Efficacy and safety of acupuncture as adjuvant treatment on sepsis related gastrointestinal dysfunction: a meta-analysis_Chinese Journal of Evidence-Based Medicine

Authors：

FAN Ziyang ¹ , LIAN Jinyu ¹ , ZHENG Yaman ¹ , ZHANG Jingyu ¹ , ZHANG Ying ² , ZHANG Zhen ² , LI Ningcen ¹ ,  XIE Keliang ^2,3 ,  CHEN Bo ^4,5,6

1. Research Center of Experimental Acupuncture Science, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;
2. Critical Care Medicine, General Hospital of Tianjin Medical University, Tianjin 300052, P. R. China;
3. Department of Anesthesiology, General Hospital of Tianjin Medical University, Tianjin Research Institute of Anesthesiology, Tianjin 300052, P. R. China;
4. School of Acupuncture and Moxibustion and Tuina, Tianjin University of Traditional Chinese Medicine, Tianjin 301617, P. R. China;
5. National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin 300381, P. R. China;
6. Binhai New Area Hospital of TCM, Fourth Teaching Hospital of Tianjin University of TCM, Tianjin 300451, P. R. China;

Corresponding author：

XIE Keliang, Email: xiekeliang2009@hotmail.com; CHEN Bo, Email: tjutcmchenbo@163.com

Keywords：

Acupuncture; Sepsis; Gastrointestinal dysfunction; Meta-analysis; Systematic review; Randomized controlled trial

DOI：

10.7507/1672-2531.202407097

Video：

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Objective To systematically evaluate the efficacy and safety of acupuncture as adjuvant treatment on sepsis related gastrointestinal dysfunction. Methods The PubMed, Web of Science, Cochrane Library, WanFang Data, CNKI, VIP and SinoMed databases were electronically searched to collect randomized controlled trials (RCTs) related to the objects from inception to July, 2024. Two reviewers independently screened literature, extracted data and assessed the risk of bias of the included studies. Meta-analysis was then performed by using RevMan 5.3 software. Results A total of 20 RCTs involving 1 384 patients were included. The results of meta-analysis showed that the bowel sound frequency per minute on the 7^th day (MD=0.82, 95%CI 0.57 to 1.07, P<0.01), the effective rate of improvement in sepsis-related gastrointestinal dysfunction on the 7^th day (RR=1.38, 95%CI 1.25 to 1.54, P<0.01), intra-abdominal pressure at 7^th day (MD=−1.52, 95%CI −2.21 to −0.83, P<0.01), gastric residential volume on the 7^th day (MD=−14.94, 95%CI −24.72 to −5.16, P<0.01), APACHE-Ⅱ score at 7^th day (MD=−2.40, 95%CI −3.56 to −1.24, P<0.01), concentrations of procalcitonin on the 7^th day (MD=−1.82, 95%CI −2.68 to −0.97, P<0.01) in the acupuncture group were all superior to the conventional treatment group. However, there was no significant difference between the two groups concerning the 28-day mortality. Conclusion Current evidence shows that acupuncture adjuvant treatment can promote the recovery of bowel sounds, reduce intra-abdominal pressure, and decrease gastric residual volume in patients with sepsis and gastrointestinal dysfunction, with good safety. Due to the limited quality and quantity of the included studies, more high quality studies are needed to verify the above conclusion.

