益肾健脾养血法治疗维持性血液透析患者营养不良的临床研究

发布时间：2018-04-28 09:45

本文选题：益肾健脾养血法 + 维持性血液透析　；参考：《河南中医药大学》2016年硕士论文

【摘要】：目的:通过观察益肾健脾养血颗粒对脾肾气虚证血液透析患者营养不良的中医证候积分,血红蛋白,血白蛋白,血前白蛋白,血尿素氮,血肌酐,主观综合性营养评估评分,肝功能,电解质的影响,初步探讨其作用机制,客观评价益肾健脾养血颗粒在改善脾肾气虚证血液透析患者营养不良的临床疗效,为临床应用,新药开发提供理论依据。方法:本研究共纳入60例符合MHD营养不良纳入标准的研究病例,均来源于河南中医药大学第二附属医院肾内科2015年1月至2016年1月期间住院的血透患者,随机分为治疗组(30例)和对照组(30例),两组患者均给予充分血液透析,优质蛋白低盐低磷饮食,纠正贫血,补铁,调节钙磷代谢,积极控制血压、血糖等对症支持治疗,治疗组在常规西医治疗基础上加服益肾健脾养血颗粒,而对照组单用西医基础治疗,两组疗程均为3个月,在治疗前、后分别进行一次中医证候积分,中医单个症状积分,实验室检测指标(血红蛋白、血白蛋白、血前白蛋白、血尿素氮、血肌酐)、主观综合性营养评估评分(SGA)、安全性观察指标(肝功、电解质、心电图)等项目的检查,并进行记录,逐项记分。研究结束后分别对中医证候积分,中医单个症状积分,实验室检测指标,SGA评分等临床数据进行收集,整理,分析,总结,从而得出研究结论。结果:临床研究过程中,无脱落病例,实际完成60例,治疗组及对照组均30例。结果显示:1.中医证候积分:治疗后,治疗组总有效率为93.3%,对照组为66.6%,差异显著,具有统计学意义(P0.05);两组患者治疗后中医证候积分较治疗前下降,组内比较,差异有统计学意义(P0.05)。单个中医症状积分比较,治疗后,两组症状积分均有所降低,具有统计学意义(P0.05);组间比较,治疗组中倦怠乏力、气短懒言、腰膝酸软、大便不实症状积分较对照组明显改善(P0.05)。2.实验室检测指标:治疗后,两组患者的血红蛋白、血白蛋白、血前白蛋白数值均高于治疗前(P0.05),其中治疗组中血红蛋白、血白蛋白、血前白蛋白数值较对照组显著升高,两组间对比,差异有统计学意义(P0.05);治疗前后比较,两组患者的血尿素氮、血肌酐水平无明显变化,无统计学意义(P0.05),组间对比,亦无变化,差异无统计学意义(P0.05)。3.主观综合性营养评估评分:治疗后,两组SGA评分均较治疗前升高,差异有统计学意义(P0.05);两组间比较,治疗组SGA评分明显优于对照组,差异有统计学意义(P0.05)。4.安全性指标比较:治疗后,两组肝功能(谷丙转氨酶ALT)、电解质(k+、Ca2+、P3+)数值比较,无明显差异(P0.05);且组内对比无显著差异,无统计学意义(P0.05)。结论:益肾健脾养血颗粒配合西医基础治疗在改善MHD患者营养不良的总临床效果上有明显优势,能更好的改善患者的中医症状及体征,提高了Al B、Hb、PA水平,SGA评分,疗效优于单用西医基础治疗,治疗过程中无明显不良反应,安全有效,能更好的提高患者长期生活质量。
[Abstract]:Objective: to observe the scores of TCM syndromes, hemoglobin, serum albumin, serum prealbumin, blood urea nitrogen, serum creatinine and subjective comprehensive nutritional evaluation of hemodialysis patients with spleen and kidney qi deficiency syndrome treated with Yishen Jianpi Yangxue granule. The effects of liver function and electrolytes, the mechanism of action, the objective evaluation of Yishen Jianpi Yangxue granule in improving the clinical effect of dystrophy in hemodialysis patients with deficiency of spleen and kidney qi, providing theoretical basis for clinical application and development of new drugs. Methods: a total of 60 patients with MHD malnutrition were included in this study. All of them were hemodialysis patients hospitalized in Department of Nephrology, second affiliated Hospital of Henan University of traditional Chinese Medicine from January 2015 to January 2016. The patients in the two groups were given adequate hemodialysis, high quality protein, low salt and low phosphorus diet, correction of anemia, iron supplementation, regulation of calcium and phosphorus metabolism, active control of blood pressure and blood sugar, etc. In the treatment group, on the basis of routine western medicine treatment and taking Yishen Jianpi Yangxue granule, the control group was treated with western medicine alone and the two groups were treated for 3 months. Before and after treatment, the TCM syndromes integral and the TCM single symptom integral were performed respectively. Laboratory indexes (hemoglobin, serum albumin, serum prealbumin, blood urea nitrogen, serum creatinine), subjective comprehensive nutrition assessment score (SGAA), safety observation index (liver function, electrolyte, electrocardiogram) and other items were examined and recorded. Score item by item. After the study, the clinical data such as TCM syndrome integral, TCM single symptom score, laboratory test index and SGA score were collected, sorted, analyzed and summarized, and the research conclusions were obtained. Results: in the course of clinical study, there were no cases of shedding, 60 cases of actual completion, 30 cases of treatment group and control group. The result is 1: 1. TCM syndrome score: after treatment, the total effective rate of treatment group was 93.3g and that of control group was 66.6, the difference was significant (P 0.05); after treatment, the score of TCM syndrome in two groups was lower than that before treatment, and the difference was statistically significant (P 0.05). Compared with the single TCM symptom score, the symptom scores of the two groups were all decreased after treatment, with statistical significance (P0.05A), and compared with the control group, the scores of fatigue, shortness of breath, weakness of waist and knee, and symptoms of defecation in the treatment group were significantly improved compared with those in the control group (P0.05. 2). Laboratory indicators: after treatment, the levels of hemoglobin, serum albumin and prealbumin in the two groups were higher than those in the pre-treatment group (P 0.05), and the levels of hemoglobin, serum albumin and prealbumin in the treatment group were significantly higher than those in the control group. There was no significant difference in blood urea nitrogen and creatinine levels between the two groups before and after treatment, and there was no significant difference in blood urea nitrogen and creatinine levels between the two groups, and there was no significant difference between the two groups in blood urea nitrogen and creatinine levels. Subjective comprehensive nutritional assessment score: after treatment, the SGA scores of the two groups were higher than those before treatment, the difference was statistically significant (P 0.05), and the SGA score of the treatment group was significantly better than that of the control group (P 0.05 路4). Comparison of safety indexes: after treatment, there was no significant difference in liver function between the two groups (alanine aminotransferase (alt), electrolytes (K) Ca 2 + P 3), and there was no significant difference between the two groups (P 0.05). Conclusion: Yishen Jianpi Yangxue granule combined with Western basic treatment has obvious advantages in improving the total clinical effect of malnutrition in patients with MHD. The curative effect is better than that of western medicine alone. There is no obvious adverse reaction in the course of treatment. It is safe and effective and can better improve the long-term quality of life of patients.
【学位授予单位】：河南中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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