Objective: To observe the effect of electroacupuncture (EA) of Zusanli(ST36) and Zhongwan (CV12) on intestinal nutritional feeding intolerance in patients with severe acute pancreatitis (SAP).
Methods: A total of 68 SAP patients (hospitalized from January of 2018 to December of 2019 in Cangzhou Hospital of Integrated Medicine) were randomly divided into control and EA groups (n=34 cases in each group). All patients of the two groups received the same early enteral nutrition treatment through nasojejunal tube. EA (5-15 Hz, 1-5 mA) was applied to bilateral ST36 and CV12 for 20 min, twice a day for 7 days. The incidence of feeding intolerance (abdominal distension, vomiting, diarrhea, constipation, gastrointestinal bleeding), time to reach energy target, intraperitoneal pressure and the number of borborygmus in 1 min were recorded. The contents of plasma high sensitivity -C reactive protein (hs-CRP), IL-6 and endotoxin were measured using Latex immunoturbidimetric method, chemiluminescence and Tachypiens Amebocyte Lysate Azo substrate color development method, respectively, and the contents of urinary lactulose and mannitol detected using high-performance liquid chromatography. The total protein and albumin levels in the blood were measured for assessing the patients' nutrition status, and acute physiology and chronic health evaluation scoring system (APACHE-Ⅱ) score was determined for assessing the severity of disease.
Results: Compared with the control group, the incidence of abdominal distension, vomiting and constipation, intolerance rate to feeding, time to reach the energy target, intraperitoneal pressure on day 7, inflammatory indexes, hs-CRP, IL-6, endotoxin, urine L/M on day 4 and 7, and the APACHE Ⅱ score on day 7 were significantly lower (P<0.01), and the number of borborygmus in 1 min on day 4 and 7 after the treatment was significantly higher in the EA group (P<0.01). In comparison with pretreatment, the abdominal pressure and plasma endotoxin level on day 4 and 7, hs-CRP, IL-6 and L/M ratio on day 1, 4 and 7, as well as APACHE Ⅱ score on day 7 after the treatment were significantly decreased in the two groups (P<0.01), and the number of borborygmus on day 4 and 7, and the total protein and albumin on day 7 significantly increased in both the control and EA groups (P<0.01).
Conclusion: EA of ST36 and CV12 can shorten the time to reach the energy target, reduce inflammatory response, improve the intestinal mucosal barrier function, and thus reduce the incidence of feeding intolerance in SAP patients.
目的：通过观察针刺足三里、中脘对重症急性胰腺炎(SAP)患者肠内营养(早期肠内营养)喂养不耐受的影响，探讨其改善临床喂养疗效机制。方法：选取符合SAP诊断标准的患者68例作为观察对象，随机分为对照组和电针组，每组34例。两组通过鼻空肠管接受相同肠内营养剂，电针组在对照组基础上电针刺激足三里、中脘，每次20 min，每日2次，治疗7 d。比较两组患者早期喂养不耐受症状(腹胀、呕吐、腹泻、便秘、胃肠道出血)发生率、喂养不耐受发生率、能量达标时间；比较两组患者治疗前及治疗1、4、7 d腹腔内压值及分钟肠鸣音次数；比较两组治疗前及治疗1、4、7 d血浆超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6)、内毒素、尿乳果糖/甘露醇比值(L/M)和7 d总蛋白、白蛋白、急性生理及慢性健康状况评分Ⅱ(APACHEⅡ)。结果：与对照组比较，电针组腹胀、呕吐和便秘的发生率降低(P<0.01)，喂养不耐受率降低(P<0.01)，能量达标时间明显减少(P<0.01)。与本组治疗前比较，两组治疗4、7 d腹腔内压值降低(P<0.01)，分钟肠鸣音次数明显增加(P<0.01)，治疗1、4、7 d血浆hs-CRP、IL-6明显降低（P<0.01），4、7 d内毒素、尿L/M水平明显降低(P<0.01)，治疗7 d总蛋白、白蛋白明显升高(P<0.01),APACHEⅡ评分明显降低（P<0.01）；与对照组比较，电针组治疗7 d后腹腔内压值明显降低(P<0.01)，治疗4、7 d分钟肠鸣音次数明显增加(P<0.01)，治疗4、7 d血浆hs-CRP、IL-6、内毒素、尿L/M水平及治疗7 d APACHE Ⅱ评分明显降低(P<0.01)，治疗7 d总蛋白、白蛋白明显升高(P<0.01)。结论：针刺足三里、中脘可缩短早期肠内营养达到能量目标的时间，降低炎性反应，改善肠黏膜屏障功能，从而减少SAP患者喂养不耐受的发生。.
Keywords: Electroacupuncture; Inflammatory response; Intestinal nutritional feeding intolerance; Mucosal barrier function; Severe acute pancreatitis.