肠内营养对溃疡性结肠炎患者的疗效评价及生活质量评估

发布时间：2018-05-25 00:02

本文选题：肠内营养 + 溃疡性结肠炎　；参考：《吉林大学》2016年硕士论文

【摘要】：研究背景及目的:溃疡性结肠炎(UC)是一种发生于粘膜层即肠壁表面的自身免疫性疾病,多位于乙状结肠和直肠,也可延伸至降结肠,甚至整个结肠。其病因不明,可能与遗传、免疫、感染及饮食等有关。临床表现为腹泻、血便、腹痛等。该病多见于西方国家,尤其是在欧美国家,在我国近年报道的病例明显增多,可能与我国人民生活水平提高后,饮食特点越来越接近西方化(高脂肪和精制碳水化合物和低纤维)有关。UC是一种慢性病,常反复发作。其并发症很多,体重减轻与营养不良也是UC患者的常见并发症。营养不良可导致患者发育不良、肠道黏膜免疫紊乱、菌群失调、病情进展或加重,有恶变的可能。再者药物疗效差或病情加重,使患者感到紧张、焦虑、失眠等严重影响患者的生活质量。所以有必要进行营养干预改善机体的营养状况,诱导疾病进入缓解期,改善患者的生活质量。本研究通过对活动期UC患者进行营养干预,来探讨肠内营养对溃疡性结肠炎患者的疗效评价及生活质量评估;进一步对不同严重程度、病变范围的UC患者的临床疗效进行比较。方法:选取2014年4月~2016年3月就诊于吉林大学白求恩第一医院的52例确诊为溃疡性结肠炎患者作为研究对象,完成病例资料的收集,内容包括姓名、性别、年龄。按照病变部位分为为直肠、乙状结肠型,左半结肠型、全结肠型,根据改良Truelove和Witts分型标准将UC患者分为轻、中、重三型。将以上入选的52例UC患者随机分为两组,对照组(传统抗炎治疗+少渣饮食),实验组(对照组+整蛋白型肠内营养剂),统计治疗前后的血红蛋白(HB)、总蛋白(TP)、白蛋白(ALB)、体重、血沉(ESR)、C反应蛋白(CRP)、内镜下表现;随访患者治疗前后临床表现、不良反应、日常活动、情绪变化;采用美国研究所研制的SF-36生活质量表对患者治疗前后现场填写生活质量表进行生活质量评估;统计学分析应用SPSS 21.0统计软件,计数资料用例数(n),两组一般情况比较采用t检验和?2检验;两组营养指标、炎性指标比较采用t检验;两组临床疗效的有效率比较采用?2检验;两组患者SF-36量表比较采用秩和检验。所有检验均以P0.05为差异有统计学意义。结果:1、一般情况一般情况包括年龄、性别、病变类型、病变范围、严重程度,两组对照差异无统计学意义(P0.05),具有可比性。2、营养指标本研究营养指标包括:ALB、TP、HB、体重。实验组和对照组ALB、TP、HB在治疗前比较大致相同,不具有统计学意义(P0.05),实验组治疗后各营养指标较治疗前明显升高,差异有统计学意义(P0.05)。而对照组治疗前后比较变化不明显,差异无统计学意义(P0.05)。两组在治疗后各营养指标比较,实验组明显高于对照组,差异有统计学意义(P0.05)。3、炎性指标本研究炎性指标包括:ESR、CRP。实验组和对照组在治疗前比较,ESR、CRP的差异均无统计学意义(P0.05);实验组治疗后各炎性指与治疗前比较都有明显降低,差异有统计学意义(P0.05);而对照组各炎性指标治疗前后比较变化不明显,差异无统计学意义(P0.05)。实验组和对照组治疗后各炎性指标ESR、CRP比较,差异有统计学意义(P0.05)。4、临床疗效治疗后实验组疗效的总有效率为88.9%,对照组为48%,实验组明显优于对照组,两组比较差异有统计学意义(P0.05)。4.1根据严重程度进行临床疗效比较轻度UC患者的临床疗效比较:实验组和对照组差异无统计学意义(P0.05);中-重度UC患者的临床疗效比较:实验组明显优于对照组,差异有统计学意义(P0.05)。4.2根据病变部位进行临床疗效比较直肠、乙状结肠型的UC患者临床疗效,实验组和对照组比较差异无统计学意义(P0.05);左半结肠型的UC患者的临床疗效比较,两组差异无统计学意义(P0.05);全结肠型UC患者的临床疗效比较:实验组明显优于对照组,差异有统计学意义(P0.05)。5、生活质量评估生活质量量表的各个维度比较:治疗前,实验组和对照组比较差异无统计学意义(P0.05),治疗后,实验组和对照组9个维度评分都比治疗前增高,差异有统计学意义(P0.05),治疗后。2组生活质量表的各个维度比较,差异均有统计学意义(P0.05)。结论:1、多部位病变和中-重度的UC患者,应给予充足的肠内营养支持,疗效较好2、肠内营养支持可以作为活动期UC患者的临床辅助治疗3、药物联合肠内营养支持更具临床疗效4、肠内营养有利于营养不良症的改善、有效地缓解临床症状、改善肠道黏膜免疫功能还能更有效的提高生活质量。
[Abstract]:Research background and purpose: ulcerative colitis (UC) is an autoimmune disease occurring on the surface of the mucosa of the mucosa, mostly in the sigmoid colon and rectum, and can also extend to the descending colon and even the whole colon. Its etiology is unknown, which may be related to heredity, immunity, infection and drinking. The clinical manifestations are diarrhea, bloody stool, abdominal pain, etc. In the western countries, especially in the European and American countries, the cases reported in recent years have increased significantly in our country. After the improvement of the living standards of our people, the dietary characteristics are becoming more and more close to Westernization (high fat and refined carbohydrates and low fiber)..UC is a chronic disease, often recurring. There are many complications, weight loss and nutrition. Malnutrition is also a common complication of UC patients. Malnutrition can lead to dysplasia of the patients, intestinal mucosal immune disorder, dysbacteria, progress or aggravation of the disease, the possibility of malignant change. Moreover, the drug effect is poor or the condition is aggravated, so that the patient feels nervous, anxiety, insomnia and so on seriously affect the quality of life of the patient. Therefore, it is necessary to do nutrition dry. To improve the nutritional status of the body, induce the disease to enter the remission period and improve the quality of life of the patients. This study explored the efficacy and quality of life of enteral nutrition in patients with ulcerative colitis by nutritional intervention in active UC patients, and further to the clinical efficacy of UC patients with different severity and range of severity. Methods: 52 cases of ulcerative colitis diagnosed in the first hospital of Bethune, Jilin University, April 2014, were selected as the subjects of ulcerative colitis. The case data were collected, including the name, sex and age. According to the lesion, the patients were divided into rectum, sigmoid, left semicolon, and all colonic type, according to the change. The Truelove and Witts classification standards were divided into light, medium, and heavy three patients. 