Objective: To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound.
Methods: A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and diaphragm thickening fraction (TFdi) were observed in each group. Before and after treatment, the inflammatory and immune indexes (levels of white blood cell [WBC], procalcitonin [PCT], hypersensitive C-reactive protein [hs-CRP] and T lymphocyte percentage [ %]), auxiliary respiratory muscle movement score, the score of chronic obstructive pulmonary disease (COPD) assessment test (CAT), the score of the modified British Medical Research Council dyspnea scale (mMRC) and the TCM syndrome score were compared in each group. The duration of mechanical ventilation, relative complications, 14-day clinical controlled discharge rate and the therapeutic effect were observed in each group.
Results: On day 3, 7 and 10 of treatment, PaO2 and TFdi were all increased as compared with those before treatment (P<0.01) and PaCO2 was reduced as compared with that before treatment in each group (P<0.01). After treatment, % was increased as compared with that before treatment in each group (P<0.01), WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score, mMRC score and TCM syndrome score were all reduced as compared with those before treatment in each group (P<0.01). After treatment, PaCO2, WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score and mMRC score in the acupuncture group were all lower than the other two groups (P<0.01), PaO2 and TFdi were higher than the other two groups (P<0.01); % was higher and TCM syndrome score was lower in the acupuncture group compared with those in the non-acupoint acupuncture group (P<0.01). The duration of mechanical ventilation and the total incidence of complications in the acupuncture group were all lower than the other two groups (P<0.01), and the 14-day clinical controlled discharge rate and total clinical effective rate were higher than the other two groups (P<0.01).
Conclusion: Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.
目的：观察针刺联合西医常规疗法治疗慢性阻塞性肺疾病急性加重期（AECOPD）Ⅱ型呼吸衰竭的疗效，并利用床边超声评价针刺对患者膈肌功能及预后的影响。方法：将111例AECOPD Ⅱ型呼吸衰竭患者随机分为针刺组、常规治疗组和非穴位针刺组，每组37例。3组均进行常规AECOPD护理及西医治疗，针刺组予针刺定喘、肺俞、太渊、膻中、中脘等穴；非穴位针刺组于针刺组取穴旁开5~10 mm处针刺，针刺均每日1次，每次30 min，连续治疗10 d。观察各组治疗前及治疗第3、7、10天动脉血氧分压（PaO2）及二氧化碳分压（PaCO2）、膈肌呼吸变异度（TFdi）；比较各组治疗前后炎性与免疫指标[白细胞计数（WBC）、降钙素原（PCT）、超敏C反应蛋白（hs-CRP）、 T淋巴细胞百分比（ %）的水平]、辅助呼吸肌运动评分、慢性阻塞性肺疾病（COPD）评估测试（CAT）评分、改良版英国医学研究委员会呼吸困难问卷（mMRC）评分、中医证候评分；观察各组机械通气时间、相关并发症情况、14 d临床控制出院率及临床疗效。结果：治疗第3、7、10天，各组PaO2、TFdi均较治疗前升高（P<0.01），PaCO2较治疗前降低（P<0.01）。治疗后，各组 %较治疗前升高（P<0.01），WBC、PCT、hs-CRP、辅助呼吸肌运动评分、CAT评分、mMRC评分、中医证候评分均较治疗前降低（P<0.01）；治疗后，针刺组PaCO2、WBC、PCT、hs-CRP、辅助呼吸肌运动评分、CAT评分、mMRC评分低于其余2组（P<0.01），PaO2、TFdi高于其余2组（P<0.01），针刺组 %高于、中医证候评分低于非穴位针刺组（P<0.01）。针刺组机械通气时间、并发症总发生率低于其余2组（P<0.01），14 d临床控制出院率、临床总有效率高于其余2组（P<0.01）。结论：针刺辅助治疗AECOPD Ⅱ型呼吸衰竭疗效显著，可改善膈肌功能，促进动脉氧合和改善二氧化碳储留，减轻临床症状，缩短机械通气时间与住院时间，同时床边超声探测可客观反映针刺对AECOPD合并Ⅱ型呼吸衰竭患者膈肌功能的影响。.
Keywords: acupuncture treatment; acute exacerbation of chronic obstructive pulmonary disease; diaphragm thickening fraction (TFdi); randomized controlled trial (RCT); type Ⅱ respiratory failure.