十全大补汤肠内营养治疗胃癌术后气血两虚证临床观察
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摘要
目的观察十全大补汤肠内营养治疗胃癌术后气血两虚证的临床疗效。方法将48例胃癌术后气血两虚证患者按照随机数字表法分为2组。对照组22例术后予肠内营养混悬液(TPF)肠内营养治疗;治疗组26例在对照组治疗基础上联合十全大补汤肠内营养治疗。2组均治疗7 d后统计疗效,比较2组术后首次排气时间、恢复经口进食时间及总住院时间,比较2组治疗前后营养指标[包括体质量指数(BMI)及营养风险筛查2002(NRS 2002)评分]、实验室指标[包括血清总蛋白(TP)、白蛋白(Alb)及血红蛋白(Hgb)]、中医症状评分(包括神疲乏力、面色少华、头晕目眩、形体消瘦、心悸气短、畏寒肢冷、自汗盗汗及心烦不寐)变化情况。结果治疗组术后首次排气时间、恢复经口进食时间及总住院时间均短于对照组(P<0.05);2组治疗后BMI及NRS 2002评分与本组治疗前比较,BMI水平均明显增加(P<0.05),NRS 2002评分均明显降低(P<0.05),且治疗组治疗后对BMI及NRS 2002评分改善均优于对照组(P<0.05);2组治疗后血清TP、Alb及Hgb水平与本组治疗前比较均明显增加(P<0.05),且治疗组治疗后TP、Alb及Hgb水平均高于对照组(P<0.05);2组治疗后中医症状神疲乏力、面色少华、头晕目眩、形体消瘦、心悸气短、畏寒肢冷、自汗盗汗及心烦不寐评分与本组治疗前比较均明显降低(P<0.05),且治疗组治疗后各中医症状评分均低于对照组(P<0.05)。结论十全大补汤肠内营养治疗胃癌术后气血两虚证临床疗效确切,可明显改善患者中医症状,改善患者营养状态,增加TP、Alb及Hgb水平,促进术后病情恢复,缩短住院时间。
Objective To observe the clinical effects of Shiquan Dabu decoction combined with enteral nutrition on deficiency of both qi and blood syndrome after gastric cancer operation. Methods 48 patients with deficiency of both qi and blood after gastric cancer operation were divided into two groups according to random number table method. 22 cases in control group were treated by enteral nutrition suspension(TPF) after operation. 26 cases in treatment group were treated by enteral nutrition combined with Shiquan Dabu decoction on the basis of the control group. The curative effects of the two groups were evaluated after 7 days of treatment. The first exhaust time, the time of resuming oral feeding and the total hospitalization time after operation were compared between the two groups. The changes of nutritional index [ body mass index(BMI) and nutritional risk screening 2002(NRS 2002) score], laboratory index [total serum protein(TP), albumin(Alb) and hemoglobin(Hgb)] and TCM symptom score [fatigue, complexion lacks luster, dizziness, emaciation, palpitation and shortness of breath, cold limbs, spontaneous sweating and night sweat, vexation and insomnia] before and after treatment were compared between the two groups. Results The first exhaust time, the time of resuming oral feeding and the total hospitalization time after operation in the treatment group were shorter than those in the control group(P<0.05). After treatment, BMI in two groups were significantly increased than that in the group before treatment(P<0.05), the NRS 2002 scores in two groups were significantly decreased than that in the group before treatment(P<0.05), and the improvement of BMI and NRS 2002 scores in treatment group was better than that in control group(P<0.05). After treatment, the levels of serum TP, Alb and Hgb in two groups were significantly increased than those in control group before treatment(P<0.05), and the improvement of TP, Alb and Hgb in treatment group was better than that in control group(P<0.05). After treatment, the scores of TCM symptoms such as fatigue, complexion lacks luster, dizziness, emaciation, palpitation and shortness of breath, cold limbs, spontaneous sweating and night sweat, vexation and insomnia in two groups were significantly lower than those in the group before treatment(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). Conclusion Shiquan Dabu decoction combined with enteral nutrition has definite clinical effect in the treatment of deficiency of both qi and blood after gastric cancer operation. It can significantly improve the TCM symptoms, improve the nutritional status of patients, increase the levels of TP, Alb and Hgb, promote the recovery of the disease after operation, and shorten the hospitalization time.
Objective To observe the clinical effects of Shiquan Dabu decoction combined with enteral nutrition on deficiency of both qi and blood syndrome after gastric cancer operation. Methods 48 patients with deficiency of both qi and blood after gastric cancer operation were divided into two groups according to random number table method. 22 cases in control group were treated by enteral nutrition suspension(TPF) after operation. 26 cases in treatment group were treated by enteral nutrition combined with Shiquan Dabu decoction on the basis of the control group. The curative effects of the two groups were evaluated after 7 days of treatment. The first exhaust time, the time of resuming oral feeding and the total hospitalization time after operation were compared between the two groups. The changes of nutritional index [ body mass index(BMI) and nutritional risk screening 2002(NRS 2002) score], laboratory index [total serum protein(TP), albumin(Alb) and hemoglobin(Hgb)] and TCM symptom score [fatigue, complexion lacks luster, dizziness, emaciation, palpitation and shortness of breath, cold limbs, spontaneous sweating and night sweat, vexation and insomnia] before and after treatment were compared between the two groups. Results The first exhaust time, the time of resuming oral feeding and the total hospitalization time after operation in the treatment group were shorter than those in the control group(P<0.05). After treatment, BMI in two groups were significantly increased than that in the group before treatment(P<0.05), the NRS 2002 scores in two groups were significantly decreased than that in the group before treatment(P<0.05), and the improvement of BMI and NRS 2002 scores in treatment group was better than that in control group(P<0.05). After treatment, the levels of serum TP, Alb and Hgb in two groups were significantly increased than those in control group before treatment(P<0.05), and the improvement of TP, Alb and Hgb in treatment group was better than that in control group(P<0.05). After treatment, the scores of TCM symptoms such as fatigue, complexion lacks luster, dizziness, emaciation, palpitation and shortness of breath, cold limbs, spontaneous sweating and night sweat, vexation and insomnia in two groups were significantly lower than those in the group before treatment(P<0.05), and the scores of TCM symptoms in the treatment group were lower than those in the control group(P<0.05). Conclusion Shiquan Dabu decoction combined with enteral nutrition has definite clinical effect in the treatment of deficiency of both qi and blood after gastric cancer operation. It can significantly improve the TCM symptoms, improve the nutritional status of patients, increase the levels of TP, Alb and Hgb, promote the recovery of the disease after operation, and shorten the hospitalization time.