52 cases of UC were randomly divided into two groups, the control group (traditional anti-inflammatory treatment + less slag diet), the experimental group (control group + Intacted Protein Enteral Nutrition Powder), the blood erythroprotein (HB), total protein (TP), albumin (ALB), weight, ESR), C counter before and after the treatment. CRP, endoscopy, follow-up of clinical manifestations, adverse reactions, daily activities, and emotional changes before and after treatment, and the quality of life assessment of the quality of life for patients before and after treatment by the SF-36 life quality table developed by the American Institute; statistical analysis and application of the SPSS 21 statistical software, and the number of use cases (n), Two groups of general conditions were compared with t test and 2 test; two groups of nutritional indicators, inflammatory indexes compared with t test; two groups of effective efficacy compared to 2 test; the two group SF-36 scale compared with the rank sum test. All the tests were statistically significant with the difference of P0.05. Results: 1, general general conditions include age, sex. There was no statistically significant difference between the two groups (P0.05) and comparable.2. The nutritional indexes included ALB, TP, HB, and weight. The experimental and control group ALB, TP, HB were roughly the same before treatment, and were not statistically significant (P0.05). The nutritional indexes of the experimental group were compared with the treatment. The difference was statistically significant (P0.05), but there was no significant difference in the control group before and after treatment (P0.05). In the two groups, the experimental group was significantly higher than the control group after the treatment. The difference was statistically significant (P0.05).3. The inflammatory indicators included the ESR, CRP. experimental group and the control group. There was no significant difference between ESR and CRP in the group before treatment (P0.05), and there was a significant reduction in each inflammatory finger after treatment in the experimental group (P0.05), but the difference was not significant before and after treatment in the control group (P0.05). The inflammatory properties of the experimental group and the control group after treatment were not statistically significant. Index ESR, CRP comparison, the difference was statistically significant (P0.05).4, the total effective efficiency of the experimental group after clinical curative effect was 88.9%, the control group was 48%, the experimental group was obviously superior to the control group. The two groups were statistically significant (P0.05).4.1 according to the severity of the clinical curative effect comparison of mild UC patients compared with the clinical effect: experimental group and the experimental group. There was no statistically significant difference in the control group (P0.05); the clinical efficacy of moderate to severe UC patients was compared: the experimental group was significantly better than the control group (P0.05), the difference was statistically significant (P0.05). The clinical efficacy of.4.2 was compared with the rectal and sigmoid colon type UC patients, and there was no significant difference between the experimental group and the control group (P0.05); The clinical efficacy of the semicolon type UC patients was compared, the difference between the two groups was not statistically significant (P0.05); the clinical efficacy of the total colon type UC patients was compared: the experimental group was significantly better than the control group, the difference was statistically significant (P0.05).5, the quality of life assessment of the quality of life of each dimension comparison: before the treatment, the experimental group and the control group were different. Study significance (P0.05), after treatment, the 9 dimensions of the experimental group and the control group were all higher than before the treatment, the difference was statistically significant (P0.05). The differences in each dimension of the quality of life of the.2 group after treatment were statistically significant (P0.05). Conclusion: 1, the patients with multi site disease and moderate to severe UC should be given adequate enteral nutrition support, the curative effect should be given. 2, enteral nutrition support can be used as a clinical adjuvant therapy of 3 in active UC patients. The combination of drug and enteral nutrition support is more effective than 4. Enteral nutrition is beneficial to the improvement of malnutrition. It can effectively alleviate the clinical symptoms and improve the intestinal mucosal immune function, which can improve the quality of life more effectively.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R574.62

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