调理脾胃中药对血液透析患者营养状况的改善作用

目的]探讨调理脾胃中药对血液透析患者营养不良症的改善作用。方法]将61例血液透析(简称血透)并营养不 良症患者随机分为中药治疗组(简称治疗组)31例和单纯血透治疗组(简称对照组)30倒,两组在对症治疗、血透相关因 素一致条件下维持血液透析,治疗组结合辨证服用调理脾胃中药(脾胃虚弱为主者选用六君子汤加减;湿浊中阻为主者选 用黄连温胆汤加减)。系统观察两组患者营养不良症的主要症状、体征、肱三头肌皮褶厚度(TSF)、上臂中段肌肉周径 (MAMC)、血清总蛋白(TP)、血清白蛋白(Alb)、转铁蛋白(TRF)、血红蛋白(Hb)、蛋白分解率(nPCR)、改良主观综合 性营养评估(SGA)评分等方面的变化。结果]治疗组比对照组体征症状改善明显(P<0.01),干体重增加(P<0.05), TSF和MAMC增加(P<0.05),血清TP、Alb、TRF、Hb含量明显提高(P<0.01),nPCR提高(P<0.05),SGA评分显著 下降(P<0.01)。结论]调理脾胃法对改善维持血透营养不良症患者的症状体征及脂肪、蛋白质储存的不足,提高患者 血清TP、Alb、TSF含量和nPCR等多项营养生化指标有较好的疗效。

Effect of Spleen-stomach Regulating Herbal Medicine in Improving Nutritional Status of Patients Receiving Hemodialysis

Objective] To observe the effect of spleen-stomach regulating herbal medicine in improving the nutritional status in dystrophic patients receiving maintenance hemodialysis. Methods ] Sixty-one dystrophic cases receiving maintenance hemodialysis were randomized into two groups. Group A ( n = 31) and group B ( n = 30) received the same symptomatic treatment and the same maintenance hemodialysis, and group A received spleen-stomach regulating herbal medicine additionally. For those in group A with spleen-stomach deficiency, Liujunzi Decoction was applied; for those with stagnation of phlegm, modified Huanglian Wendan Decoction was used. After treatment, the main symptoms and signs of dystrophy, triceps skin fold (TSF), and middle-arm muscle circumference (MAMC) were observed, as well as serum levels of total protein (TP), albumins (Alb) and transferrin (TRF), hemoglobin (HB), protein catabolic rate (nPCR) and SGA scoring for comprehensively nutritional evaluation. Results] Compared with group B, symptoms and signs were much improved ( P < 0.01), body weight, TSF and MAMC increased ( P < 0.05), serum TP, Alb, TRF and Hb levels increased ( P < 0.01), nPCR raised ( P < 0.05) but SGA scoring decreased ( P < 0.01) in group A. Conclusion] Spleen-stomach regulating herbal medicine has an effect in improving the symptoms and signs of nutrition disorder, increasing the storage of fat and protein and enhancing the serum levels of TP, Alb, TRF and PCR in dystrophic patients receiving maintenance hemodialysis.