调脾益肾法联合肠内营养治疗脾肾亏虚型老年股骨颈骨折术后营养不良的临床研究

发布时间：2018-05-24 00:33

本文选题：调脾益肾法 + 营养不良　；参考：《南京中医药大学》2016年硕士论文

【摘要】：目的：观察调脾益肾法联合肠内营养治疗脾肾亏虚型老年股骨颈骨折患者术后营养不良的临床疗效。方法：将48例脾肾亏虚型老年股骨颈骨折术后营养不良患者随机分为中药组24例,对照组24例,于患者术前及术后1周进行量表打分,营养状况测评以及血液指标检验,并予以药物干预,其中中药组予以调脾益肾方汤剂日二次水煎服,同时予以肠内营养方案,对照组仅予以肠内营养,治疗三周后再次进行量表打分,营养状况测评及血液指标检验,对比三次数据,讨论结论。结果： (1)证候积分对比：两组术前积分与治疗前积分对比,差异无统计学意义(p0.05)；治疗前积分对比,差异无统计学意义(p0.05),中药组治疗前后对比,差异有统计学意义(p0.05),对照组治疗前后对比,差异无统计学意义(p0.05);两组疗后积分对比差异有统计学意义(p0.05)；(2)营养风险筛查：两组患者术前积分、治疗前积分对比,差异无统计学意义(t=0.59,p0.05),中药组治疗后与治疗前相比差异有统计学意义(p0.05)；对照组治疗后治疗前相比差异有统计学意义(p0.05),中药组与对照组治疗后对比差异有统计学意义(p0.05)(3)SGA评分等级：两组患者术前积分、治疗前积分对比,差异无统计学意义(p0.05),中药组治疗后与治疗前相比差异有统计学意义(p0.05)；对照组治疗后治疗前相比差异有统计学意义(p0.05),中药组与对照组治疗后对比差异有统计学意义(p0.05)(4)血液指标：两组患者术前、治疗前血液指标(血红蛋白、白蛋白、前白蛋白)对比,差异无统计学意义(p0.05),中药组治疗后与治疗前相比差异均有统计学意义(p0.05)；对照组在血红蛋白、白蛋白方面治疗后治疗前相比差异有统计学意义(p0.05),前白蛋白方面治疗前后对比差异无统计学意义(p0.05)中药组与对照组治疗后血液指标对比差异均有统计学意义(p0.05)。结论：1、股骨颈骨折术后患者在术后一周所有会出现不同程度的营养不良状况,这可能与术中出血、手术应激以及术后活动减少,饮食吸收差等有关。2、调脾益肾法联合肠内营养与单纯肠内营养均能改善脾肾亏虚型老年股骨颈骨折术后营养不良状况。3、调脾益肾法具有益气健脾、强筋补肾等功效,联合肠内营养对脾肾亏虚型老年股骨颈骨折术后营养不良的效果优于单纯应用肠内营养。
[Abstract]:Objective: to observe the clinical effect of regulating spleen and tonifying kidney combined with enteral nutrition in treating postoperative malnutrition in elderly patients with deficiency of spleen and kidney. Methods: 48 cases of senile femoral neck fracture with deficiency of spleen and kidney were randomly divided into Chinese medicine group (n = 24) and control group (n = 24). The traditional Chinese medicine group was given decoction of Tiaopi Yishen decoction twice a day and enteral nutrition program was given, while the control group was given enteral nutrition only. After three weeks of treatment, the Chinese medicine group was scored again with the scale. Nutritional status evaluation and blood index test were compared with three times of data, and the conclusion was discussed. Results: comparison of syndrome score: there was no significant difference between preoperative integral and pre-treatment score in the two groups, but there was no significant difference in the score before treatment (P 0.05), while in the traditional Chinese medicine group, the difference was not statistically significant before and after treatment, and there was no significant difference between the two groups before and after treatment. The difference was statistically significant (P 0.05). There was no significant difference before and after treatment in the control group (P 0.05). There was a significant difference between the two groups (P < 0.05). The nutritional risk screening: the scores before operation and before treatment were compared between the two groups. There was no statistical difference between the two groups. There was a significant difference between the Chinese medicine group and the control group after treatment, and there was a significant difference before and after treatment in the control group, and there was a significant difference between the Chinese medicine group and the control group after treatment. SGA score grade: two groups of patients before operation integral, Score comparison before treatment, There was no significant difference between Chinese medicine group and control group after treatment, there was significant difference before and after treatment in Chinese medicine group, and there was significant difference before treatment in control group, and there was significant difference between Chinese medicine group and control group after treatment. Blood index: two groups of patients before operation, There was no significant difference in blood indexes (hemoglobin, albumin, prealbumin) before treatment. Before and after treatment, there was no significant difference in blood indexes between the Chinese medicine group and the control group (P 0.05, P 0.05), and there was no significant difference before and after treatment in the traditional Chinese medicine group and the control group (P < 0.05), and there was no significant difference between the Chinese medicine group and the control group before and after treatment. Conclusion 1: all patients with femoral neck fracture have different degrees of malnutrition at the first week after operation, which may be associated with intraoperative bleeding, surgical stress and decreased postoperative activity. The method of regulating spleen and tonifying kidney combined with enteral nutrition and simple enteral nutrition can improve the malnutrition status of senile patients with deficiency of spleen and kidney after operation of femoral neck fracture. The method of regulating spleen and tonifying kidney has the effects of tonifying qi and invigorating spleen, strengthening the tendon and tonifying the kidney, and so on. Combined enteral nutrition was superior to enteral nutrition in the treatment of malnutrition after operation for senile femoral neck fracture with deficiency of spleen and kidney.
【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】：2016
【分类号】：R274.9

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