耳穴贴压对提高甲状旁腺全切加前臂自体移植术后尿毒症患者的生活质量研究

Effects of auricular plaster therapy on quality of life in uremia patients after parathyroidectomy plus autograft

目的:观察耳穴贴压对甲状旁腺全切加前臂自体移植(PTX+AT)术后尿毒症患者的生活质量的影响。方法:将34例行PTX+AT的尿毒症并继发性甲状旁腺功能亢进症(SHPT)患者随机分为观察组和对照组,每组17例。对照组根据术后血钙水平进行补钙治疗,原则为每小时补钙1~2 mg/kg,并根据血钙值进行调整。术后次日口服碳酸钙1.5 g,每日3次,餐前服用,必要时加用骨化三醇0.5~4μg/d,术后1周均行无肝素血液透析治疗。观察组术后除补钙治疗外,第2天加用耳穴贴压治疗,取穴为神门、交感、内分泌、肾穴,并根据证型不同取配穴。观察两组患者术前和术后1、2、4、8周免疫反应性甲状旁腺激素(i PTH)、血钙、血磷等实验室指标及SF-36量表评定患者生存质量[含生理功能(PF)、生理职能(RP)、躯体疼痛(BP)、总体健康(GH)、活力(VT)、社会功能(SF)、情感职能(RE)、精神健康(EB)8个维度]。结果:术后1、2、4、8周,两组患者i PTH降低明显(均P<0.05),血钙、血磷也有不同程度的改善,同术前比较亦降低(均P<0.05);两组间术后各时间点血钙、血磷和i PTH比较,差异均无统计学意义(均P>0.05)。两组SF-36量表评分比较,SHPT患者术前PF、RP、BP、GH、VT、SF、RE、EB值均较低;术后两组SF-36量表各维度评分均有不同程度的改善(均P<0.05);术后8周,观察组在改善PF、RP、BP、GH、EB方面优于对照组,差异有统计学意义(均P<0.05);在VT、SF、RE方面,两组比较差异无统计学意义(均P>0.05)。结论:耳穴贴压可改善PTX+AT术后尿毒症患者的生理和精神健康,缓解术后疼痛,提高其生活质量,疗效优于单纯补钙治疗。

Objective To observe the effects of auricular plaster therapy on quality of life in uremia patients after parathyroidectomy plus autograft （PTX＋AT）.MethodsA total of 34 uremia patients complicated with secondary hyperparathyroidism （SHPT） who received PTX＋AT were randomly divided into an observation group and a control group, 17 cases in each one. The patients in the control group were treated with calcium supplementation after surgery, 1 to 2 mg/kg an hour; one day after surgery, the patients were treated with oral administration of calcium carbonate before meals, 1.5 g, three times per day, and calcitriol （0.5 to 4μg/d） was added if necessary. None-heparin hemodialysis was performed for one week after surgery. Besides calcium supplementation, patients in the observation group were treated with auricular plaster therapy at Shenmen （TF4）, Jiaogan （AH6a）, Neifenmi （CO18） and Shen （CO10）.The laboratory indexes, including immunoreactive parathyroid hormone （iPTH）, calcium, phosphorus, and SF-36 questionnaire, including 8 dimensions of physical function （PF）, role-physical （RP）, bodily pain （BP）, general health （GH）, vitality （VT）, social function （SF）, role-emotional （RE） and emotional well-being （EB）, were observed before surgery and 1 week, 2 weeks, 4 weeks and 8 weeks after surgery in the two groups.ResultsThe iPTH in the two groups was significantly decreased 1 week, 2 weeks, 4 weeks and 8 weeks after surgery, and the serum calcium and phosphorus were also improved to a certain degree （allP〈0.05）; however, the differences of iPTH, calcium and phosphorus between the two groups were not significant at each time point after surgery （allP〉0.05）.The PF, RP, BP, GH, VT, SF, RE and EB of SF-36 in the two groups before surgery were lower than the normal score; after surgery,each dimension of SF-36 were improved to some extent in the two groups （allP〈0.05）. Eight weeks after surgery, the improvement of PF, RP, BP, GH and EB in the observation group was superior to that in the control group （allP〈0.05）; however,in terms of VT, SF and RE, no significant difference was observed between the two groups （allP〉0.05）.ConclusionThe auricular plaster therapy can improve the physical and mental health, relieve pain and improve quality of life in patients with uremia after PTX＋AT, which is superior to calcium carbonate alone.