| Mechanical ventilation is an important mean to save patients’ lives in the Department of Critical Care Medicine,but long-term mechanical ventilation will cause patients to have adverse emotions such as anxiety and agitation,which will affect the prognosis of patients,prolong the time of mechanical ventilation,ICU hospitalization,total hospitalization,increase the consumption of sedative and analgesic drugs,and even increase the mortality.In clinical practice,most patients with mechanical ventilation have experienced mild or severe pain.Pain will greatly increase the metabolism of various organs and oxygen consumption of patients,affect the psychological status of patients,and even make patients make behaviors that hurt themselves.Analgesia can reduce the discomfort of patients,alleviate the anxiety and restlessness of patients,and promote the treatment process better.At present,appropriate sedation and analgesia has become one of the important treatment methods for patients with mechanical ventilation.However,due to the patient’s lack of correct understanding of pain,the medical staffs lack of full attention to the patient’s pain,and the deliberate control of the use of opioid analgesics out of concern about the addiction and adverse reactions of analgesics,the patient often has insufficient analgesia and can not effectively cooperate with the treatment,thus affecting the treatment effect.Sedation is usually combined with analgesia.Sedation,as a common treatment method in the Department of Critical Care Medicine,can reduce the oxygen consumption of the body,control the tension of patients,make patients better adapt to the movement rhythm of ventilator,reduce the injury of mechanical ventilation to patients to the greatest extent,and achieve the therapeutic effect.However,because the depth of sedation is difficult to grasp,insufficient or excessive sedation will cause damage to patients and lead to difficulty in offline.At present,there are various types of analgesic and sedative drugs in clinical practice,but they all have adverse reactions and side effects of varying degrees,which affect the clinical efficacy and safety to a certain extent.Therefore,finding new therapeutic drugs or means with definite analgesic and sedative efficacy,controllable degree and low adverse reactions has become an urgent clinical problem to be solved.In recent years,the sedative and analgesic effect of external treatment of TCM has gradually attracted widespread attention.A number of studies have confirmed that acupuncture has a significant analgesic effect,not only by promoting the release of endogenous opioid peptides and exerting a central anesthetic effect,but also by inhibiting peripheral inflammatory factors and reducing peripheral inflammatory pain.Acupuncture,electro-acupuncture,percutaneous electro-acupuncture and other external treatment methods of traditional Chinese medicine are also widely used in labor analgesia.Auricular acupoint pressing is a commonly used external therapy for sedation and analgesia in traditional Chinese medicine.It is widely used because of its simplicity,low cost,and excellent efficacy.Auricular magnetic bead sticking is a new type of ear acupoint pressing method,and the effect is more significant.Based on this,this study intends to clarify the efficacy of ear point magnetic bead sticking in the adjuvant treatment of analgesia and sedation in patients with mechanical ventilation,and explore its mechanism,so as to provide a theoretical basis for its clinical application.This research is divided into three parts:literature review,meta-analysis and clinical trial research.1.Literature review:this part reviews the research progress of analgesic and sedative mechanism of acupuncture therapy.2.Meta analysis of the effect of acupuncture assisted mechanical ventilation on sedation and analgesia in patients.Purpose:To evaluate the clinical efficacy of acupuncture combined with conventional western medicine and simple conventional western medicine in severe patients with mechanical ventilation.Method:The computer searched CNKI,Wanfang Data,Chinese biomedical literature database(CBM),VIP,PubMed,EMBASE,Cochrane,Chinese clinical trial center and American clinical trial center for randomized controlled trials on the treatment of severe patients with acupuncture assisted mechanical ventilation.The key words were ear acupoints,ear acupoint magnetic beads,ear acupuncture,acupoint sticking pressure,acupuncture,electroacupuncture,sedation,analgesia,ICU and mechanical ventilation,The retrieval time is from the establishment of the database to January 17,2022.After literature screening,data extraction,literature quality evaluation and bias risk assessment,Revman 5.3 was used for meta-analysis to evaluate the effect of acupuncture on analgesia and sedation in patients with mechanical ventilation.Result:14 literatures were included,463 cases in the experimental group and 468 cases in the control group.The results of meta-analysis showed that compared with conventional western medicine alone,external treatment of traditional Chinese medicine combined with conventional western medicine could significantly reduce the dose of dexmedetomidine[MD(95%CI)=-124.39(-235.28,-13.50)],the dose of sufentanil[MD(95%CI)=-48.31(-74.47,-22.1)],significantly shorten the time of mechanical ventilation[MD(95%CI)=-118.99(-179.80,-58.19)],and the length of stay in