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2.	Reintam A, Parm P, Kitus R, et al. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand, 2009, 53(3): 318-324.
3.	Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
4.	Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The nutritional and metabolic working group of the Spanish society of intensive care medicine and coronary units. Crit Care Med, 1999, 27(8): 1447-1453.
5.	Hill TL. Gastrointestinal tract dysfunction with critical illness: clinical assessment and management. Top Companion Anim Med, 2019, 35: 47-52.
6.	Sasabuchi Y, Matsui H, Lefor AK, et al. Risks and benefits of stress ulcer prophylaxis for patients with severe sepsis. Crit Care Med, 2016, 44(7): e464-e469.
7.	Piton G, Belon F, Cypriani B, et al. Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality. Crit Care Med, 2013, 41(9): 2169-2176.
8.	Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
9.	Chen FQ, Xu WZ, Gao HY, et al. Clinical effect of Changweishu on gastrointestinal dysfunction in patients with sepsis. J Int Med Res, 2020, 48(8): 300060520919579.
10.	韩悦, 冷玉鑫, 么改琦. 抗菌药物对肠道菌群和肠黏膜屏障功能的影响及机制. 中华危重病急救医学, 2017, 29(11): 1047-1051.
11.	Wang Y, Yang JW, Yan SY, et al. Electroacupuncture vs sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: a multicenter, randomized clinical trial. JAMA Surg, 2023, 158(1): 20-27.
12.	中华中医药学会. 2022年度中医药十大学术进展. 江苏中医药, 2023, 55(4): 9-10.
13.	王婷玉, 孟捷. 针灸辅助治疗脓毒症胃肠功能障碍疗效Meta分析. 辽宁中医药大学学报, 2022, 24(2): 165-170.
14.	Wang X, Chen Y, Liu Y, et al. Reporting items for systematic reviews and meta-analyses of acupuncture: the PRISMA for acupuncture checklist. BMC Complement Altern Med, 2019, 19(1): 208.
15.	Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med, 2003, 31(4): 1250-1256.
16.	Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
17.	Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
18.	中国中西医结合学会急救医学专业委员会. 重修“95庐山会议”多器官功能障碍综合征病情分期诊断及严重程度评分标准(2015). 中华危重病急救医学, 2016, (2): 99-101.
19.	方军, 李兰, 李冰冰, 等. 针灸对严重脓毒症患者胃肠功能障碍及胃肠激素影响分析. 湖南中医药大学学报, 2016, 36(1): 11.
20.	Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
21.	刘括, 孙殿钦, 廖星, 等. 随机对照试验偏倚风险评估工具2. 0修订版解读. 中国循证心血管医学杂志, 2019, 11(3): 284-291.
22.	Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res, 2018, 27(6): 1785-1805.
23.	Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
24.	李亚莉, 褚玉茹, 于乃浩, 等. 针灸改善脓毒症患者胃肠功能障碍的临床观察. 天津中医药, 2021, 38(4): 479-482.
