应用复方环磷酸腺苷的肠内营养对急性白血病化疗患者的支持作用研究

发布时间：2018-03-25 15:45

本文选题：环磷酸腺苷　切入点：急性白血病　出处：《山西医科大学》2017年硕士论文

【摘要】：目的:选用添加复方环磷酸腺苷的肠内营养干预方式,观察其对急性白血病化疗患者的临床症状、贫血状态、免疫功能及营养状况的干预效果,探讨适合于急性白血病化疗患者的肠内营养干预方式,以期改善急性白血病化疗患者的营养状况,缓解临床症状,纠正贫血,增强免疫防御能力,缩短住院治疗时间。方法:选用山西医科大学第二医院血液科确诊的急性白血病化疗患者73例,随机分为干预组37例,对照组36例。两组患者在常规临床治疗的基础上,均按照每标准公斤体重等热量(105k J/d)等氮(1.5g/d)的膳食原则,分别给予个体化营养指导及肠内营养食谱的常规肠内营养支持,干预组患者在常规肠内营养支持的基础上给予复方环磷酸腺苷40ml/d,连续使用4周。在干预试验过程中,观察患者的生命体征,记录其胃肠道功能、精神睡眠状况的变化情况以及住院治疗时间,分别于干预前、干预的第2周末和第4周末抽取两组患者空腹静脉血(禁食12h),检测相关观察指标:(1)血液指标:血红蛋白(HGB)、红细胞(RBC)及血小板(PLT);(2)免疫指标:T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/CD8+)及NK细胞;(3)营养指标:血清总蛋白(TP)、前白蛋白(PA)及白蛋白(ALB)。结果:1.临床观察指标:在肠内营养干预试验中,两组患者各项生命体征保持平稳,胃肠道不良反应发生率无明显差异(P0.05)。与对照组患者相比,干预组患者的精神及睡眠状况在试验期间较稳定,恶心的发生情况也较轻(P0.05);食欲下降及呕吐的发生情况虽有所减轻,但组间差异无统计学意义(P0.05)。2.血液指标:试验前,干预组与对照组患者的血液指标组间无明显差异(P0.05)。在干预的第2周末及第4周末,干预组患者的HGB、RBC及PLT较干预前均明显升高(P0.05)。且与对照组患者相比,干预组患者的HGB、RBC及PLT在干预的第2周末及第4周末升高更为显著(P0.05)。3.免疫指标:试验前,干预组与对照组患者的免疫指标组间均衡可比(P0.05)。与对照组患者相比,干预组患者的NK细胞含量在干预的第2周末及第4周末均高于对照组(P0.05)。而干预组患者的CD3+、CD4+、CD8+及CD4+/CD8+仅在干预的第4周末明显优于对照组(P0.05)。在干预的第2周末,干预组患者的T淋巴细胞亚群指标虽均高于对照组,但无统计学意义(P0.05)。4.营养指标:试验前,干预组与对照组患者的营养指标组间差异无统计学意义(P0.05)。在干预的第2周末及第4周末,干预组患者的TP、PA及ALB较干预前均明显升高(P0.05)。且与对照组患者相比,干预组患者的TP、PA及ALB在干预的第2周末及第4周末升高更为显著(P0.05)。5.平均住院治疗时间:在肠内营养干预试验中,干预组患者的平均住院治疗时间与对照组相比缩短(P0.05)。结论:天然肠内营养支持物复方环磷酸腺苷可减轻患者的胃肠道负担。应用复方环磷酸腺苷的肠内营养支持可纠正患者的贫血状况,增强机体免疫防御功能,改善患者的营养状况,且有助于改善患者的胃肠道功能、精神及睡眠状况,减轻化疗的毒副反应,缩短患者的住院治疗时间。
[Abstract]:Objective: to use compound cyclic adenosine monophosphate enteral nutrition intervention, observe the clinical symptoms of patients with acute leukemia chemotherapy anemia, intervention effect of immune function and nutritional status, to explore suitable for patients with acute leukemia and enteral nutrition intervention methods, in order to improve the nutritional status of patients with acute leukemia. Alleviate the clinical symptoms, correct anemia, enhance the immune defense ability, shorten the time of hospitalization. Methods: 73 patients with acute leukemia by the second hospital of Shanxi Medical University Department of Hematology diagnosed cases, 37 cases were randomly divided into intervention group, 36 cases in the control group. Two groups of patients on the basis of routine clinical treatment, in accordance with the standard per kg of body weight. Heat (105K J/d) and nitrogen (1.5g/d) dietary principles were given routine intestinal individualized nutritional guidance and enteral nutrition diet nutrition support, patients in the intervention group Based on the conventional enteral nutrition support with compound camp 40ml/d, using for 4 weeks. In the intervention process, observe the patient's vital signs, record the gastrointestinal function, changes of sleep status of spirit and the time of hospitalization, respectively, before the intervention, the intervention of second and fourth weeks from two groups fasting venous blood (fasting 12h), observe the relevant indexes: (1) blood hemoglobin (HGB), red blood cell (RBC) and platelet (PLT); (2) immune index: T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and NK cells (3); nutrition index serum total protein (TP), prealbumin (PA) and albumin (ALB). Results: 1. clinical observation indexes: in enteral nutrition intervention trials, two groups of patients with various vital signs, gastrointestinal adverse reaction incidence rate had no significant difference (P0.05). Compared with the control group, intervention groups of patients The spirit and sleep status was stable during the experiment, the incidence of nausea was lower (P0.05); loss of appetite and vomiting is mitigated, but no significant difference between the groups (P0.05):.2. blood test before the intervention group and the control group had no significant difference between groups of patients with blood index (P0.05). In the second and 4 weekend weekend intervention, the intervention group of HGB, RBC and PLT were significantly higher than those before intervention (P0.05). Compared with control group, intervention group were HGB, RBC and PLT in the second week and 4 week intervention were higher (P0.05).3. immune index: before the test, the intervention group and the control group of patients with immune index between equallycomparable (P0.05). Compared with the control group, the intervention group of patients with NK cells were second and 4 in the intervention weekend weekend were higher than the control group (P0.05). The patients in the intervention group CD3+, CD4+, and CD8+ CD 4+/CD8+ only in the intervention fourth weeks was significantly better than the control group (P0.05). In the second week intervention, intervention index of T lymphocyte subsets in patients was higher than that of the control group, but no statistical significance (P0.05).4. nutrition index: before the test, the intervention group and the control group of patients with nutritional index group no significant difference meaning (P0.05). In the second week and 4 week intervention, the intervention group of TP, PA and ALB were significantly higher than those before intervention (P0.05). Compared with control group, intervention group were TP, PA and ALB in the second week and 4 week intervention is more significant rise (P0.05).5.: the average time of hospitalization in enteral nutrition intervention trials, the average hospitalization time of intervention group and control group were shortened (P0.05). Conclusion: natural enteral nutrition compound camp can reduce the gastrointestinal burden. Application of compound cyclic adenosine monophosphate Enteral nutrition support can correct the anemia of patients, enhance the immune defense function, improve the nutritional status of patients, and help improve gastrointestinal function, mental and sleep status, reduce the toxic and side effects of chemotherapy, and shorten the hospitalization time of patients.

【学位授予单位】：山西医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71;R459.3

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