ICU[MD(95%CI)=-1.43(-2.82,-0.03)],There was no significant difference in midazolam,fentanyl,propofol dose and Ramsay score between the two groups.Conclusion:Acupuncture assisted analgesia and sedation therapy for patients with mechanical ventilation can reduce the consumption of some analgesic and sedative drugs,shorten the time of mechanical ventilation and ICU hospitalization,but it needs to be verified by more high-quality studies.3.Observation on analgesic and sedative effect and mechanism of auricular magnetic bead sticking and pressing in patients with mechanical ventilationObjective:To evaluate the clinical efficacy of auricular magnetic bead sticking combined with conventional western medicine and simple conventional western medicine in severe patients with mechanical ventilation,and to explore the possible mechanism.Methods:the patients admitted to the intensive care unit of the Chinese Academy of traditional Chinese medicine in January 2020 were randomly divided into the mechanical control group and the mechanical control group according to the standard of the Chinese Academy of traditional Chinese medicine in January 2020.Both the control group and the experimental group were treated with routine analgesic and sedative treatment of Western medicine.On this basis,the experimental group applied auricular magnetic beads to Shenmen point,subcortical point,sympathetic point and heart point.To observe the vital signs,CPOT,Riker sedation and agitation score(SAS),mechanical ventilation time and the occurrence of cardiovascular adverse events,and to evaluate the efficacy of ear point magnetic bead sticking in the adjuvant treatment of analgesia and sedation in patients with mechanical ventilation;Serum ACTH,epinephrine,norepinephrine,dopamine,melatonin and β-endorphin,methionine enkephalin,cortisol and interleukin-6 were tested before and 4h and 24h after enrollment,and to explore the possible mechanism of ear point magnetic bead sticking in the adjuvant treatment of analgesia and sedation in patients with mechanical ventilation.Results:There was no significant difference in age(P=0.653),gender(P=0.345),APACHEⅡ score(P=0.973),pre enrollment oxygenation index(P=0.364),pre enrollment CPOT score(P=0.743),pre enrollment SAS score(P=0.821)and basic composition of disease(P=0.896)between the two groups.1)Efficacy evaluation indicators:①Sedation and analgesia score:CPOT score and SAS score were decreased significantly after routine analgesia and sedation and combined auricular magnetic bead plaster intervention.Repeated measurement ANOVA was used to analyze the effects of group factors,time factors and interaction factors on the changes of observation indexes over time.It was found that there was no significant difference between the experimental group and the control group in improving CPOT score and SAS score.There were significant differences in CPOT score and SAS score between the experimental group and the control group at different time points of 4h,8h,12h,16h,20h and 24h.Both the experimental group and the control group could improve the CPOT score and SAS score,and had no interaction with the grouping.② Mechanical ventilation time:the mechanical ventilation time of patients in the experimental group was shorter than that of patients in the control group.③Safety evaluation:no adverse cardiovascular events occurred in the experimental group and the control group during the study period.2)Preliminary mechanism evaluation indicators:① The level of serum ACTH in the experimental group was higher than that in the control group,and increased with the extension of intervention time;Group factor P=0.266>0.05,suggesting that there is no significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating serum ACTH level;Time factor P=0.540>0.05,suggesting that the effect of the experimental group and the control group on serum ACTH level has nothing to do with the extension of time after enrollment;The interaction factor between group and time is P=0.749>0.05,suggesting that routine analgesia and sedation and combined with auricular magnetic beads have no interaction with group on the level of serum ACTH.②Compared with before enrollment,the serum adrenaline level of patients in the control group increased with the extension of intervention time,and the serum adrenaline level of patients in the experimental group decreased with the extension of intervention time.Because there was a statistical difference in adrenaline levels between the control group and the test group before enrollment(baseline factor P<0.001),it was found that the group factor P=0.874>0.05,suggesting that there was no significant difference in regulating the square surface of serum adrenaline between the control group and the test group;Time factor P=0.193>0.05,suggesting that there was no significant difference in serum adrenaline level at different time points;The interaction factor between group and time P=0.071>0.05,suggesting that the serum adrenaline level changes with time,and there is no significant difference between the control group and the experimental group.