25.	孙一凡, 裴颖皓, 陈明祺, 等. 基于气机升降理论运用电针干预脓毒症患者急性胃肠损伤的临床研究. 中国中医急症, 2024, 33(7): 1178-1182.
26.	程璐. 针刺治疗脓毒症急性胃肠损伤的随机对照研究. 北京: 北京中医药大学, 2021.
27.	蔡莉娟, 丁学军, 刘文兵, 等. 电针对脓毒症患者胃肠功能障碍的干预作用. 中国中医急症, 2014, 23(2): 268-270.
28.	刘超, 肖阳春, 梁立新, 等. 针刺联合多潘立酮治疗脓毒症急性胃肠损伤疗效观察. 上海针灸杂志, 2020, 39(1): 6-10.
29.	Meng JB, Jiao YN, Zhang G, et al. Electroacupuncture improves intestinal dysfunction in septic patients: a randomised controlled trial. Biomed Res Int, 2018, 2018: 8293594.
30.	胡瑞英, 杨广, 李健. 电针治疗脓毒症肠功能障碍的临床研究. 辽宁中医杂志, 2015, 42(11): 2195-2196.
31.	刘凯, 孙宏, 李冀, 等. 腹部电针对脓毒症胃肠功能障碍的影响. 上海针灸杂志, 2019, 38(10): 1118-1121.
32.	刘凯, 王秀珍, 王亚楠, 等. 电腹针对脓毒症并发肠屏障功能障碍的临床研究. 针灸临床杂志, 2022, 38(3): 17-20.
33.	孙德阳, 杨洋, 杜纯鹏, 等. 电针治疗脓毒症胃肠功能障碍的临床研究. 针灸临床杂志, 2019, 35(10): 47-50.
34.	孙芳园, 卢明, 沈伟鸿. 肠三针治疗脓毒症肠功能障碍的临床疗效观察. 蚌埠医学院学报, 2021, 46(10): 1357-1359,1364.
35.	王丽娟. 腹针治疗脓毒症急性胃肠损伤的临床研究. 广州: 广州中医药大学, 2019.
36.	王晓鹏. 针刺辅助治疗脓毒症胃肠功能障碍的随机对照临床研究. 北京: 北京中医药大学, 2019.
37.	王玉华. 脓毒症胃肠功能障碍患者应用穴位电刺激的临床观察. 实用中西医结合临床, 2021, 21(10): 72-73.
38.	韦志友. 复元针法治疗脓毒症患者急性胃肠损伤的临床观察. 北京: 北京中医药大学, 2017.
39.	杨卉卉. 针刺治疗脓毒症患者脾胃虚弱型胃肠功能障碍的临床研究. 济南: 山东中医药大学, 2018.
40.	虞意华, 金肖青, 俞迈红, 等. 针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究. 中华中医药学刊, 2015, 33(8): 1953-1956.
41.	卓剑丰, 李健. 针灸对老年严重脓毒症患者胃肠功能的影响. 山西中医, 2017, 33(5): 30, 32.
42.	李海峰, 胡国强, 刘雯雯. 针刺华佗夹脊穴治疗脓毒血症胃肠功能障碍临床疗效观察. 针刺研究, 2019, 44(1): 43-46.
43.	李仕业, 李志亨, 何朝. 穴位电刺激改善脓毒症胃肠功能障碍患者早期肠内营养耐受性. 世界最新医学信息文摘(连续型电子期刊), 2021, 21(26): 255-256.
44.	Puleo F, Arvanitakis M, Van Gossum A, et al. Gut failure in the ICU. Semin Respir Crit Care Med, 2011, 32(5): 626-638.
45.	Klaus DA, Motal MC, Burger-Klepp U, et al. Increased plasma zonulin in patients with sepsis. Biochem Med (Zagreb), 2013, 23(1): 107-111.
46.	Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems. Intensive Care Med, 2012, 38(3): 384-394.
47.	周燕. TEAS改善危重症患者胃肠损伤的临床研究. 南京: 南京中医药大学, 2021.
48.	Sungono V, Hariyanto H, Soesilo TEB, et al. Cohort study of the APACHE-Ⅱ score and mortality for different types of intensive care unit patients. Postgrad Med J, 2022, 98(1166): 914-918.
49.	Mittal R, Coopersmith CM. Redefining the gut as the motor of critical illness. Trends Mol Med, 2014, 20(4): 214-223.
50.	Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis, 2013, 13(5): 426-435.
51.	Schuetz P, Birkhahn R, Sherwin R, et al. Serial procalcitonin predicts mortality in severe sepsis patients: results from the multicenter procalcitonin monitoring sepsis (MOSES) study. Crit Care Med, 2017, 45(5): 781-789.

