益气健脾法对机械通气患者营养影响的临床研究

Clinical research on replenishing qi to invigorate spleen therapy for patients with mechanical ventilation

目的探讨益气健脾中药联合肠内营养剂对危重症机械通气患者营养的影响。方法60例危重症机械通气患者，完全随机分为对照组和试验组，各30例。对照组采用常规肠内营养剂，试验组在常规肠内营养剂基础上加用益气健脾中药（四君子汤），分别在治疗前和治疗5、10d记录患者总蛋白、白蛋白、前白蛋白、血红蛋白等营养学指标和主要安全性指标。结果总蛋白：试验组治疗10d后与治疗前和对照组同期比较，差异均有统计学意义[（65±4）g,／L比（56±5）g／L，（61±6）g／L，均P〈0．05]。白蛋白：试验组治疗5和10d与治疗前比较差异有统计学意义[（31．8±2．6）g／L，（35．2±3．0）g/L比（30．0±2．8）g／L，均P〈0．05]；且治疗10d时与对照组[（31．9±4．2）g／L]比较差异有统计学意义（P〈0．05）。前白蛋白：试验组治疗10d时与治疗前和对照组同期比较差异有统计学意义[（276±58）g／L比（204±51）g／L，（213±48）g／L，均P〈0．05]。血红蛋白：在对照组和试验组治疗后均有升高趋势，但与治疗前比较差异无统计学意义（P〉0．05）。2组治疗前后主要安全性指标差异均无统计学意义（均P〉0．05）。结论机械通气的危重症患者存在营养不良，通过单纯的肠内营养可能不改善患者营养不良的状况，而在常规肠内营养基础之上，添加四君子汤通过益气健脾可能改善其营养不良状况。

Objective To explore the method of replenishing qi to invigorate spleen combined with enteral nutrition therapy in patients with mechanical ventilation. Methods Sixty cases of critically patients with mechanical ventilation who came from the Qingdao Hiser Hospital of ICU from January 2010 to October 2011 were chosen. According to the unified criteria of patients selection, the control group received enteral nutrition only and the experiment group received enteral nutrition combined with the traditional Chinese medicine to Replenish qi to invigorate spleen. Nutritional markers （total protein, albumin, preabumin, hemoglobin）in two groups on the first day before the nourishment therapy, fifth day and tenth day after treatment were detected. Results Total protein in experimental group after 10 d treatment had significant differences compared with before treatment and control group [ （65 ± 4） g/L vs （56 ± 5） g/L, （61 ± 6） g/L, P 〈 0. 05 ]. Albumin in experimental group treated with 5 d and 10 d had significant differences compared with before treatment [ （31.8 ±2. 6）g/L, （35.2 ±3. 0）g/L vs （30. 0 ± 2. 8） g/L, all P 〈 0. 05 ] ; after 10 d treatment there was a significant difference between experimental group and control group [ （35.2 ± 3.0） g/L vs （31.9 ± 4.2） g/L, P 〈 0.05]. Pre-albumin in experimental group after 10 d treatment had significant differences compared with before treatment and control group [ （276 ± 58 ）g/L, （204 ± 51）g/L vs （213 ±48）g/L, P 〈0. 05]. The difference of hemoglobin was not statistically significant in the control group and the experimental group after treatment （ P 〉 0. 05 ）. There were no significant differences in the main safety indexes between 2 groups before and after treatment （P 〉 0.05 ）. Conclusion Chinese medicine of replenishing qi to invigorate spleen therapy combined with enteral nutrition is superior to enteral nutrition only, and it can improve malnutrition in patients with mechanical ventilation.