[Shengqing Jiangzhuo acupuncture method for sepsis-associated gastrointestinal dysfunction: a randomized controlled trial].

Abstract / Summary

To observe the efficacy and safety of Shengqing Jiangzhuo (raising the clear and lowering the turbid) acupuncture method for sepsis-associated gastrointestinal dysfunction, and to preliminarily explore its mechanism. Ninety-six patients with sepsis-associated gastrointestinal dysfunction were randomly divided into an observation group (48 cases, 1 case dropped out) and a control group (48 cases, 5 cases dropped out). The observation group was treated with Shengqing Jiangzhuo acupuncture method on the basis of conventional western medical treatment, with acupoints including bilateral Zusanli (ST36), Neiguan (PC6), and Taichong (LR3), once daily for 7 days. The control group was treated with sham acupuncture on the basis of conventional western medical treatment, with corresponding non-acupoints, once daily for 7 days. Acute gastrointestinal injury ultrasonography score (AGIUS) was assessed before treatment and after 1, 3, and 7 days of treatment. Gastric residual volume (GRV) and incidence of feeding intolerance on days 1, 3, and 7 after initiation of enteral nutrition, daily caloric intake on days 1 and 3, and time required to reach target caloric intake were recorded.Peripheral blood inflammatory indexes [interleukin (IL)-10, IL-6, tumor necrosis factor-α (TNF-α), IL-17A, systemic immune- inflammation index (SII), white blood cell count (WBC), and procalcitonin (PCT)] and sequential organ failure assessment (SOFA) score were measured before and after treatment. The 28-day mortality and adverse events were recorded. After 1 day of treatment, AGIUS in the observation group was lower than that before treatment (P<0.001). After 3 and 7 days of treatment, AGIUS in both groups were lower than those before treatment and after 1 day of treatment (P<0.001). After 7 days of treatment, AGIUS in the observation group was lower than that after 3 days of treatment (P<0.001). After 1, 3, and 7 days of treatment, AGIUS in the observation group were lower than those in the control group (P<0.001). On days 3 and 7 after initiation of enteral nutrition, GRV in both groups was lower than that on day 1 (P<0.001),and GRV on day 7 was lower than that on day 3 (P<0.001); GRV in the observation group at all time points was lower than that in the control group (P<0.001). On days 1 and 3 after initiation of enteral nutrition, the incidence of feeding intolerance in the observation group was lower than that in the control group (P<0.001, P<0.01), and daily caloric intake was higher than that in the control group (P<0.05, P<0.01). The time required to reach target caloric intake in the observation group was shorter than that in the control group (P<0.05). After treatment, SOFA scores in both groups were lower than those before treatment (P<0.001), and SOFA score in the observation group was lower than that in the control group (P<0.001). There was no statistically significant difference in 28-day mortality between the two groups (P>0.05).After treatment, the levels of IL-6, TNF-α, IL-17A, SII, WBC, and PCT in the observation group were lower than those before treatment (P<0.05), and IL-10 level was higher than that before treatment (P<0.05); in the control group, IL-6 and WBC levels were lower than those before treatment (P<0.05), and IL-10 level was higher than that before treatment(P<0.05). After treatment, except for IL-10, other inflammatory indexes in the observation group were lower than those in the control group (P<0.01, P<0.05). No adverse events related to acupuncture treatment or operation occurred in either group. Shengqing Jiangzhuo acupuncture method can improve gastrointestinal function in patients with sepsis-associated gastrointestinal dysfunction, reduce the risk of early feeding intolerance. Its mechanism may be related to alleviating inflammatory response. 目的：观察“升清降浊”法针刺治疗脓毒症胃肠功能障碍的疗效及安全性，初步探索其作用机制。 方法：将96例脓毒症胃肠功能障碍患者随机分为观察组（48例，脱落1例）和对照组（48例，脱落5例）。观察组在西医常规治疗基础上联合“升清降浊”法针刺治疗，穴取双侧足三里、内关、太冲等，每日1次，共治疗7 d。对照组在西医常规治疗基础上联合假针刺治疗，取对应非经非穴，每日1次，共治疗7 d。观察两组治疗前及治疗1、3、7 d后急性胃肠损伤超声评分（AGIUS）；记录两组肠内营养启动后第1、3、7天的胃残余量（GRV）和喂养不耐受发生率，肠内营养启动后第1、3天的每日摄取热量，以及达到目标热量所需时间；检测两组治疗前、治疗后外周血炎症指标[白细胞介素（IL）-10、IL-6、肿瘤坏死因子-α（TNF-α）、IL-17A、全身免疫炎症指数（SII）、白细胞计数（WBC）、降钙素原（PCT）]水平，以及序贯器官衰竭评估（SOFA）评分；记录28天死亡率及不良反应发生情况。 结果：治疗1 d后，观察组AGIUS较治疗前降低（P<0.001）；治疗3、7 d后，两组AGIUS均低于治疗前及治疗1 d后（P<0.001）；治疗7 d后，观察组AGIUS低于治疗3 d后（P<0.001）；治疗1、3、7 d后，观察组AGIUS均低于对照组（P<0.001）。肠内营养启动后第3、7天，两组GRV均低于第1天（P<0.001），且第7天低于第3天（P<0.001）；观察组以上各时点GRV均低于对照组（P<0.001）。肠内营养启动后第1、3天，观察组喂养不耐受发生率低于对照组（P<0.001，P<0.01），每日摄取热量均高于对照组（P<0.05，P<0.01）。观察组达到目标热量所需时间短于对照组（P<0.05）。治疗后，两组SOFA评分较治疗前降低（P<0.001），且观察组低于对照组（P<0.001）。两组28天死亡率比较，差异无统计学意义（P>0.05）。治疗后，观察组IL-6、TNF-α、IL-17A、SII、WBC、PCT水平均较治疗前降低（P<0.05），IL-10水平较治疗前升高（P<0.05）；对照组IL-6、WBC水平均较治疗前降低（P<0.05），IL-10水平较治疗前升高（P<0.05）；治疗后除IL-10外，观察组其他炎症指标水平均低于对照组（P<0.01，P<0.05）。两组均未出现与针刺治疗及操作相关的不良反应。 结论：“升清降浊”法针刺可以改善脓毒症胃肠功能障碍患者胃肠功能，降低早期喂养不耐受风险，其作用机制可能与减轻炎症反应有关。.

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