1. Shankar-Hari M, Phillips GS, Levy ML, et al. Developing a new definition and assessing new clinical criteria for septic shock: for the third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 775-787.
2. Reintam A, Parm P, Kitus R, et al. Gastrointestinal symptoms in intensive care patients. Acta Anaesthesiol Scand, 2009, 53(3): 318-324.
3. Mutlu GM, Mutlu EA, Factor P. GI complications in patients receiving mechanical ventilation. Chest, 2001, 119(4): 1222-1241.
4. Montejo JC. Enteral nutrition-related gastrointestinal complications in critically ill patients: a multicenter study. The nutritional and metabolic working group of the Spanish society of intensive care medicine and coronary units. Crit Care Med, 1999, 27(8): 1447-1453.
5. Hill TL. Gastrointestinal tract dysfunction with critical illness: clinical assessment and management. Top Companion Anim Med, 2019, 35: 47-52.
6. Sasabuchi Y, Matsui H, Lefor AK, et al. Risks and benefits of stress ulcer prophylaxis for patients with severe sepsis. Crit Care Med, 2016, 44(7): e464-e469.
7. Piton G, Belon F, Cypriani B, et al. Enterocyte damage in critically ill patients is associated with shock condition and 28-day mortality. Crit Care Med, 2013, 41(9): 2169-2176.
8. Reintam Blaser A, Starkopf J, Alhazzani W, et al. Early enteral nutrition in critically ill patients: ESICM clinical practice guidelines. Intensive Care Med, 2017, 43(3): 380-398.
9. Chen FQ, Xu WZ, Gao HY, et al. Clinical effect of Changweishu on gastrointestinal dysfunction in patients with sepsis. J Int Med Res, 2020, 48(8): 300060520919579.
10. 韩悦, 冷玉鑫, 么改琦. 抗菌药物对肠道菌群和肠黏膜屏障功能的影响及机制. 中华危重病急救医学, 2017, 29(11): 1047-1051.
11. Wang Y, Yang JW, Yan SY, et al. Electroacupuncture vs sham electroacupuncture in the treatment of postoperative ileus after laparoscopic surgery for colorectal cancer: a multicenter, randomized clinical trial. JAMA Surg, 2023, 158(1): 20-27.
12. 中华中医药学会. 2022年度中医药十大学术进展. 江苏中医药, 2023, 55(4): 9-10.
13. 王婷玉, 孟捷. 针灸辅助治疗脓毒症胃肠功能障碍疗效Meta分析. 辽宁中医药大学学报, 2022, 24(2): 165-170.
14. Wang X, Chen Y, Liu Y, et al. Reporting items for systematic reviews and meta-analyses of acupuncture: the PRISMA for acupuncture checklist. BMC Complement Altern Med, 2019, 19(1): 208.
15. Levy MM, Fink MP, Marshall JC, et al. 2001 SCCM/ESICM/ACCP/ATS/SIS international sepsis definitions conference. Crit Care Med, 2003, 31(4): 1250-1256.
16. Dellinger RP, Levy MM, Rhodes A, et al. Surviving sepsis campaign: international guidelines for management of severe sepsis and septic shock: 2012. Crit Care Med, 2013, 41(2): 580-637.
17. Singer M, Deutschman CS, Seymour CW, et al. The third international consensus definitions for sepsis and septic shock (sepsis-3). JAMA, 2016, 315(8): 801-810.
18. 中国中西医结合学会急救医学专业委员会. 重修“95庐山会议”多器官功能障碍综合征病情分期诊断及严重程度评分标准(2015). 中华危重病急救医学, 2016, (2): 99-101.
19. 方军, 李兰, 李冰冰, 等. 针灸对严重脓毒症患者胃肠功能障碍及胃肠激素影响分析. 湖南中医药大学学报, 2016, 36(1): 11.
