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Article(id=1322928426339926042, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, articleNumber=null, orderNo=null, doi=10.13193/j.issn.1673-7717.2025.11.007, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=null, receivedDateStr=null, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340315659, onlineDateStr=2026-10-30, pubDate=1762704000000, pubDateStr=2025-11-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340315659, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340315659, creator=13701087609, updateTime=1793340315659, updator=13701087609, issue=Issue{id=1322926985957221241, tenantId=1146029695717560320, journalId=1255847919539208197, year='2025', volume='43', issue='11', pageStart='1', pageEnd='258', issueExtLink='null', onlineDate='null', pubDate='1762704000000', pubDateStr='2025-11-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=0, createTime=1793339972247, creator='13701087609', updateTime=1793340743335, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322930220201804556, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322930220201804557, tenantId=1146029695717560320, journalId=1255847919539208197, issueId=1322926985957221241, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=31, endPage=34, ext={EN=ArticleExt(id=1322928426742579227, articleId=1322928426339926042, tenantId=1146029695717560320, journalId=1255847919539208197, language=EN, title=Effect of Buyang Huanwu Decoction（补阳还五汤）Combined with Acupuncture on Immune Function and Muscle Strength Recovery in Patients with ICU Acquired Myasthenia, columnId=1256183361521967297, journalTitle=Chinese Archives of Traditional Chinese Medicine, columnName=Target on National Project, runingTitle=null, highlight=null, articleAbstract=
Objective

To study the effect of Buyang Huanwu Decoction（补阳还五汤）combined with acupuncture on immune function and muscle strength recovery in patients with acquired myasthenia in Intensive Care Unit（ICU）.

Methods

From January to October 2023，72 patients with ICU-acquired myasthenia in the hospital were selected. The random number table method was divided into two groups，36 cases in each group. Both groups received routine rehabilitation intervention. At the same time，the control group was treated with acupuncture and moxibustion，and the observation group was treated with Buyang Huanwu Decoction combined with acupuncture. The recovery time，muscle strength，daily activity ability，immune function index and adverse reactions were compared between the two groups.

Results

The mechanical ventilation time，ICU hospitalization time and total hospitalization time in the observation group were shorter than those in the control group［（5.97±2.10）d，（16.32±3.77）d，（32.67±3.18）d vs（7.45±1.84）d，（18.90±4.06）d，（35.29±4.06）d］（P<0.05）. There was no significant difference in muscle strength，daily activity ability or immune function between the two groups before treatment（P>0.05）. At 2 and 4 weeks after treatment，the muscle strength rating scale（MRC）scores of the observation group were lower than those of the control group［（76.85±6.92）points，（86.90±5.83）points vs（72.03±5.11）points，（82.76±6.47）points］（P<0.05）. The Barthel index（MBI）score of the observation group was lower than that of the control group［（74.34±5.68）points，（90.25±5.36）points vs（68.21±6.10）points，（86.03±6.33）points］（P<0.05）. The levels of interleukin（IL）-6，IL-8，tumor necrosis factorα（TNF-α）and insulin-like growth factor 1（IGF-1）in the observation group were better than those in the control group［（22.51±2.64）pg/mL，（43.74±5.60）pg/mL，（29.49±2.85）pg/mL，（117.50±10.49）ng/mL vs（26.08±3.05）pg/mL，（47.09±6.11）pg/mL，（33.01±2.48）pg/mL，（105.63±11.20）ng/mL］（P<0.05）. The incidence of adverse reactions was 8.33% in the observation group and 13.89% in the control group（P>0.05）.

Conclusion

Buyang Huanwu Decoction combined with acupuncture is effective in the treatment of ICU acquired myasthenia. It can enhance muscle strength，improve daily living ability，regulate immune balance，and promote faster recovery of patients. It is a safe and reliable treatment plan.