引文
[1] 郑朝旭,郑荣寿,张思维,等.中国2010年胃癌发病与死亡分析[J].中国肿瘤,2014,23(10):795-800.
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[9] 刘洪一,王白石,张加金,等.早期肠内营养与肠外营养在胃癌根治术后应用效果比较[J].中国肿瘤临床,2014,41(18):1166-1169.
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[13] 孔烨,花亚伟,张占东,等.胃癌患者术后应用肠内营养混悬液的临床观察[J].中国当代医药,2011,18(23):30-31.
[14] 潘放,邓毅.艾迪注射液联合肠内营养混悬液(TPF)治疗晚期胃癌的疗效观察[J].中国医院用药评价与分析,2018,18(4):506-508.
[15] 郑培永,李凯,郑丰杰.胃癌的中医发病机制及研究思路探讨[J].辽宁中医杂志,2008,35(4):509-511.
[16] 杜春海,戎瑞雪,王梦,等.十全大补汤多糖成分抑瘤及免疫调节作用的初步研究[J].河北中医药学报,2014,29(4):3-6.
[17] 戎瑞雪,王蓓,曹志然,等.十全大补汤总多糖的体外抗肿瘤作用[J].山东医药,2011,51(7):15-17.
[18] 杜锦芳,禹雯琦,周诣,等.十全大补汤对结肠癌原发瘤切除后转移瘤生长及NK细胞的影响[J].上海中医药杂志,2017,51(12):79-83.
[19] 武继成,赵爽,伍威,等.十全大补汤对SV40 T抗原转基因小鼠晶状体自发肿瘤的抑制作用及其分子机制[J].吉林大学学报(医学版),2018,44(1):13-17.
[2] 张亚群,徐惠绵.胃癌术后腹腔化疗疗效对比分析及评价[J].中国肿瘤临床,2005,32(3):154-157.
[3] 吴小丽,刘纳新,吴建胜.老年胃癌患者营养风险筛查及术后早期肠内营养治疗的研究[J].医学研究杂志,2014,43(12):56-59.
[4] 中华人民共和国卫生部医政司.胃癌诊疗规范(2011年版)[J].中国医学前沿杂志:电子版,2012,4(5):62-71.
[5] 郑筱萸.中药新药临床研究指导原则(试行)[M].北京:中国医药科技出版社,2002:378-383.
[6] 杨剑,许静涌,康维明,等.营养风险及营养风险筛查工具营养风险筛查2002临床应用专家共识(2018版)[J].中华临床营养杂志,2018,26(3):131-135.
[7] 周群英,姜忠于.足量营养支持对肿瘤病人化疗后的营养状况及生活质量的影响[J].肠外与肠内营养,2018,25(3):138-141.
[8] 张伟,朱维铭.晚期胃癌规范化营养支持治疗[J].中国实用外科杂志,2017,37(10):1118-1123.
[9] 刘洪一,王白石,张加金,等.早期肠内营养与肠外营养在胃癌根治术后应用效果比较[J].中国肿瘤临床,2014,41(18):1166-1169.
[10] 胡涛,董永红.胃癌术后早期肠内营养的研究进展[J].中国现代医药杂志,2017,19(3):105-108.
[11] 秦环龙,吴肇汉.肠内营养在外科临床中的应用[J].肠外与肠内营养,2000,7(2):119-121.
[12] 靳云云,郭松雪,有传刚,等.营养风险筛查2002在中国的应用概况[J].中华临床营养杂志,2015,23(4):255-258.
[13] 孔烨,花亚伟,张占东,等.胃癌患者术后应用肠内营养混悬液的临床观察[J].中国当代医药,2011,18(23):30-31.
[14] 潘放,邓毅.艾迪注射液联合肠内营养混悬液(TPF)治疗晚期胃癌的疗效观察[J].中国医院用药评价与分析,2018,18(4):506-508.
[15] 郑培永,李凯,郑丰杰.胃癌的中医发病机制及研究思路探讨[J].辽宁中医杂志,2008,35(4):509-511.
[16] 杜春海,戎瑞雪,王梦,等.十全大补汤多糖成分抑瘤及免疫调节作用的初步研究[J].河北中医药学报,2014,29(4):3-6.
[17] 戎瑞雪,王蓓,曹志然,等.十全大补汤总多糖的体外抗肿瘤作用[J].山东医药,2011,51(7):15-17.
[18] 杜锦芳,禹雯琦,周诣,等.十全大补汤对结肠癌原发瘤切除后转移瘤生长及NK细胞的影响[J].上海中医药杂志,2017,51(12):79-83.
[19] 武继成,赵爽,伍威,等.十全大补汤对SV40 T抗原转基因小鼠晶状体自发肿瘤的抑制作用及其分子机制[J].吉林大学学报(医学版),2018,44(1):13-17.