divide into the control group(21 cases), the Bacillus Licheniformis group(20 cases) and the observation group(22 cases). The control group was treated with conventional western medicine, including limited fluid resuscitation, anti-infection and maintenance of hemodynamics, and the enteral nutrition was provided when the hemodynamics became stable and the dosage of vasoactive drugs was reduced. The Bacillus Licheniformis group on the basis of the treatment of the control group, was treated with oral administration Bacillus Licheniformis, three times a day, two at a time. The observation group on the basis of the treatment of the Bacillus Licheniformis group, was treated with electroacupuncture points at Quchi, Tianshu, Zhongwan, Zusanli, Xiawan,Shangjuxu, Shuifen adn Qihai when the enteral nutrition was provided(dilatational wave, 20 Hz, twice a day, 30 min each time), and the electroacupuncture points stopped when enteral nutrition was normal for three days. The duration from providing enteral nutrition to normal enteral nutrition was recorded.The acute gastrointestinal injure(AGI) classification, admission time of intensive care unit(ICU), Intra-abdominal pressure, recovery of bowel sounds,duration of mechanical ventilation(MV), infection rate of hospital acquired pneumonia(HAP) and length of hospital stay were compared. Results The duration from providing enteral nutrition to normal enteral nutrition was(4.3±0.9) days in the observation group, which was shorter than(5.3±1.1) days in the control group and(5.1±1.0) days in the Bacillus Licheniformis group(P<0.05). The ICU time was(13.7±1.3) days, MV time was(6.2±3.9) days,the hospitalization time was(19.6±1.2) days in the observation group, which were shorter than those in the control group and in the Bacillus Licheniformis group(P<0.05). But there was no significant difference in hospitalization time in the Bacillus Licheniformis group. The recovery of bowel sounds times,decreed IAP and the improvement of AGI classification after treatment in the observation group was significantly superior to the control group(P<0.05).Conclusion Electroacupuncture points combined with Bacillus Licheniformis can significantly lower IAP, promote the recovery of gastrointestinal function and improve the early intestinal nutrition tolerance in patients with sepsis, so as to shorten the time of reaching the standard of enteral nutrition and hospitalization time. Its curative effect is better than convention western medicine treatment alone.更多还原