, authors=Lihong DONG, Yijie WANG, Haiyan ZHAO, Xiaolin ZHU, Chen HE, authorsList=Lihong DONG, Yijie WANG, Haiyan ZHAO, Xiaolin ZHU, Chen HE, authorCompany=null, correspAuthors=null, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322928429783449638, articleId=1322928426339926042, tenantId=1146029695717560320, journalId=1255847919539208197, language=CN, title=补阳还五汤联合针刺治疗重症监护病房获得性肌无力对患者免疫功能及肌力恢复的影响, columnId=1256183362172142382, journalTitle=中华中医药学刊, columnName=国家项目点击, runingTitle=null, highlight=null, articleAbstract=
目的

研究补阳还五汤联合针刺治疗重症监护病房（intensive care unit，ICU）获得性肌无力对患者免疫功能及肌力恢复的影响。

方法

选取ICU获得性肌无力患者72例，随机数表法均分为两组，每组36例，两组患者均接受常规康复干预，同时对照组采用针灸治疗，观察组采用补阳还五汤联合针刺治疗。比较两组患者的恢复时间、肌力、日常活动能力、免疫功能指标、不良反应情况。

结果

观察组机械通气时间、ICU住院时间、总住院时间均短于对照组［（5.97±2.10）d、（16.32±3.77）d、（32.67±3.18）d vs（7.45±1.84）d、（18.90±4.06）d、（35.29±4.06）d］，差异有统计学意义（P<0.05）；治疗前两组肌力、日常活动能力、免疫功能指标差异无统计学意义（P>0.05），治疗后2、4周，观察组肌力评定量表（medical research council scale，MRC）评分低于对照组［（76.85±6.92）分、（86.90±5.83）分vs（72.03±5.11）分、（82.76±6.47）分］，差异有统计学意义（P<0.05）；观察组Barthel指数（modified Barthel index，MBI）评分低于对照组［（74.34±5.68）分、（90.25±5.36）分vs（68.21±6.10）分、（86.03±6.33）分］，差异有统计学意义（P<0.05）；治疗后观察组白细胞介素（interleukin，IL）-6、IL-8、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及胰岛素样生长因子-1（insulin-like growth factor 1，IGF-1）水平优于对照组［（22.51±2.64）pg/mL、（43.74±5.60）pg/mL、（29.49±2.85）pg/mL、（117.50±10.49）ng/mL vs（26.08±3.05）pg/mL、（47.09±6.11）pg/mL、（33.01±2.48）pg/mL、（105.63±11.20）ng/mL］，差异有统计学意义（P<0.05）；观察组不良反应发生率8.33%（3/36）、对照组13.89%（5/36），差异无统计学意义（P>0.05）。

结论

补阳还五汤联合针刺治疗ICU获得性肌无力效果满意，能增强肌力，改善日常生活能力，调节免疫平衡，促进患者更快康复，是安全可靠的治疗方案。

, authors=董丽宏, 王怡洁, 赵海燕, 朱晓琳, 何辰, authorsList=董丽宏, 王怡洁, 赵海燕, 朱晓琳, 何辰, authorCompany=null, correspAuthors=null, authorNote=

董丽宏（1976-），女，云南昆明人，主任医师，硕士，研究方向：重症医学。

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董丽宏（1976-），女，云南昆明人，主任医师，硕士，研究方向：重症医学。

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董丽宏（1976-），女，云南昆明人，主任医师，硕士，研究方向：重症医学。

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journalId=1255847919539208197, articleId=1322928426339926042, doi=null, pmid=null, pmcid=null, year=2021, volume=39, issue=7, pageStart=228, pageEnd=231, url=null, language=null, rfNumber=［22］, rfOrder=21, authorNames=周玉玲, 张颜彦, 胡婧, journalName=中华中医药学刊, refType=null, unstructuredReference=周玉玲，张颜彦，胡婧，等. 补阳还五汤联合针刺疗法对重症监护病房获得性肌无力肢体运动功能及免疫功能影响［J］. 中华中医药学刊，2021，39（7）：228-231., articleTitle=补阳还五汤联合针刺疗法对重症监护病房获得性肌无力肢体运动功能及免疫功能影响, refAbstract=null), Reference(id=1322928440021745780, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, doi=null, pmid=null, pmcid=null, year=2024, volume=37, issue=1, pageStart=39, pageEnd=47, url=null, language=null, rfNumber=［23］, rfOrder=22, authorNames=张涛, 叶斌, 严隽陶, journalName=西部中医药, refType=null, unstructuredReference=张涛，叶斌，严隽陶，等. 基于网络药理学方法探讨黄芪治疗骨骼肌减少症的作用机制［J］. 西部中医药，2024，37（1）：39-47., articleTitle=基于网络药理学方法探讨黄芪治疗骨骼肌减少症的作用机制, refAbstract=null), Reference(id=1322928440105631861, tenantId=1146029695717560320, 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组别例数性别/（例）平均年龄/（岁±s）原发疾病/（例）
男女急性肺损伤慢性阻塞性肺疾病感染性休克多器官功能衰竭
对照组36191744.6±5.3137610
观察组36211545.4±6.1128511
χ2/t值0.2250.5940.245
P值0.6350.5540.970
), ArticleFig(id=1322928434338463825, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, language=CN, label=表1, caption=

