Objective To evaluate the therapeutic effect of acupoint catgut embedding on gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury.Methods Sixty-eight consecutively hospitalized patients with gastrointestinal dysfunction after surgery in patients with severe traumatic brain injury admitted to the Department of Intensive Care Unit (ICU) in the First Affiliated Hospital of Zhejiang University of Chinese Medicine from January 2015 to December 2015 were enrolled.Six of those patients were withdrawn from the course of observation,and actually only 62 patients entered the study.They were divided into an observation group (32 cases) and a control group (30 cases) by random number table.All the patients of two groups were given conventional treatment of western medicine for consecutive 7 days.The observation group was additionally treated with acupoint catgut embedding.The control group took mosapride tablets via a nasogastric tube 5 mg,3 times a day.Intra-abdominal pressure (IAP),gastric residual volume (GRV),time for reaching standard enteral nutrition,serum diamine oxidase(DAO),D-Lactate activity,incidence of hospital-acquired pneumonia (HAP),hospitalization days in ICU,28-day mortality and adverse reactions of acupoint catgut embedding were observed in the two groups.Results After treatment,the levels of IAP,DAO,D-lactic acid were lower than those before treatment,GRV was less than that before treatment in the two groups,and after treatment for 7 days the changes were more significant in the observation group [IAP (cmH2O,1 cmH2O =0.098 kPa):12.42±3.11 vs.17.70 ± 2.98,GRV (mL):129.54 ± 57.54 vs.242.91 ± 99.29,DAO (U/L):9.06± 2.84 vs.13.60 ± 7.16,D-Lactate (mg/L):16.47 ± 5.39 vs.26.29 ± 9.62,all P ＜ 0.01].Days of mechanical ventilation (days:6.97 ± 4.13 vs.9.23 ± 4.61),time for reaching standard enteral nutrition (days:4.25 ± 3.15 vs.5.50 ± 3.12) and hospitalization days in ICU (days:9.50± 4.03 vs.12.20 ± 6.38) in observation group were significantly shorter than those in control group (all P ＜ 0.05).The incidence of HAP [15.6％ (5/32) vs.40.0％ (12/30)] and 28-day mortality [3.1％ (1/32) vs.6.7％ (2/30)] in observation group were obviously lower than those in control group.The patients in observation group had no significant adverse reactions of acupoint catgut embedding.Conclusions Acupoint catgut embedding therapy is not only easy to operate,but also can effectively improve gastrointestinal motility and intestinal barrier function in patients with gastrointestinal dysfunction after surgery of severe head injury,thus it is beneficial to reaching the enteral nutritional goal in less time,reducing the incidence of HAP,shortening the hospitalization time in ICU and promoting the recovery of the patients.%目的 评价穴位埋线治疗方法对重型颅脑损伤术后患者胃肠功能障碍的疗效.方法 选择2015年1月至12月浙江中医药大学附属第一医院重症加强治疗病房(ICU)连续收治的重型颅脑损伤术后合并胃肠功能障碍患者68例,观察过程中有6例退出研究,实际入组病例62例,将患者按随机数字表法分为观察组(32例)和对照组(30例).两给均给予西医常规治疗,连续治疗7d;观察组在西医常规治疗基础上给予穴位埋线治疗,对照组鼻饲莫沙必利5 mg,每日3次.观察两组患者腹内压(IAP)、胃残留量(GRV)、肠内营养达标时间、血清二胺氧化酶(DAO)、D-乳酸活性、院内获得性肺炎(HAP)发生率、住ICU时间、28 d病死率、穴位埋线不良反应.结果 两组治疗后IAP、DAO、D-乳酸均较治疗前降低,GRV较治疗前减少,且以观察组治疗后7d的变化更显著[IAP (cmH20,1 cmH2O=0.098 kPa):12.42±3.11比17.70±2.98,GRV (mL):129.54±57.54比242.91±99.29,DAO (U/L):9.06±2.84比13.60±7.16,D-乳酸(mg/L):16.47±5.39比26.29±9.62,均P＜0.01];观察组治疗后机械通气时问(d:6.97±4.13比9.23±4.61)、肠内营养达标时间(d:4.25±3.15比5.50±3.12)、住ICU时间(d:9.50±4.03比12.20±6.38)均较对照组明显缩短(均P＜0.05),HAP发生率[15.6％ (5/32)比40.0％(12/30)]和28 d病死率[3.1％ (1/32)比6.7％ (2/30)]均较对照组降低.观察组无明显穴位埋线不良反应.结论 穴位埋线治疗不仅操作简便,而且能有效改善重型颅脑损伤术后胃肠功能障碍患者胃肠动力及肠屏障功能,有利于早期肠内营养达标,减少HAP的发生,缩短住ICU时间,促进患者康复.
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