辨证施灸方案改善维持性血液透析患者营养不良的临床观察

Clinical Research About Moxibustion According to the Syndrome Differentiation Improve the Malnutrition of the Patients with Maintenance Hemodislysis

目的:观察"辨证施灸方案"改善维持性血液透析患者营养不良的临床疗效。方法:采用前瞻性、多中心、随机对照试验,选取5家医院共计92例营养不良的血液透析患者,采用中央随机系统分为观察组、对照组,两组均采用西医常规治疗方法,观察组在此基础上加用"辨证施灸方案",4周为一疗程,观察3个疗程,共计12周。观察记录两组患者人体测量指标(体重指数、肱三头肌皮褶厚度、上臂围、上臂肌围、体脂百分比含量)、改良定量综合营养评估量表(MQSGA)、生化指标(白蛋白、前白蛋白、血红蛋白、转铁蛋白)、临床症状的改善等,分析评价"辨证施灸方案"的临床疗效。结果:在人体测量学中,观察组患者体重指数(BMI)、体脂百分比含量与治疗前相比,差异有统计学意义(P<0.05)。MQSGA评分组间比较及组内治疗前后比较,差异有统计学意义(P<0.05)。且观察组MQSGA差值明显优于对照组,差异有统计学意义(P<0.05)。依据MQSGA总积分判定,两组营养状态分布、有效率比较,差异有统计学意义(P<0.05)。观察组中医症状积分改善明显优于对照组(P<0.05),治疗结束虚证分布差异有统计学意义(P<0.05),而实证分布差异无统计学意义(P>0.05)。结论:"辨证施灸方案"可以改善维持性血液透析患者的体重指数、体脂百分比含量,改善患者MQSGA评分及营养不良程度,从而改善患者的营养状况;"辨证施灸方案"可以改善维持性血液透析患者中医症状评分,改善虚证证候。"辨证施灸方案"为尿毒症血透患者营养状况的改善提供简便、有效的中医治疗手段。

Objective ： To observe the effects of moxibustion accordance with syndrome differentiation for improving the malnutrition of the patients with maintenance hemodislysis. Methods： Using prospective, muhicenter, randomized controlled method. 92 cases in five centers（ Wangjing Hospital of CATCM ,Beijing aerospace general hospital ,Dongzhimen Hospital Beijing University of Chinese Medicine, etc） of end - stage renal disease patients with maintenance hemodialysis were divided into the control group and the observation group by stratified random method. The treatment phase of the control group using Western conventional treatment methods. The observation group in Western conventional treatment given above moxibustion accordance with syndrome differentiation. 4 weeks for a course, the study observed 3 courses, a total of the observation is 12 weeks. Anthropometric parameters （including body mass index, triceps skin fold, upper ann circumference, upper arm muscle circumference, Percentage of body fat）, modified subjective global assessment （ MQSGA）, biochemical indicators （ such as blood albumin, blood prealbumin, hemoglobin and transferring before dialysis） and the improvements of clinical symptoms were observed and recorded. Clinical efficacy of moxibustion accordance with syndrome differentiation was analyzed and evaluated. Results： After treatment, the levels of body mass index, percentage of body fat in observation group were increased compared with before. The difference of MQSGA scores in the observation group （4.63 ± 1.53） were higher than the control group （0.82 ± 1.62）. The differences were statistically significant （P 〈0.05）. Based on the total credit of MQSGA, the difference of nutritional state and efficiency between two groups was statistically significant （P 〈 0.05 ）. The improvement of symptoms of Chinese medicine in observation group was better than that of control group （P 〈 0.05 ）. The difference of Deficiency Syndrome Distribution was statistically significant （ P 〈 0.05 ）, whereas the difference of the Empirical Syndrome distribution was not statistically significant （ P 〉 0.05 ）. Conclusion： The moxibustion accordance with syndrome differentiation can improve the malnutrition of the patients with maintenanee hemodislysis. This program provides a simple and effective traditional Chinese medicine treatment for improving the malnutrition of the patients with maintenance hemodislysis.