两组重症监护病房获得性肌无力患者一般资料比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数性别/（例）平均年龄/（岁±s）原发疾病/（例）
男女急性肺损伤慢性阻塞性肺疾病感染性休克多器官功能衰竭
对照组36191744.6±5.3137610
观察组36211545.4±6.1128511
χ2/t值0.2250.5940.245
P值0.6350.5540.970
), ArticleFig(id=1322928434653036626, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数机械通气时间ICU住院时间总住院时间
观察组365.97±2.1016.32±3.7732.67±3.18
对照组367.45±1.8418.90±4.0635.29±4.06
t值3.1802.7943.048
P值0.0020.0070.003
), ArticleFig(id=1322928435068272723, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, language=CN, label=表2, caption=

两组重症监护病房获得性肌无力患者恢复时间比较（±s）

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组别例数机械通气时间ICU住院时间总住院时间
观察组365.97±2.1016.32±3.7732.67±3.18
对照组367.45±1.8418.90±4.0635.29±4.06
t值3.1802.7943.048
P值0.0020.0070.003
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组别例数治疗前治疗后2周治疗后4周
观察组3644.39±5.4076.85±6.92a86.90±5.83ab
对照组3643.84±5.0772.03±5.11a82.76±6.47ab
t值0.4463.3622.852
P值0.6570.0010.006
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两组重症监护病房获得性肌无力患者MRC评分比较（±s）

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组别例数治疗前治疗后2周治疗后4周
观察组3644.39±5.4076.85±6.92a86.90±5.83ab
对照组3643.84±5.0772.03±5.11a82.76±6.47ab
t值0.4463.3622.852
P值0.6570.0010.006
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组别例数治疗前治疗后2周治疗后4周
观察组3646.80±5.1974.34±5.68a90.25±5.36ab
对照组3647.09±4.8268.21±6.10a86.03±6.33ab
t值0.2464.4133.053
P值0.807<0.0010.003
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两组重症监护病房获得性肌无力患者MBI评分比较（±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数治疗前治疗后2周治疗后4周
观察组3646.80±5.1974.34±5.68a90.25±5.36ab
对照组3647.09±4.8268.21±6.10a86.03±6.33ab
t值0.2464.4133.053
P值0.807<0.0010.003
), ArticleFig(id=1322928436024574040, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数IL-6/（pg/mL）IL-8/（pg/mL）TNF-α/（g/L）IGF-1/（ng/mL）
治疗前治疗后4周治疗前治疗后4周治疗前治疗后4周治疗前治疗后4周
观察组3639.30±3.7922.51±2.64a77.92±6.8243.74±5.60a46.02±3.9429.49±2.85a78.61±5.73117.50±10.49a
对照组3640.21±4.1026.08±3.05a78.15±7.2047.09±6.11a45.31±4.3633.01±2.48a79.24±6.08105.63±11.20a
t值0.9785.3100.1392.4250.7255.5900.4524.641
P值0.332<0.0010.8900.0180.471<0.0010.652<0.001
), ArticleFig(id=1322928436095877209, tenantId=1146029695717560320, journalId=1255847919539208197, articleId=1322928426339926042, language=CN, label=表5, caption=

