益气健脾法对重症老年患者营养不良的影响

The method of replenishing qi to invigorate spleen for treatment of senior patients with severemalnutrition

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（100ml／d），于治疗前、治疗5d和10d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5d时就出现了统计学意义，PA治疗10d时出现统计学意义（均P〈0．05）；且治疗10d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5d和10dHb（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。

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 lOth day showed the same in the comparisons statistically （all P〈0.05 ） . On the lOth 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.