目的:探讨腕踝针疗法(WAA)在急性胰腺炎(AP)患者中的镇痛效果、安全性及作用机制,为优化AP镇痛治疗提供新思路。方法:采用随机对照试验设计,纳入2023年8月至2024年10月福建中医药大学附属第二人民医院急诊科50例AP患者,随机分为对照组(布洛芬 + 常规治疗,n = 25)和WAA组(常规治疗 + WAA,n = 25)。对照组采用生长抑素、乌司他丁、布洛芬等药物联合镇痛;WAA组在常规治疗基础上,根据疼痛区域选取腕踝部特定穴位行浅刺治疗。通过NRS评分评估治疗前(T0)、治疗后15分钟(T1)、30分钟(T2)、1小时(T3)的疼痛程度,并比较两组临床疗效。结果:治疗后两组NRS评分均下降,但WAA组在T2 (3.72 ± 1.17 vs. 4.68 ± 1.18)和T3 (2.64 ± 1.15 vs. 3.52 ± 1.16)的评分显著低于对照组(均P χ2 = 2.311, P = 0.315),但治疗组在显效率(20.0% vs. 8.0%)和无效率(4.0% vs. 12.0%)方面均表现出优于对照组的趋势。结论:WAA作为AP的辅助治疗可显著增强镇痛效果,尤其在治疗后30分钟至1小时效果更优,且安全性良好,为AP镇痛提供了非药物干预的新选择。OBJECTIVE: To explore the analgesic effect, safety and mechanism of action of wrist and ankle acupuncture (WAA) in patients with acute pancreatitis (AP), and to provide new ideas for optimizing the analgesic treatment of AP. METHODS: A randomized controlled trial design was used to include 50 AP patients in the Emergency Department of the Second People’s Hospital Affiliated to Fujian University of Traditional Chinese Medicine from August 2023 to October 2024, and they were randomly divided into the control group (ibuprofen + conventional treatment, n = 25) and the WAA group (conventional treatment + WAA, n = 25). The control group was treated with growth inhibitors, ulinastatin and other drugs combined with analgesia;the WAA group was treated with superficial stabbing of specific acupoints at the wrist and ankle selected according to the pain area on the basis of conventional
目的探讨血必净联合乌司他丁对脓毒症心肌损伤患者的影响及其可能机制。方法随机将83例脓毒症心肌损伤患者分为对照组18例、乌司他丁组20例、血必净组20例、联合组25例。对照组按照脓毒症治疗指南进行常规治疗。在对照组常规治疗基础上,乌司他丁组加用乌司他丁40万IU静脉推注,每12 h 1次,连用5 d;血必净组加用血必净注射液100 mL静脉滴注,每12 h 1次,连用5 d;联合组给予乌司他丁40万IU静脉推注+血必净注射液100 mL静脉滴注,均每12 h 1次,连用5 d。检测4组患者治疗前后心肌肌钙蛋白I(cTnI)、磷酸肌酸激酶同工酶(CK-MB)、B型钠尿肽(BNP)、降钙素原(PCT)、C反应蛋白(CRP)水平,并进行APACHEⅡ评分,统计ICU住院时间。结果治疗后4组cTnI、BNP、PCT、CRP水平及APACHEⅡ评分均明显降低(P均<0.05),且联合组cTnI、BNP、PCT、CRP水平均明显低于其他3组(P均<0.05),乌司他丁组、血必净组均明显低于对照组(P均<0.05);血必净组PCT、CRP水平均明显低于乌司他丁组(P均<0.05);联合组APACHEⅡ评分明显低于对照组(P<0.05),但与血必净组、乌司他丁组比较差异均无统计学意义(P均>0.05)。联合组ICU住院时间明显短于其他3组(P均<0.05),血必净组、乌司他丁组均明显短于对照组(P均<0.05),但乌司他丁组与血必净组比较差异无统计学意义(P>0.05)。结论血必净联合乌司他丁治疗脓毒症心肌损伤存在协同治疗效果,可增强损伤心肌的保护效应,缩短ICU住院时间,改善预后。