两组重症监护病房获得性肌无力患者免疫功能指标比较（±s）

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组别例数IL-6/（pg/mL）IL-8/（pg/mL）TNF-α/（g/L）IGF-1/（ng/mL）
治疗前治疗后4周治疗前治疗后4周治疗前治疗后4周治疗前治疗后4周
观察组3639.30±3.7922.51±2.64a77.92±6.8243.74±5.60a46.02±3.9429.49±2.85a78.61±5.73117.50±10.49a
对照组3640.21±4.1026.08±3.05a78.15±7.2047.09±6.11a45.31±4.3633.01±2.48a79.24±6.08105.63±11.20a
t值0.9785.3100.1392.4250.7255.5900.4524.641
P值0.332<0.0010.8900.0180.471<0.0010.652<0.001
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组别例数恶心呕吐静脉血栓感染合计
观察组362（5.56）0（0.00）1（2.78）3（8.33）
对照组362（5.56）1（2.78）2（5.56）5（13.89）
χ2值0.141
P值0.708
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两组重症监护病房获得性肌无力患者不良反应情况比较

, figureFileSmall=null, figureFileBig=null, tableContent=
组别例数恶心呕吐静脉血栓感染合计
观察组362（5.56）0（0.00）1（2.78）3（8.33）
对照组362（5.56）1（2.78）2（5.56）5（13.89）
χ2值0.141
P值0.708
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补阳还五汤联合针刺治疗重症监护病房获得性肌无力对患者免疫功能及肌力恢复的影响
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董丽宏 , 王怡洁 , 赵海燕 , 朱晓琳 , 何辰
中华中医药学刊 | 国家项目点击 2025,43(11): 31-34
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中华中医药学刊 |国家项目点击 2025 , 43 (11) : 31 -34
补阳还五汤联合针刺治疗重症监护病房获得性肌无力对患者免疫功能及肌力恢复的影响
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董丽宏, 王怡洁, 赵海燕, 朱晓琳, 何辰
作者信息
  • 昆明医科大学第一附属医院，云南 昆明 650032
作者简介:

董丽宏（1976-），女，云南昆明人，主任医师，硕士，研究方向：重症医学。

Effect of Buyang Huanwu Decoction（补阳还五汤）Combined with Acupuncture on Immune Function and Muscle Strength Recovery in Patients with ICU Acquired Myasthenia
Lihong DONG, Yijie WANG, Haiyan ZHAO, Xiaolin ZHU, Chen HE
Affiliations
  • First Affiliated Hospital of Kunming Medical University，Kunming 650032，Yunnan，China
出版时间: 2025-11-10 doi: 10.13193/j.issn.1673-7717.2025.11.007
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摘要
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目的

研究补阳还五汤联合针刺治疗重症监护病房（intensive care unit，ICU）获得性肌无力对患者免疫功能及肌力恢复的影响。

方法

选取ICU获得性肌无力患者72例，随机数表法均分为两组，每组36例，两组患者均接受常规康复干预，同时对照组采用针灸治疗，观察组采用补阳还五汤联合针刺治疗。比较两组患者的恢复时间、肌力、日常活动能力、免疫功能指标、不良反应情况。

结果

观察组机械通气时间、ICU住院时间、总住院时间均短于对照组［（5.97±2.10）d、（16.32±3.77）d、（32.67±3.18）d vs（7.45±1.84）d、（18.90±4.06）d、（35.29±4.06）d］，差异有统计学意义（P<0.05）；治疗前两组肌力、日常活动能力、免疫功能指标差异无统计学意义（P>0.05），治疗后2、4周，观察组肌力评定量表（medical research council scale，MRC）评分低于对照组［（76.85±6.92）分、（86.90±5.83）分vs（72.03±5.11）分、（82.76±6.47）分］，差异有统计学意义（P<0.05）；观察组Barthel指数（modified Barthel index，MBI）评分低于对照组［（74.34±5.68）分、（90.25±5.36）分vs（68.21±6.10）分、（86.03±6.33）分］，差异有统计学意义（P<0.05）；治疗后观察组白细胞介素（interleukin，IL）-6、IL-8、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及胰岛素样生长因子-1（insulin-like growth factor 1，IGF-1）水平优于对照组［（22.51±2.64）pg/mL、（43.74±5.60）pg/mL、（29.49±2.85）pg/mL、（117.50±10.49）ng/mL vs（26.08±3.05）pg/mL、（47.09±6.11）pg/mL、（33.01±2.48）pg/mL、（105.63±11.20）ng/mL］，差异有统计学意义（P<0.05）；观察组不良反应发生率8.33%（3/36）、对照组13.89%（5/36），差异无统计学意义（P>0.05）。

结论

补阳还五汤联合针刺治疗ICU获得性肌无力效果满意，能增强肌力，改善日常生活能力，调节免疫平衡，促进患者更快康复，是安全可靠的治疗方案。

补阳还五汤  /  针刺  /  重症监护病房  /  获得性肌无力  /  免疫功能  /  肌力
Objective

To study the effect of Buyang Huanwu Decoction（补阳还五汤）combined with acupuncture on immune function and muscle strength recovery in patients with acquired myasthenia in Intensive Care Unit（ICU）.

