刺四缝结合营养干预治疗小儿脾失健运证厌食的临床研究

发布时间：2018-11-29 09:48

【摘要】：目的运用观察刺四缝联合营养干预治疗小儿脾失健运证厌食的疗效。系统观察其临床疗效,分析对治疗前后和治疗结束3个月回访时患儿的症状和营养素摄入情况,最后验证儿童营养门诊中针对脾失健运证小儿厌食,开展刺四缝联合营养干预方法的疗效。方法收集2016年1月至2016年7月期间就诊于南京市雨花台区妇幼保健所儿童营养门诊的脾失健运证厌食症患儿104例,年龄为1～3岁,按照随机对照的原则,受试患儿病例共分为三组:刺四缝组36例、营养干预组37例和联合组(刺四缝联合营养干预)31例。其中,刺四缝治疗是经常规消毒后用5分针速点刺掌侧食指、中指、无名指、小指第二关节中部0.1-0.5cm,挤出少量黏液或血液后用消毒棉球擦拭压迫止血,一周两次。营养干预分为膳食指导和饮食行为指导:膳食指导是家长填写3日(2工作日和1休息日)24h膳食调查表并录入营养之星膳食调查系统,分析计算出三日各营养素摄入情况,取平均值,并根据《中国居民膳食指南(2011年)》指导饮食结构;饮食行为指导采用爱饭达饮食行为评估,对厌食幼儿饮食行为习惯进行询问并评定,评定结果分为胃口差、对某种食物特别偏好、不良进食习惯、父母过度关心、害怕进食五种,并进行对应的饮食习惯养成指导或转诊治疗,营养干预一周一次。营养干预与刺四缝疗法均为2周1疗程。结果治疗结束时,联合组痊愈10例,占32.26%,显效19例,占61.29%,进步1人,占3.23%,无效1人,占3.23%,愈显率93.6%;刺四缝组痊愈10例,占27.78%,显效21例,占58.33%,进步3例,占8.33%,无效2例,占5.56%,愈显率86.11%;营养干预组痊愈3例,占8.11%,显效23例,占62.16%,进步6例,占16.22%,无效5人,占13.51%,愈显率70.27%。联合组和刺四缝组在疗效方面疗效优于营养干预组(P0.05);营养干预组能量和脂肪提升较少(P0.05),联合组蛋白质提升较多(P0.05)。治疗结束3个月回访,联合组痊愈18例,占58.06%,显效13例,占41.94%,愈显率100%;刺四缝组痊愈11例,占30.56%,显效21例,占58.33%,进步2例,占5.56%,无效2例,占5.56%,愈显率88.89%;营养干预组痊愈6例,占16.22%,显效24例,占64.86%,进步4例,占10.81%,无效3例,占8.11%,愈显率81.08%。联合组能量、蛋白质、脂肪提升疗效最好(P0.05),且疗效最优(P0.01)。三组患儿治疗结束时,厌食症状均有改善,具有临床疗效,刺四缝联合营养干预方法治疗小儿脾失健运证厌食相对于单一运用刺四缝或营养干预,治疗结束3个月时回访结果疗效更佳,整个治疗过程中,患儿无不良反应,说明三种治疗方法在营养门诊及基层单位均安全,说明刺四缝与营养干预的联合疗法具有疗效好且持久,便于操作,安全等特点,值得在儿童营养门诊中推广。结论通过本次研究,刺四缝与营养干预联合治疗小儿脾失健运证厌食的疗效优于单纯使用任一方法,并具有统计学意义(P0.05),具有疗效确切,操作简便,易被患儿及家长接受等优势,联合营养学方法,充分发挥祖国医学优势,值得在基层儿童营养门诊中推广。
[Abstract]:Objective To observe the effect of four-slit combined nutrition intervention on the treatment of anorexia of the spleen of children. The clinical effect of the system was observed, and the symptoms and nutrient intake of the children were analyzed before and after treatment and at the end of 3 months. Methods 104 children with anorexia nervosa were collected from January 2016 to July 2016 in the children's nutrition clinic of Yuhua District, Nanjing. The age ranged from 1 to 3 years. According to the principle of randomized control, the cases of children with anorexia were divided into three groups: The nutrition intervention group (37 cases) and the combined group (4-joint nutrition intervention) were used in 31 cases. in which, the four-stitch treatment is carried out by using a 5-minute hand-side index finger, a middle finger, a ring finger and a small finger in the middle of the second joint of the second joint after the conventional disinfection, and the middle finger, the middle finger and the ring finger are used for wiping and pressing the hemostasis with the sterilized cotton ball after the small amount of the mucus or the blood is extruded, and the hemostasis is performed twice a week. The nutrition intervention is divided into the dietary guidance and the dietary behavior guidance: the dietary instruction is that the parent fills in the meal questionnaire of 3 days (2 working days and 1 day of rest) and enters the nutrient star dietary survey system, and the analysis and calculation of the three-day nutrient intake conditions, taking the average value, according to the dietary guidelines of the Chinese residents (2011)> to guide the diet structure, Parents care about, fear to eat five, and carry on the corresponding eating habits to develop the guidance or referral treatment, the nutrition intervention once a week. Both the nutrition intervention and the four-slit therapy were two weeks and one treatment course. Results At the end of the treatment, the combined group was cured in 10 cases, accounting for 32.26%, markedly effective 19 cases (61.29%), progressive 1 (3.23%), invalid 1 (3. 23%), more effective rate (93.6%), healing of the four-slit group (27. 78%), effective 21 (58. 33%), progressive 3 cases (8.33%), and invalid 2 cases. The rate of treatment was 5.56%, the more obvious rate was 81.11%, and in the nutrition intervention group, 3 cases were cured, 8. 11%, 23 cases were effective, 62. 16%, 6 cases in progress, 16. 22%, 5 were invalid, 13. 51%, and the more obvious rate was 70. 27%. The curative effect of the combined group and the four-suture group was superior to that of the nutrition intervention group (P0.05). The energy and fat of the nutrition intervention group were less (P0.05), and the protein of the combined group was higher (P0.05). At the end of the 3-month follow-up, the combined group was cured in 18 cases, accounting for 58. 06%, effective 13 cases, 41. 94%, the more obvious rate was 100%. The four-slit group was cured in 11 cases, accounting for 30. 56%, effective 21 cases, 58. 33%, progress 2 cases, 5. 56%, invalid 2 cases, 5. 56%, the more obvious rate 88. 89%; In the nutrition intervention group, 6 cases, 16. 22%, 24 cases, 64. 86%, 4 cases, 10.81%, 3 cases, 8.11% and 81.08%, were cured. The effect of energy, protein and fat in the combined group was the best (P0.05), and the curative effect was optimal (P0.01). at the end of the treatment of the three groups of children, the symptoms of the anorexia are improved, The patient has no adverse reaction, and the three treatment methods are safe in the nutrition clinic and the grass-root unit, and the combination therapy of the four-stitch and the nutrition intervention has the characteristics of good curative effect and lasting, convenient operation, safety and the like, and is worthy of being popularized in the pediatric nutrition clinic. Conclusion The results of this study indicate that the curative effect of the combination of the four-stitch and the nutrition intervention on the anorexia of the spleen of the child is superior to that of the simple method, and has the statistical significance (P0.05). It has the advantages of definite curative effect, simple and convenient operation, easy to be accepted by the child and the parent, and the combined nutrition method. giving full play to the medical advantage of the motherland, and is worthy of being popularized in the nutrition clinic of the grass-roots children.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R246.4

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