| BackgroundThe gastrointestinal is the first organ affected by inflammatory shock in patients with sepsis.Septic Acute Gastrointestinal Injury(SAGI)has the characteristics of high morbidity and mortality.Modern medicine usually uses gastric motility drugs and microbial preparations to intervene,but the effect is not good.Acupuncture therapy is effective in regulating gastrointestinal function,but it is not clear whether adding filiform needle therapy on the basis of conventional therapy can improve the gastrointestinal function of patients with sepsis,thereby improving the condition of sepsis.ObjectiveThe efficacy and safety of acupuncture in the treatment of SAGI were analyzed through systematic evaluation,and common acupoints and common outcome indicators were screened at the same time to provide reference for clinical research.Through randomized controlled trials,explore the effects of conventional Western medicine combined with filiform needle therapy and Western medicine alone in improving gastrointestinal function,reducing the severity of sepsis,and reducing the level of inflammatory indicators.MethodsStudy 1 A Systematic Review of SAGI treated with acupunctureSearched the seven databases of China Knowledge Network,Wanfang,VIP,Chinese Biomedical Literature and PubMed,Embase,Cochrane Library,and included randomized controlled studies of conventional Western medicine combined with acupuncture in the treatment of SAGI.After data extraction,the outcome indicators appearing in each study were classified and frequency statistics,and the outcome indicators with frequency?3 were quantitatively or qualitatively analyzed.At the same time,it summarizes the characteristics of acupoint selection and program design included in the study.Study 2 Randomized Controlled Trial of Acupuncture Treatment of SAGIUse randomized controlled trials to carry out exploratory research.Sixty-six SAGI patients were recruited,and they were randomly assigned to the control group and the test group using the random number table method,with 33 patients in each group,and the assignment was hidden with an envelope.The control group received conventional western medicine treatment,and the experimental group added filiform needle treatment on its basis.Observe the subjects'bowel sounds classification,gastric residual volume,gastrointestinal tolerance score,AGI classification,as well as APACHE II,SOFA,blood inflammation indicators,etc.1 Treatment plan1.1 Control groupBased on the principles of "2016 International Sepsis Guidelines Sepsis 3.0 Standards"and "2012 European Critical Care Society Consensus on Gastrointestinal Function Impairment"as the principles,the corresponding control of infection,maintenance of volume,gastrointestinal decompression,etc.are formulated according to the patient's condition Western medicine treatment plan.1.2 Test groupOn the basis of the control group,filiform needle treatment was added.Acupoint selection:main points:Zhongwan(RN12),Tianshu(ST25),Zusanli(ST36),Shangjuxu(ST37),and Xiajuxu(ST39);matching points:excess with Quchi(LI11),deficiency with Qihai(RN6),vomiting with Neiguan(PC6),diarrhea with Yinlingquan(SP9).Operation:Directly or obliquely puncture 0.5-1 inch from the central cavity;puncture the Tianshu(ST25)straightly and slowly and deeply,with the needle tip breaking through the peritoneum by 1-2mm;puncture 0.8-1.2 inch directly from Zusanli(ST36),Shangjuxu(ST37),Xiajuxu(ST39).After the acupuncture points get qi,use the method of replenishing,replenishing and reducing energy for 30 seconds.Directly pierce the Qihai(RN6)for 0.5-1 inch obliquely downwards.After gaining qi,apply twisting and replenishing method for 30 seconds;Quchi(LI11)piercing straightly 0.5-1 inch,applying twisting and reducing method for 30 seconds after gaining qi;Neiguan(PC6)straight puncture 0.5-1 cun,pierce the Liangmen(ST21)straight or 0.5-1 cun diagonally downward,and 0.8-1.2 cun straight at the Yinlingquan(SP9).After the acupuncture points get qi,use the method of leveling,replenishing and reducing for 30 seconds.After performing the corresponding maneuvers for each acupoint,keep the needle for 20 minutes.The treatment is performed with filiform needles once a day,7 days of treatment is a course of treatment,and a total of 1 course of treatment.2 Observation index and evaluation time point2.1 Main outcomesBowel sound classification,residual gastric volume,gastrointestinal tolerance score,AGI classification.Daily monitoring,and evaluation before treatment,on the 3rd day of treatment,and on the 7th day of treatment.2.2 Secondary outcomesAcute physiological function and chronic health status scoring system ?