Methods

From January to October 2023，72 patients with ICU-acquired myasthenia in the hospital were selected. The random number table method was divided into two groups，36 cases in each group. Both groups received routine rehabilitation intervention. At the same time，the control group was treated with acupuncture and moxibustion，and the observation group was treated with Buyang Huanwu Decoction combined with acupuncture. The recovery time，muscle strength，daily activity ability，immune function index and adverse reactions were compared between the two groups.

Results

The mechanical ventilation time，ICU hospitalization time and total hospitalization time in the observation group were shorter than those in the control group［（5.97±2.10）d，（16.32±3.77）d，（32.67±3.18）d vs（7.45±1.84）d，（18.90±4.06）d，（35.29±4.06）d］（P<0.05）. There was no significant difference in muscle strength，daily activity ability or immune function between the two groups before treatment（P>0.05）. At 2 and 4 weeks after treatment，the muscle strength rating scale（MRC）scores of the observation group were lower than those of the control group［（76.85±6.92）points，（86.90±5.83）points vs（72.03±5.11）points，（82.76±6.47）points］（P<0.05）. The Barthel index（MBI）score of the observation group was lower than that of the control group［（74.34±5.68）points，（90.25±5.36）points vs（68.21±6.10）points，（86.03±6.33）points］（P<0.05）. The levels of interleukin（IL）-6，IL-8，tumor necrosis factorα（TNF-α）and insulin-like growth factor 1（IGF-1）in the observation group were better than those in the control group［（22.51±2.64）pg/mL，（43.74±5.60）pg/mL，（29.49±2.85）pg/mL，（117.50±10.49）ng/mL vs（26.08±3.05）pg/mL，（47.09±6.11）pg/mL，（33.01±2.48）pg/mL，（105.63±11.20）ng/mL］（P<0.05）. The incidence of adverse reactions was 8.33% in the observation group and 13.89% in the control group（P>0.05）.

Conclusion

Buyang Huanwu Decoction combined with acupuncture is effective in the treatment of ICU acquired myasthenia. It can enhance muscle strength，improve daily living ability，regulate immune balance，and promote faster recovery of patients. It is a safe and reliable treatment plan.

