耳穴贴压对提高甲状旁腺全切加前臂自体移植术后尿毒症患者的生活质量研究

发布时间：2018-05-04 04:34

本文选题：尿毒症 + 甲状旁腺全切除　；参考：《中国针灸》2017年09期

【摘要】：目的:观察耳穴贴压对甲状旁腺全切加前臂自体移植(PTX+AT)术后尿毒症患者的生活质量的影响。方法:将34例行PTX+AT的尿毒症并继发性甲状旁腺功能亢进症(SHPT)患者随机分为观察组和对照组,每组17例。对照组根据术后血钙水平进行补钙治疗,原则为每小时补钙1~2 mg/kg,并根据血钙值进行调整。术后次日口服碳酸钙1.5 g,每日3次,餐前服用,必要时加用骨化三醇0.5~4μg/d,术后1周均行无肝素血液透析治疗。观察组术后除补钙治疗外,第2天加用耳穴贴压治疗,取穴为神门、交感、内分泌、肾穴,并根据证型不同取配穴。观察两组患者术前和术后1、2、4、8周免疫反应性甲状旁腺激素(i PTH)、血钙、血磷等实验室指标及SF-36量表评定患者生存质量[含生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(EB)8个维度]。结果:术后1、2、4、8周,两组患者i PTH降低明显(均P0.05),血钙、血磷也有不同程度的改善,同术前比较亦降低(均P0.05);两组间术后各时间点血钙、血磷和i PTH比较,差异均无统计学意义(均P0.05)。两组SF-36量表评分比较,SHPT患者术前PF、RP、BP、GH、VT、SF、RE、EB值均较低;术后两组SF-36量表各维度评分均有不同程度的改善(均P0.05);术后8周,观察组在改善PF、RP、BP、GH、EB方面优于对照组,差异有统计学意义(均P0.05);在VT、SF、RE方面,两组比较差异无统计学意义(均P0.05)。结论:耳穴贴压可改善PTX+AT术后尿毒症患者的生理和精神健康,缓解术后疼痛,提高其生活质量,疗效优于单纯补钙治疗。
[Abstract]:Objective: to observe the effect of auricular acupoint pressure on the quality of life of uremia patients after total parathyroid gland resection and autotransplantation of forearm PTX ATT. Methods: 34 PTX AT uremic patients with secondary hyperparathyroidism were randomly divided into observation group and control group with 17 cases in each group. The control group was treated with calcium supplementation according to the blood calcium level after operation. The principle of calcium supplementation was 1 mg / kg per hour and adjusted according to the blood calcium level. The second day after operation, calcium carbonate was taken orally at 1.5 g, 3 times a day, before meal, followed by 0.5 渭 g / d of calcitriol 0.5 渭 g / d if necessary. Hemodialysis without heparin was performed 1 week after the operation. In the observation group, in addition to calcium supplement treatment, auricular acupoints were applied on the second day. The acupoints were taken as Shenmen, sympathetic, endocrine and kidney points, and the points were selected according to the different types of syndromes. The immunoreactive parathyroid hormone (PTH) and serum calcium were observed before and 8 weeks after operation. The quality of life (QOL) was assessed by blood phosphorus and SF-36 scale [including 8 dimensions: physiological function, physical function, body pain, general health, VT, social function, emotional function and mental health. Results: I PTH was significantly decreased in both groups (P 0.05, P 0.05, P 0.05, P 0.05, P 0.05), and compared with that before operation (P 0.05), and the levels of serum calcium, phosphorus and I PTH were compared between the two groups at different time points after operation, and there was no significant difference between the two groups in blood calcium, serum phosphorus and I PTH at different time points after operation. The difference was not statistically significant (P 0.05). The scores of SF-36 scale in two groups were lower than those in the control group, the scores of each dimension of SF-36 in the two groups were improved in different degrees (all P 0.05), and at the 8th week after operation, the observation group was superior to the control group in the improvement of SF-36. The difference was statistically significant (all P 0.05), but there was no significant difference between the two groups (P 0.05). Conclusion: auricular point pressing can improve the physiological and mental health of uremic patients after PTX AT operation, relieve postoperative pain and improve their quality of life, and the curative effect is better than that of calcium supplement alone.
【作者单位】：广州中医药大学第四临床医学院;广州中医药大学附属中山中医院;
【基金】：国家临床重点专科基金资助项目:财社[2013]239号
【分类号】：R246.2

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