[Effect of acupuncture on analgesia and sedation in elderly patients with severe pneumonia during invasive mechanical ventilation].

OBJECTIVE: To observe the analgesic and sedative effects of acupuncture in elderly patients with severe pneumonia during invasive mechanical ventilation. METHODS: A total of 188 elderly patients with severe pneumonia were randomly divided into an observation group and a control group, 94 cases in each group. Both groups were treated with routine nursing and treatment of severe pneumonia such as invasive mechanical ventilation, analgesia and sedation. Based on these, the observation group was treated with acupuncture at Neiguan (PC 6), Hegu (LI 4), Yintang (GV 29) and Baihui (GV 20), twice a day until the mechanical ventilation was offline. The critical care pain observation tool (CPOT) score and Richmond agitation-sedation score (RASS) were observed before treatment and 0.5 h after analgesia and sedation; the average time of reaching the standard, the reaching standard rate of shallow sedation and analgesia within 0.5 h and 72 h as well as the dosage of analgesic and sedative drugs and compilations were compared between the two groups. The mean arterial pressure (MAP), heart rate (HR), respiratory rate (RR) and blood oxygen saturation (SpO2) were observed before treatment and 0.5 h, 1 h and 2 h after analgesia and sedation. The levels of partial pressure of blood oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and lactic acid (Lac) were observed before treatment and 12 h, 24 h, 48 h, 72 h, 96 h, 120 h and 144 h after analgesia and sedation. The white blood cell (WBC), neutrophil percentage (NEUT%), high-sensitivity C-reactive protein (hs-CRP), aspartate aminotransferase (AST), alanine aminotransferase (ALT) and creatinine (Cr) were observed before treatment and 72 h after analgesia and sedation. The tracheal intubation time and ICU hospitalization time were compared between two groups. RESULTS: At the time point of 0.5 h after treatment, the CPOT and RASS scores in the two groups were lower than those before treatment (P<0.05); the average time of reaching the standard in the observation group was shorter than that in the control group (P<0.01); the 30 min reaching standard rates of CPOT and RASS scores as well as the rate of reaching the shallow sedation and analgesia within 72 h in the observation group were higher than those in the control group (P<0.01, P<0.05). The dosage and duration of dexmedetomidine, propofol and butorphanol in the observation group were less than those in the control group (P<0.05), and the occurrence times of hypotension, respiratory depression, bradycardia, constipation as well as average tracheal intubation time and average ICU hospitalization time in the observation group were less than those in the control group (P<0.05). After 0.5 h, 1 h and 2 h of treatment, the HR and RR were lower than those before treatment in the two groups (P<0.05), MAP and SpO2 were higher than those before treatment in the two groups (P<0.05); the MAP 0.5 h after treatment in the observation group was higher than that in the control group (P<0.05); the HR after 1 h and 2 h of treatment in the observation group was lower than that in the control group (P<0.05). Compared before treatment, the levels of PaCO2 and Lac were reduced and the levels of PaO2 were increased 12 h, 24 h, 48 h, 72 h, 96 h, 120 h and 144 h after treatment in both groups (P<0.05); compared before treatment, the WBC, NEUT%, hs-CPR, ALT and Cr were reduced 72 h after treatment in the two groups (P<0.05), and the hs-CRP in the observation group was lower than that in the control group (P<0.05). CONCLUSION: Acupuncture has analgesic and sedative effect in elderly patients with severe pneumonia during invasive mechanical ventilation, which could reduce the dosage of sedative and analgesic drugs and the occurrence of complications, improve blood oxygen, and has good safety.

[Effect of acupuncture on diaphragmatic function in patients with AECOPD typeâ ¡ respiratory failure evaluated by ultrasound detection].

OBJECTIVE: To observe the therapeutic effect of acupuncture combined with western conventional therapy on type Ⅱ respiratory failure of acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and evaluate the effect of acupuncture on diaphragmatic function and prognosis by bedside ultrasound. METHODS: A total of 111 patients with AECOPD type Ⅱ respiratory failure were randomized into an acupuncture group, a conventional treatment group and a non-acupoint acupuncture group, 37 cases in each one. The routine AECOPD nursing care and treatment with western medicine were provided in the 3 groups. Additionally, in the acupuncture group, acupuncture was applied at Dingchuan (EX-B 1), Feishu (BL 13), Taiyuan (LU 9), Danzhong (CV 17) and Zhongwan (CV 12), etc. In the non-acupoint acupuncture group, acupuncture was given at the points 5 to 10 mm lateral to each of the acupoints selected in the acupuncture group. Acupuncture was given once every day, 30 min each time, consecutively for 10 days in the above two groups. Separately, before treatment, on day 3, 7 and 10 of treatment, arterial partial pressure of oxygen (PaO2), partial pressure of carbon dioxide (PaCO2) and diaphragm thickening fraction (TFdi) were observed in each group. Before and after treatment, the inflammatory and immune indexes (levels of white blood cell [WBC], procalcitonin [PCT], hypersensitive C-reactive protein [hs-CRP] and T lymphocyte percentage [ %]), auxiliary respiratory muscle movement score, the score of chronic obstructive pulmonary disease (COPD) assessment test (CAT), the score of the modified British Medical Research Council dyspnea scale (mMRC) and the TCM syndrome score were compared in each group. The duration of mechanical ventilation, relative complications, 14-day clinical controlled discharge rate and the therapeutic effect were observed in each group. RESULTS: On day 3, 7 and 10 of treatment, PaO2 and TFdi were all increased as compared with those before treatment (P<0.01) and PaCO2 was reduced as compared with that before treatment in each group (P<0.01). After treatment, % was increased as compared with that before treatment in each group (P<0.01), WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score, mMRC score and TCM syndrome score were all reduced as compared with those before treatment in each group (P<0.01). After treatment, PaCO2, WBC, PCT, hs-CRP, auxiliary respiratory muscle movement score, CAT score and mMRC score in the acupuncture group were all lower than the other two groups (P<0.01), PaO2 and TFdi were higher than the other two groups (P<0.01); % was higher and TCM syndrome score was lower in the acupuncture group compared with those in the non-acupoint acupuncture group (P<0.01). The duration of mechanical ventilation and the total incidence of complications in the acupuncture group were all lower than the other two groups (P<0.01), and the 14-day clinical controlled discharge rate and total clinical effective rate were higher than the other two groups (P<0.01). CONCLUSION: Acupuncture as adjunctive therapy achieves significant therapeutic effect on AECOPD type Ⅱ respiratory failure. It improves diaphragmatic function, promotes oxygenation and relieves carbon dioxide retention of artery, alleviates clinical symptoms and reduces the time of mechanic ventilation and hospitalization. Besides, the bedside ultrasound detection can objectively reflect the effect of acupuncture on diaphragmatic function in the patients with AECOPD complicated with typeⅡrespiratory failure.