(APACHE ?),Sequential Organ Failure Assessment(SOFA).Evaluation was performed before treatment,on the 3rd day of treatment,and on the 7th day of treatment.2.3 Inflammatory indicatorsProcalcitonin(PCT),C-reactive protein(CRP),neutrophil percentage(NE%),white blood cell(WBC).Evaluation was performed before treatment,on the 3rd day of treatment,and on the 7th day of treatment.ResultStudy 11 Included literatureA total of 243 randomized controlled research articles were retrieved,and 16 articles were finally included,including 14 Chinese articles and 2 English articles.All are reported in domestic literature,the sample size is small and has not been estimated.The included auxiliary control involves acupuncture and electroacupuncture.2 Result analysisCompared with conventional Western medical treatment,increasing acupuncture can reduce abdominal pressure[MD=-0.86mmHg,95%CI(-1.22,-0.51)],increase the frequency of bowel sounds[MD=0.84,95%CI(0.47,1.20),P<0.00001],improve comprehensive efficacy(RR=0.22,95%CI(0.15,0.28),P<0.00001],reduce APACHE ? score[RR=-0.54,95%CI(-0.72,-0.36),P<0.00001],reduce PCT level[MD=-0.82,95%CI(-1.49,-0.15)P=0.02]and CRP level[MD=-0.40,95%CI(-0.61,-0.19),P=0.0002]and other aspects have advantages.It is not effective in shortening the length of ICU hospitalization and reducing the 28-day mortality rate.Acupoint selection plan and design features:The foot-yangming stomach meridian and Renmai acupoints are mostly used.The main acupoint is the most used in Zusanli(14/15).16).The treatment course is mostly 5 days(6/16)and 7 days(5/16).The outcome indicators involved 37 items.The gastrointestinal related indicators were abdominal pressure(11/16),bowel sounds(8/16),gastrointestinal dysfunction score(5/16),target feeding time(4/16),and stomach residue Amount(3/16),AGI grade(3/16)are more;sepsis-related indicators are based on APACHE ? score(9/16),ICU stay(5/16),28-day mortality rate(4/16),SOFA score(3/16)is more;inflammation indicators are mostly CRP(7/16),PCT(7/16),WBC(3/16).Quality analysis:The level of evidence for efficacy indicators is low,which may limit the accuracy and extrapolation of conclusions.Study 2 Clinical studyA total of 66 SAGI patients were enrolled in this study.During the treatment,2 people fell off from the control group and 1 person from the experimental group.Finally,63 people were included,including 32 in the control group and 31 in the experimental group.1 General information and baseline conditionsThe two groups of patients had no difference in demographic data such as gender,age,past medical history,and severity of sepsis,and they were comparable.2 Curative effect index analysis2.1 Main outcomes(1)Classification of bowel soundsIn comparison between the groups,the bowel sound classification of the control group did not change significantly over time;the test group was lower on the 7th day of treatment than before treatment(P<0.05).The bowel sound changes in the test group immediately after acupuncture were analyzed.The difference was significant before and after 1 day(P<0.05),the difference was not obvious on the 3rd day,and the difference was significant on the 7th day(P<0.0001).In comparison between groups,on the 3rd day of treatment,there was no difference between the two groups.On the 7th day of treatment,the bowel sounds of the experimental group were lower than those of the control group(P<0.05).(2)Residual gastric volume(ml)In comparison within the group,on the 7th day of treatment,the residual gastric mass in the control group increased compared to before treatment(P=0.004<0.001);the residual gastric mass in the experimental group showed a decreasing trend over time,which was not statistically significant(P>0.05).Because the baseline levels of the gastric residual volume of the two groups of patients were not uniform,the difference between the gastric residual volume on the 3rd and 7th day and before the treatment was first calculated,and then the difference between the groups was compared.The results suggest that the difference between the 7th day of treatment and that before treatment is different between the two groups,and the difference between the experimental group and the control group is smaller(P<0.05).