Buyang Huanwu Decoction（补阳还五汤）  /  acupuncture  /  intensive care unit  /  acquired muscle weakness  /  immune function  /  muscle strength
董丽宏, 王怡洁, 赵海燕, 朱晓琳, 何辰. 补阳还五汤联合针刺治疗重症监护病房获得性肌无力对患者免疫功能及肌力恢复的影响. 中华中医药学刊, 2025 , 43 (11) : 31 -34 . DOI: 10.13193/j.issn.1673-7717.2025.11.007
Lihong DONG, Yijie WANG, Haiyan ZHAO, Xiaolin ZHU, Chen HE. Effect of Buyang Huanwu Decoction（补阳还五汤）Combined with Acupuncture on Immune Function and Muscle Strength Recovery in Patients with ICU Acquired Myasthenia[J]. Chinese Archives of Traditional Chinese Medicine, 2025 , 43 (11) : 31 -34 . DOI: 10.13193/j.issn.1673-7717.2025.11.007
正文
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重症监护病房（intensive care unit，ICU）获得性肌无力是危重病患者中常见的后遗症，随着医药技术的进步ICU患者整体存活率得以提高，ICU获得性肌无力得到更多关注，以保证ICU患者后续生存质量[1-2]。病情严重程度高、脓毒症、多器官功能衰竭、长时间制动和高血糖等多种原因均可能导致ICU获得性肌无力的发生，特征是广泛性肢体乏力，增加患者并发症发生，使得机械通气时间得以延长甚至发生脱机困难，患者致残、病死率增加[3-5]。对患者而言，早期、目标性的康复治疗非常重要。近年来有研究提示中医药治疗可提高ICU获得性肌无力患者的临床疗效，提高肌力和日常生活能力[6]。也有研究表明ICU获得性肌无力的不同中医证型与临床预后存在一定相关性[7]。ICU获得性肌无力在中医学中归属“痿证”范畴，中医药干预方案在该疾病中的应用值得探讨，本研究分析补阳还五汤联合针刺治疗ICU获得性肌无力对患者免疫功能及肌力恢复的影响，为疾病的诊治工作提供参考信息，现报道如下。
1　资料与方法
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1.1　一般资料
选取2023年1月—10月医院ICU获得性肌无力患者72例，纳入标准：均符合《ICU获得性肌无力的发生和诊断及治疗》中诊断标准[8]，年龄18～65岁，机械通气时间>48 h，脑神经功能正常，患者和/或其家属知情同意研究内容。排除标准：体内存在除颤器或起搏器植入者及其他金属植入者；腰椎间盘突出或其他骨骼疾病等患者；肿瘤放化疗患者；各种原因导致不能配合完成研究内容者。随机数表法均分为两组，每组36例，两组一般资料均衡可比，差异无统计学意义（P>0.05），见表1。
1.2　方法
两组患者均接受常规康复干预，包括治疗原发疾病、密切监测生命体征、营养支持、根据个体情况每日适当进行被动和/或主动锻炼。同时对照组采用针灸治疗，上肢取肩髃穴、曲池穴、合谷穴，下肢取足三里、丰隆穴、三阴交、内庭穴，选用0.3 mm×40 mm毫针，将穴位及其周边皮肤进行常规消毒，指切法进针，得气后完成小幅度提插捻转，每个穴位行针2 min，留针30 min，隔日1次。观察组采用补阳还五汤联合针刺治疗，针刺疗法完全同对照组，补阳还五汤成分：生黄芪60 g，当归10 g，赤芍15 g，地龙10 g，川芎15 g，红花5 g，桃仁10 g，每日1剂以水煎煮后分早晚2次服用。两组患者的治疗均2周为1个疗程，治疗2个疗程。
1.3　观察指标
（1）恢复时间：记录并比较两组患者的机械通气时间、ICU住院时间、总住院时间。（2）肌力：采用医学研究委员会（medical research council，MRC）[9]提出的用数字等级0～5级来表示肌力，评估肌群包括上肢（双侧腕关节伸展、肘关节屈曲、肩关节外展）和下肢（双侧足背屈、膝关节伸展、髋关节屈曲）部分，总分60分，评分越高，肌力状况越好。（3）日常活动能力：采用Barthel指数（modified Barthel index，MBI）评估，包括10个方面共计100分，能够完全独立地进食10分，能够独立地洗澡5分，能够完成修饰5分，独立穿衣10分，能够自己控制大便10分，独立控制小便10分，自己上厕所10分，能够独立完成床椅转移15分，能够自己平地行走15分，能够独立上下楼梯10分，总分越高则表明日常活动能力越强[10]。（4）免疫功能指标：取患者晨起空腹静脉血获得分离血清样本，以酶联免疫吸附法检测白细胞介素（interleukin，IL）-6、IL-8、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）及胰岛素样生长因子-1（insulin-like growth factor 1，IGF-1）水平。（5）不良反应发生情况：记录治疗期间患者有无恶心呕吐、静脉血栓、感染等不良反应发生。
1.4　统计学分析
