CAJ | 학술논문

目的探讨益气健脾中药四君子汤联合肠内营养剂治疗重症老年患者营养不良的有效性和安全性.方法采用前瞻性随机对照研究方法,将青岛市海慈医疗集团所属医院重症监护病房(ICU)2010年1月至2011年11月收治的100例重症老年患者按照随机数字表法分为对照组和试验组,每组50例.对照组给予常规肠内营养剂能全力,试验组在常规肠内营养剂基础上加用四君子汤(100 ml/d),于治疗前、治疗5 d 和10 d 取血,检测患者总蛋白(TP)、白蛋白(Alb)、前白蛋白(PA)、血红蛋白(Hb)等营养学指标,同时观察肝、肾功能以评价其安全性.结果两组治疗后 TP、Alb 和 PA 均有增长趋势,但对照组治疗前后比较差异均无统计学意义(均 P>0.05);试验组 TP 和 Alb 在治疗5 d 时就出现了统计学意义,PA 治疗10 d 时出现统计学意义(均 P<0.05);且治疗10 d 试验组上述指标明显高于对照组〔TP(g/L):65.04±3.74比59.50±4.85,Alb(g/L):34.26±3.07比30.98±3.54,PA(g/L):268.50±54.30比204.82±39.56,均 P<0.05〕;试验组与对照组治疗前、治疗5 d 和10 d Hb(g/L)比较差异均无统计学意义(97.68±8.13、96.14±6.38、98.82±7.15比98.84±11.37、99.52±12.82、98.54±8.66,均 P>0.05).两组治疗后肝、肾功能均未出现明显变化.结论单纯肠内营养改善重症老年患者伴发的营养不良不明显;而常规肠内营养联合四君子汤通过益气健脾可以改善患者的营养不良状况.
목적탐토익기건비중약사군자탕연합장내영양제치료중증노년환자영양불량적유효성화안전성.방법채용전첨성수궤대조연구방법,장청도시해자의료집단소속의원중증감호병방(ICU)2010년1월지2011년11월수치적100례중증노년환자안조수궤수자표법분위대조조화시험조,매조50례.대조조급여상규장내영양제능전력,시험조재상규장내영양제기출상가용사군자탕(100 ml/d),우치료전、치료5 d 화10 d 취혈,검측환자총단백(TP)、백단백(Alb)、전백단백(PA)、혈홍단백(Hb)등영양학지표,동시관찰간、신공능이평개기안전성.결과량조치료후 TP、Alb 화 PA 균유증장추세,단대조조치료전후비교차이균무통계학의의(균 P>0.05);시험조 TP 화 Alb 재치료5 d 시취출현료통계학의의,PA 치료10 d 시출현통계학의의(균 P<0.05);차치료10 d 시험조상술지표명현고우대조조〔TP(g/L):65.04±3.74비59.50±4.85,Alb(g/L):34.26±3.07비30.98±3.54,PA(g/L):268.50±54.30비204.82±39.56,균 P<0.05〕;시험조여대조조치료전、치료5 d 화10 d Hb(g/L)비교차이균무통계학의의(97.68±8.13、96.14±6.38、98.82±7.15비98.84±11.37、99.52±12.82、98.54±8.66,균 P>0.05).량조치료후간、신공능균미출현명현변화.결론단순장내영양개선중증노년환자반발적영양불량불명현;이상규장내영양연합사군자탕통과익기건비가이개선환자적영양불량상황.
Objective To explore the efficacy and safety of the method of replenishing qi to invigorate spleen combined with enteral nutrition therapy for treatment of senior patients with severe malnutrition. Methods A prospective randomized controlled study was conducted. There were 100 senior cases of critically severe malnutrition who came to the intensive care unit(ICU)of Qingdao Hiser Hospital from January 2010 to November 2011. According to the unified criteria of patients selection with the method of random number table,they were divided into control and experiment groups(each,50 cases). Both groups received enteral nutrition,and the experiment group additionally received Decoction of Four Mild Drugs(100 ml/d). The nutritional markers of blood total protein(TP),albumin (Alb),preabumin(PA)and hemoglobin(Hb)were detected in the two groups before and on the 5th and 10th day after treatment. The liver and renal functions were observed to estimate the therapeutic safety. Results On the 5th and 10th day after treatment,the nutrition markers of TP,Alb and PA in both groups had a tendency to increase. In the control group,there were no statistical significances in the comparisons of the above indexes before and after treatment(all P>0.05),while in the experiment group,TP and Alb on the 5th day after treatment had significant improvement and PA on the 10th day showed the same in the comparisons statistically(all P<0.05). On the 10th day after treatment,the comparisons of all the above indexes in the experiment group were significantly higher than those in the control group〔TP(g/L):65.04±3.74 vs. 59.50±4.85,Alb(g/L):34.26±3.07 vs. 30.98±3.54,PA (g/L):268.50±54.30 vs. 204.82±39.56,all P<0.05〕. But Hb(g/L)of the experiment group and control group had no significant improvement before and on the 5th and the 10th day after treatment(97.68±8.13,96.14±6.38, 98.82±7.15 vs. 98.84±11.37,99.52±12.82,98.54±8.66,all P>0.05). The liver and renal functions had no significant changes. Conclusion From the experiment,it is shown that using enteral nutrition only to improve malnutrition is not significant,however,the combination of Chinese medicine of replenishing qi to invigorate spleen therapy and enteral nutrition can improve the status of malnutrition in senior patients.