电针改善重症监护病房患者谵妄状态临床观察

Clinical observation of electroacupuncture in improving delirium in intensive care unit patients

关键词:  电针  谵妄  重症监护病房  右美托咪定  谵妄评定量表修订版-98评分

Key words:  electroacupuncture  delirium  intensive care unit  dexmedetomidine  Delirium Rating Scale-Revised-98 score

摘要:

[目的] 研究旨在评估电针对重症监护病房（ICU）患者谵妄状态改善的疗效，特别是其对谵妄持续时间、严重程度以及减少镇静药物使用方面的影响。[方法] 研究为前瞻性、单中心随机对照试验，共纳入76例ICU患者。患者随机分为电针组38例和对照组38例。电针组接受疏密波刺激，频率为2/100 Hz的电针（双侧足三里穴、百会穴）治疗30 min，并接受右美托咪定镇静治疗，每日1次，疗程为7 d。对照组接受常规西医治疗及右美托咪定镇静治疗。研究的主要终点为治疗后谵妄评定量表修订版-98（DRS-R-98）评分变化，次要终点包括右美托咪定使用量、谵妄持续时间、急性生理与慢性健康评分（APACHE Ⅱ评分）及ICU停留时间。[结果] 重复测量方差分析结果示，组别因素方面，提示对照组和电针组在改善DRS-R-98评分方面比较，差异存在统计学意义（P<0.001）；时间因素方面，提示对照组和电针组DRS-R-98评分在入组后不同时间点比较，差异具有统计学意义（P<0.001）。随着时间延长，DRS-R-98评分逐渐降低；组别与时间的交互因素提示组别与时间对DRS-R-98评分变化存在交互作用（P<0.001）。且电针组右美托咪定使用量较对照组显著减少（P<0.05）。电针组谵妄持续时间明显短于对照组（P<0.05）。此外，电针组APACHE Ⅱ评分显著改善（P<0.05），但ICU停留时间两组比较，差异无统计学意义（P>0.05）。[结论] 电针治疗可以显著改善ICU患者的谵妄症状，缩短谵妄持续时间，减少镇静药物使用量，并改善患者的全身状况。电针作为一种安全、有效的辅助治疗手段，具有较大的临床应用潜力，可以为ICU患者的谵妄管理提供新的非药物治疗选择。

Abstract:

[Objective] To evaluate the efficacy of electroacupuncture in improving delirium in intensive care unit（ICU） patients，particularly regarding its impact on delirium duration，severity，and reduction of sedative use. [Methods] This prospective，single-center randomized controlled trial enrolled 76 ICU patients. They were randomly assigned to an electroacupuncture group（n=38） and a control group（n=38）. The electroacupuncture group received 30-minute electroacupuncture treatment with sparse-dense waves at 2/100 Hz [applied bilaterally at Zusanli（ST36） and Baihui（GV20） acupoints] once daily for 7 days，along with sedation using dexmedetomidine. The control group received conventional Western medical treatment and dexmedetomidine sedation. The primary endpoint was the change in the Delirium Rating Scale-Revised-98（DRS-R-98） score. Secondary endpoints included dexmedetomidine dosage，delirium duration，Acute Physiology and Chronic Health EvaluationⅡ（APACHE Ⅱ） score，and ICU length of stay. [Results] Repeated-measures analysis of variance revealed a statistically significant difference between the two groups in improving DRS-R-98 scores（group effect，P<0.001）. DRS-R-98 scores significantly differed across time points after enrollment（time effect，P<0.001），showing a gradual decrease over time. A significant interaction between group and time on DRS-R-98 score changes was observed（P<0.001）. The electroacupuncture group used significantly less dexmedetomidine than the control group（P<0.05）. Delirium duration was significantly shorter in the electroacupuncture group（P<0.05）. The APACHE Ⅱ score improved significantly in the electroacupuncture group（P<0.05），but no significant difference was found in ICU length of stay between the two groups（P>0.05）. [Conclusion] Electroacupuncture can significantly improve delirium symptoms，shorten delirium duration，reduce sedative drug dosage，and improve the overall condition of ICU patients. As a safe and effective adjunctive therapy，electroacupuncture holds substantial clinical potential and offers a new non-pharmacological option for managing delirium in ICU patients.