③ The serum norepinephrine level in the experimental group was higher than that in the control group,and showed a downward trend with the extension of the intervention time;Group factor P=0.860>0.05,suggesting that there is no significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum norepinephrine;The time factor P=0.468>0.05,suggesting that the effect of the experimental group and the control group on the level of serum norepinephrine has nothing to do with the extension of time after enrollment;The interaction factor between group and time P=0.180>0.05,suggesting that routine analgesia and sedation and combined with auricular magnetic beads have no interaction with group on the level of serum norepinephrine.④The level of serum cortisol in the experimental group was lower than that in the control group,and showed a downward trend with the extension of intervention time;Group factor P=0.047<0.05,suggesting that there is a statistically significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum cortisol;The time factor P=0.461>0.05,suggesting that the effect of the experimental group and the control group on the level of serum cortisol has nothing to do with the extension of time after enrollment;The interaction factor between group and time was P=0.205>0.05,suggesting that there was no interaction between routine analgesia and sedation and combined auricular magnetic bead pressing on the level of serum cortisol.⑤ The level of serum dopamine in the experimental group was higher than that in the control group,and increased first and then decreased with the extension of intervention time;Group factorP=0.033<0.05,suggesting that there is a statistically significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum dopamine;The time factor P=0.068>0.05,suggesting that the effect of the experimental group and the control group on the level of serum dopamine has nothing to do with the extension of time after enrollment;The interaction factor between group and time was P=0.287>0.05,suggesting that there was no interaction between routine analgesia and sedation and combined auricular magnetic bead sticking on the level of serum dopamine.⑥ The level of serum melatonin in the experimental group was higher than that in the control group,and showed a downward trend with the extension of intervention time;Group factor P=0.136>0.05,suggesting that there is no significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum melatonin;The time factor P=0.202>0.05,suggesting that the effect of the experimental group and the control group on the level of serum melatonin has nothing to do with the extension of time after enrollment;The interaction factor between group and time was P=0.287>0.05,suggesting that there was no interaction between routine analgesia and sedation and combined auricular magnetic bead sticking on the level of serum dopamine.⑦ Serum of patients in control group and test group β-endorphin increased first and then decreased with the extension of intervention time.Because there was a statistical difference in adrenaline levels between the control group and the test group before enrollment(baseline factor P<0.001),the baseline factor was included and repeated measurement analysis of variance found that the group factor P=0.489>0.05,suggesting that the control group and the test group are regulating serum β-endorphin,there was no significant difference in endorphin level;Time factor P=0.519>0.05,indicating serum β-endorphin was no significant difference in endorphin level at different time points;The interaction factor between group and time was P=0.694>0.05,suggesting that serum β-endorphin changed with time,and there was no significant difference between the control group and the experimental group.⑧ The level of serum IL-6 in the experimental group was lower than that in the control group,and showed a further downward trend with the extension of intervention time;Group factor P=0.133>0.05,suggesting that there is no significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum IL-6;The time factor P=0.920>0.05,suggesting that the effect of the experimental group and the control group on the level of serum IL-6 has nothing to do with the extension of time after enrollment;The interaction factor between group and time P=0.607>0.05,suggesting that routine analgesia and sedation combined and with auricular magnetic beads have no interaction with group on the level of serum IL-6.⑨ The level of serum methionine enkephalin in the experimental group was higher than that in the control group,and increased first and then decreased with the extension of intervention time;Group factor P=0.118>0.05,suggesting that there is no significant difference between combined auricular magnetic bead sticking and conventional analgesia and sedation in regulating the level of serum methionine enkephalin;The time factor P=0.756>0.05,suggesting that the effect of the experimental group and the control group on the level of serum methionine enkephalin has nothing to do with the extension of time after enrollment;The interaction factor between group and time was P=0.696>0.05,suggesting that routine analgesia and sedation and with auricular magnetic beads have no interaction with group on the level of serum methionine enkephalin.Conclusion:Auricular magnetic bead pressing method can shorten the time of mechanical ventilation and improve the scoring trend of CPOT and SAS;Auricular magnetic bead pressing method did not increase the incidence of cardiovascular adverse events;The mechanism of auricular magnetic bead application in assisting analgesia and sedation is related to the level of serum related indexes of hypothalamic pituitary adrenal axis. |
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