(3)Gastrointestinal tolerance scoreIn comparison between the groups,the control group showed an increasing trend over time,which was not statistically significant.The gastrointestinal tolerance scores of the test group were significantly reduced on the 7th day and before the treatment,and the gastrointestinal tolerance scores were significantly reduced(P<0.05).In comparison between the groups,on the 3rd day of treatment,there was no difference between the two groups.On the 7th day of treatment,the test group was significantly lower than the control group(P<0.0001).(4)AGI classificationIn comparison between the groups,the control group was worse than before treatment on the 7th day of treatment(P<0.05);the test group was less severe than before treatment on the 7th day of treatment(P<0.0001).In comparison between groups,on the 3rd day of treatment,there was no difference between the two groups.On the 7th day of treatment,the AGI classification of the test group was significantly lower than that of the control group(P<0.05).2.2 Secondary outcome indicators(1)APACHE ?Compared within the group,the control group had no significant changes over time;the test group had a decrease on the 7th day and the 3rd day of treatment on the 7th day and before the treatment(P<0.05).In comparison between groups,the APACHE ? scores of the two groups were not significantly different at each evaluation time point.(2)SOFAComparing within the group,the SOFA score of the control group showed a slow upward trend over time,with no statistical significance;the test group had a significant decrease on the 7th day and the 3rd day of treatment on the 7th day and before the treatment(P<0.05).In comparison between groups,on the 3rd day of treatment,there was no difference between the two groups.On the 7th day of treatment,the SOFA score of the experimental group was lower than that of the control group(P<0.05).3 Inflammation indicatorsPCT:Intra-group comparison,there was no difference between the 7th day of treatment and the pre-treatment of the control group,and it was lower on the 7th day than the 3rd day(P<0.05);the PCT level of the experimental group decreased with the progress of time,and the comparison between each time point was all Significant difference(P<0.05).In comparison between the groups,on the 3rd and 7th day of treatment,the PCT level of the experimental group was lower than that of the control group(P<0.05).CRP:Compared within the group,the control group had no difference between the 7th day of treatment and the pre-treatment;the test group was decreased on the 7th day of treatment and the pre-treatment,and on the 3rd day of treatment compared with the pre-treatment(P<0.05).In comparison between groups,on the 3rd day of treatment,the test group was lower than the control group(P<0.05),and on the 7th day,there was no difference between the two groups.NE%:Compared within and within the group,the changes before and after treatment were not obvious.WBC:Comparison within and between groups,the changes before and after treatment were not obvious.4 safety evaluationDuring the implementation of this study,one subject in the experimental group experienced abdominal distension during the needle retention period,and the remaining subjects had no adverse reactions.Conclusion1 Literature studies show that there are still few clinical studies on SAGI.Conventional combined Western medicine acupuncture treatment has certain advantages over simple Western medicine treatment in increasing bowel sounds,reducing intra-abdominal pressure and other gastrointestinal-related symptoms,but due to the diagnosis and outcome The inconsistency of indicators leads to poorer quality of evidence and reduced credibility of conclusions.On the basis of selecting the main acupoints for disease differentiation,it is worthy of in-depth discussion to focus on the addition of matching acupoints to the treatment of SAGI.2 Clinical studies have shown that for SAGI patients,conventional Western medicine combined with filiform needle therapy can significantly improve gastrointestinal-related symptoms compared to Western medicine treatment alone,especially in terms of restoring bowel sounds and improving gastrointestinal tolerance;improvement of gastrointestinal function is possible It has a certain effect on reducing the inflammatory reaction of sepsis. |
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