营养护理联降糖温肾汤分期干预Ⅰ、Ⅱ期糖尿病肾病随机平行对照研究

Randomized Parallel Controlled Study of Nutritional Nursing combined with Jiangtang Decoction in the Treatment of Stage Ⅰ Diabetic Nephropathy

[目的]观察营养护理联降糖温肾汤干预糖尿病肾病疗效。[方法]使用随机平行对照方法,将124例门诊患者按就诊顺序编号方法简单随机分为两组。对照组62例达美康,80mg/次,2次/d,口服;辛伐他丁,20mg/次,1次/d,口服;卡托普利,37.5mg/次,1次/d,口服。治疗组62例遵医嘱,降糖温肾汤:山药、山茱萸各15g,砂仁、沙参、玉竹各12g,巴戟天、仙灵脾、桃仁、郁金、枸杞子、酸枣仁、熟地、黄精各10g,水煎200mL,1剂/d,2次/d,口服。营养护理干预:评估患者能量需求,制定个性化饮食方案,蛋白摄入0.7~0.9g/kg·d^(-1)。病情加重,蛋白摄入量应控制在0.5~0.6g/kg·d^(-1),以鱼、蛋、豆类等为主,减少碳水化合物摄入20~30%,适当食用杂粮、面、米等食物。控制胆固醇295mg/kg·d^(-1)、食盐摄入量2~3g/kg·d^(-1)。伴高脂症,控制脂肪摄入量,约1g/kg·d^(-1);西药治疗同对照组。连续护理3个月为1疗程。观测临床症状、空腹血糖、餐后2h血糖、总胆固醇、甘油三酯、尿素氮、血肌酐、不良反应。护理1疗程(3个月),判定疗效。[结果]治疗组显效40例,有效18例,无效4例,总有效率93.55%;对照组显效28例,有效20例,无效17例,总有效率77.42%;治疗组疗效优于对照组(P<0.01)。空腹血糖、餐后2h血糖两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。总胆固醇、甘油三酯两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。尿素氮、血肌酐两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]营养护理联降糖温肾汤干预糖尿病肾病,疗效满意,无严重不良反应,值得推广。

[Objective] To observe the effect of nutritional nursing combined with Jiangtang decoction on diabetic nephropathy. [Method] 124 cases of outpatients were randomly divided into two groups according to the random number method. The control group of 62 cases of diamicron 80 mg/times, 2 times/d, oral; simvastatin, 20 mg/times, 1 times/d, oral; captopril, 37.5 mg/times, 1 times/d, oral. 62 cases in the treatment group were prescribed antidiabetic wenshen decoction： Shanyao, Shanzhuyu each 15 g, Sharen, Shashen, Yuzhu each 12 g, Bajitian, Xianlingpi, Taoren, Yujin, Gouqizi, Suanzaoren, Shudi, Huangjing each 10 g, decoction 200 mL, 1 Ji/d, 2 times/d, oral. Nutritional nursing intervention： to assess the energy needs of patients, develop a personalized diet program, protein intake of 0.7~0.9 g/kg·d^（-1）. Exacerbations, protein intake should be controlled at 0.5~0.6 g/kg·d^（-1）, fish, eggs, beans, etc., to reduce carbohydrate intake from 20 to 30%, the appropriate consumption of cereals, noodles, rice and other food. Control cholesterol 295 mg/kg·d^（-1）, salt intake 2~3 g/kg·d^（-1）. With hyperlipidemia, control of fat intake, about 1 g/kg·d^（-1）; western medicine treatment with the control group. Continuous care for 1 months for a course of 3. The clinical symptoms, fasting blood glucose, postprandial 2 h blood glucose, total cholesterol, triglyceride, urea nitrogen, serum creatinine and adverse reactions were observed. Nursing 1 course of treatment（3 months）, determine the efficacy. [Result] in the treatment group, 40 cases were markedly effective, effective in 18 cases, ineffective in all cases, the total effective rate was 93.55%, the control group was markedly effective in 28 cases, effective in 20 cases, ineffective in 17 cases, the total effective rate was 77.42%; the treatment group was better than the control group（P0.01）. Fasting blood glucose, postprandial 2 h blood glucose in the two groups were improved （P0.01）, the treatment group was better than the control group （P0.01）. Total cholesterol and triglyceride in two groups were improved （P0.01）, the treatment group was better than the control group （P0.01）. Urea nitrogen and serum creatinine in two groups were improved （P0.01）, the treatment group was better than the control group （P0.01）. [Conclusion] The effect of nutritional nursing combined with Jiangtang decoction on diabetic nephropathy was satisfactory and no serious adverse reactions were observed.