采用SPSS 23.0软件为分析工具，计数资料采用χ2检验，计量资料采用t检验，P<0.05为差异有统计学意义。
2　结果
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2.1　恢复时间比较
观察组机械通气时间、ICU住院时间、总住院时间均短于对照组，差异有统计学意义（P<0.05），见表2。
2.2　肌力比较
治疗前两组MRC评分差异无统计学意义（P>0.05），治疗后2、4周，观察组肌力MRC评分低于对照组，差异有统计学意义（P<0.05），见表3。
2.3　日常活动能力比较
治疗前两组日常活动能力差异无统计学意义（P>0.05），治疗后2、4周，观察组日常活动能力MBI评分低于对照组，差异有统计学意义（P<0.05），见表4。
2.4　免疫功能指标比较
治疗前两组免疫功能指标差异无统计学意义（P>0.05），治疗后4周，观察组IL-6、IL-8、TNFα及IGF-1水平优于对照组，差异有统计学意义（P<0.05），见表5。
2.5　不良反应比较
观察组不良反应发生率8.33%、对照组13.89%，差异无统计学意义（P>0.05）。见表6。
3　讨论
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ICU获得性肌无力使ICU患者病情更复杂、病程更长，严重影响了患者的预后[11]。中医学将ICU获得性肌无力归为痿证，是肢体筋脉弛缓，软弱无力，不能随意运动或伴有肌肉萎缩的一种病证[12]。《素问·痿证篇》提出“五脏使人痿”，并且根据病因影响脏腑的不同，分为脉痿、肉痿、骨痿、筋痿、痿躄等五痿。《景岳全书·痿证》强调精血亏虚致痿：“元气败伤，则精虚不能灌溉，血虚不能营养者亦不少。”也有研究提示“脾主肌肉”“脾主四肢”，脾虚失运，筋脉肌肉失养而肌肉痿软无力[13-14]。故治疗ICU获得性肌无力需要调理脏气，恢复正气，强调辨证施治，或单用针灸，或针药结合[15]。
多年来针灸治疗重症肌无力取得了一定的疗效[16]。本研究中对照组采用针灸治疗，一定程度上改善了患者的肌力状况及日常生活能力，机体免疫指标也得以改善。针灸上肢取穴肩髃穴、曲池穴、合谷穴，肩髃穴具有清热祛风、通利关节的功效，曲池穴疏风清热、通络止痛[17]，合谷穴清热解表、明目聪耳、通络镇痛[18]；下肢取穴足三里、丰隆穴、三阴交、内庭穴，足三里调理脾胃、补中益气、通经活络、疏风化湿、扶正祛邪，丰隆穴健脾和胃、化痰开窍、行气降逆，三阴交调补肝、脾、肾三经气血，内庭穴清降胃火、通涤腑气[19]。以上穴位针灸共同发挥提振阳气、补益气血、平衡阴阳、通利关节的作用。
研究中观察组在对照组基础上增加了补阳还五汤用药，发挥了更为显著的治疗作用。补阳还五汤是中医方剂名，出自清代王清任编撰的《医林改错》一书，近年来相关研究证实其对于舒筋、活络、补气的功效突出[20-22]。方中生黄芪补益元气、祛瘀通络，当归补血活血，赤芍清热凉血、散瘀止痛，地龙清热定惊、通经活络，川芎活血行气、祛风止痛，红花活血通经、散瘀止痛，桃仁活血祛瘀，以上诸药合用在补气活血的同时祛瘀通络，能够补而不滞，进而对于ICU获得性肌无力发挥舒筋活络作用，促进肌力恢复。现代药理学研究中，黄芪可能通过调控炎症反应及凋亡过程，影响蛋白质结合、转运活性、肌动蛋白结合、生长因子活性等分子功能对抗骨骼肌萎缩[23-24]；补阳还五汤可以通过晚期糖基化终末产物-晚期糖基化终末产物受体信号通路、白细胞介素17信号通路、TNF信号通路等多条信号通路调节机体免疫反应、细胞增殖和凋亡等过程，使得机体达到免疫平衡[25-26]。
综上所述，补阳还五汤联合针刺治疗ICU获得性肌无力效果满意，能增强肌力，改善日常生活能力，调节免疫平衡，促进患者更快康复，是安全可靠的治疗方案。
基金
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  • 国家自然科学基金地区科学基金项目(81960109)
  • 云南省科技厅昆明医科大学联合专项(202001AY070001-205)
文献
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2025年第43卷第11期
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doi: 10.13193/j.issn.1673-7717.2025.11.007
  • 首发时间：2026-10-30
  • 出版时间：2025-11-10
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基金
国家自然科学基金地区科学基金项目(81960109)
云南省科技厅昆明医科大学联合专项(202001AY070001-205)
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    昆明医科大学第一附属医院，云南 昆明 650032
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genus		 种数
Number of
species		 占总种数比例
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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