20. Sterne JAC, Savović J, Page MJ, et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ, 2019, 366: l4898.
21. 刘括, 孙殿钦, 廖星, 等. 随机对照试验偏倚风险评估工具2. 0修订版解读. 中国循证心血管医学杂志, 2019, 11(3): 284-291.
22. Luo D, Wan X, Liu J, et al. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res, 2018, 27(6): 1785-1805.
23. Wan X, Wang W, Liu J, et al. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol, 2014, 14: 135.
24. 李亚莉, 褚玉茹, 于乃浩, 等. 针灸改善脓毒症患者胃肠功能障碍的临床观察. 天津中医药, 2021, 38(4): 479-482.
25. 孙一凡, 裴颖皓, 陈明祺, 等. 基于气机升降理论运用电针干预脓毒症患者急性胃肠损伤的临床研究. 中国中医急症, 2024, 33(7): 1178-1182.
26. 程璐. 针刺治疗脓毒症急性胃肠损伤的随机对照研究. 北京: 北京中医药大学, 2021.
27. 蔡莉娟, 丁学军, 刘文兵, 等. 电针对脓毒症患者胃肠功能障碍的干预作用. 中国中医急症, 2014, 23(2): 268-270.
28. 刘超, 肖阳春, 梁立新, 等. 针刺联合多潘立酮治疗脓毒症急性胃肠损伤疗效观察. 上海针灸杂志, 2020, 39(1): 6-10.
29. Meng JB, Jiao YN, Zhang G, et al. Electroacupuncture improves intestinal dysfunction in septic patients: a randomised controlled trial. Biomed Res Int, 2018, 2018: 8293594.
30. 胡瑞英, 杨广, 李健. 电针治疗脓毒症肠功能障碍的临床研究. 辽宁中医杂志, 2015, 42(11): 2195-2196.
31. 刘凯, 孙宏, 李冀, 等. 腹部电针对脓毒症胃肠功能障碍的影响. 上海针灸杂志, 2019, 38(10): 1118-1121.
32. 刘凯, 王秀珍, 王亚楠, 等. 电腹针对脓毒症并发肠屏障功能障碍的临床研究. 针灸临床杂志, 2022, 38(3): 17-20.
33. 孙德阳, 杨洋, 杜纯鹏, 等. 电针治疗脓毒症胃肠功能障碍的临床研究. 针灸临床杂志, 2019, 35(10): 47-50.
34. 孙芳园, 卢明, 沈伟鸿. 肠三针治疗脓毒症肠功能障碍的临床疗效观察. 蚌埠医学院学报, 2021, 46(10): 1357-1359,1364.
35. 王丽娟. 腹针治疗脓毒症急性胃肠损伤的临床研究. 广州: 广州中医药大学, 2019.
36. 王晓鹏. 针刺辅助治疗脓毒症胃肠功能障碍的随机对照临床研究. 北京: 北京中医药大学, 2019.
37. 王玉华. 脓毒症胃肠功能障碍患者应用穴位电刺激的临床观察. 实用中西医结合临床, 2021, 21(10): 72-73.
38. 韦志友. 复元针法治疗脓毒症患者急性胃肠损伤的临床观察. 北京: 北京中医药大学, 2017.
39. 杨卉卉. 针刺治疗脓毒症患者脾胃虚弱型胃肠功能障碍的临床研究. 济南: 山东中医药大学, 2018.
40. 虞意华, 金肖青, 俞迈红, 等. 针灸对老年严重脓毒症患者胃肠功能及胃肠激素影响的临床研究. 中华中医药学刊, 2015, 33(8): 1953-1956.
41. 卓剑丰, 李健. 针灸对老年严重脓毒症患者胃肠功能的影响. 山西中医, 2017, 33(5): 30, 32.
42. 李海峰, 胡国强, 刘雯雯. 针刺华佗夹脊穴治疗脓毒血症胃肠功能障碍临床疗效观察. 针刺研究, 2019, 44(1): 43-46.
43. 李仕业, 李志亨, 何朝. 穴位电刺激改善脓毒症胃肠功能障碍患者早期肠内营养耐受性. 世界最新医学信息文摘(连续型电子期刊), 2021, 21(26): 255-256.
44. Puleo F, Arvanitakis M, Van Gossum A, et al. Gut failure in the ICU. Semin Respir Crit Care Med, 2011, 32(5): 626-638.
45. Klaus DA, Motal MC, Burger-Klepp U, et al. Increased plasma zonulin in patients with sepsis. Biochem Med (Zagreb), 2013, 23(1): 107-111.
46. Reintam Blaser A, Malbrain ML, Starkopf J, et al. Gastrointestinal function in intensive care patients: terminology, definitions and management. Recommendations of the ESICM working group on abdominal problems. Intensive Care Med, 2012, 38(3): 384-394.
47. 周燕. TEAS改善危重症患者胃肠损伤的临床研究. 南京: 南京中医药大学, 2021.
48. Sungono V, Hariyanto H, Soesilo TEB, et al. Cohort study of the APACHE-Ⅱ score and mortality for different types of intensive care unit patients. Postgrad Med J, 2022, 98(1166): 914-918.
49. Mittal R, Coopersmith CM. Redefining the gut as the motor of critical illness. Trends Mol Med, 2014, 20(4): 214-223.
50. Wacker C, Prkno A, Brunkhorst FM, et al. Procalcitonin as a diagnostic marker for sepsis: a systematic review and meta-analysis. Lancet Infect Dis, 2013, 13(5): 426-435.
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