本文選題：環(huán)磷酸腺苷　切入點：急性白血病　出處：《山西醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的:選用添加復(fù)方環(huán)磷酸腺苷的腸內(nèi)營養(yǎng)干預(yù)方式,觀察其對急性白血病化療患者的臨床癥狀、貧血狀態(tài)、免疫功能及營養(yǎng)狀況的干預(yù)效果,探討適合于急性白血病化療患者的腸內(nèi)營養(yǎng)干預(yù)方式,以期改善急性白血病化療患者的營養(yǎng)狀況,緩解臨床癥狀,糾正貧血,增強免疫防御能力,縮短住院治療時間。方法:選用山西醫(yī)科大學(xué)第二醫(yī)院血液科確診的急性白血病化療患者73例,隨機分為干預(yù)組37例,對照組36例。兩組患者在常規(guī)臨床治療的基礎(chǔ)上,均按照每標準公斤體重等熱量(105k J/d)等氮(1.5g/d)的膳食原則,分別給予個體化營養(yǎng)指導(dǎo)及腸內(nèi)營養(yǎng)食譜的常規(guī)腸內(nèi)營養(yǎng)支持,干預(yù)組患者在常規(guī)腸內(nèi)營養(yǎng)支持的基礎(chǔ)上給予復(fù)方環(huán)磷酸腺苷40ml/d,連續(xù)使用4周。在干預(yù)試驗過程中,觀察患者的生命體征,記錄其胃腸道功能、精神睡眠狀況的變化情況以及住院治療時間,分別于干預(yù)前、干預(yù)的第2周末和第4周末抽取兩組患者空腹靜脈血(禁食12h),檢測相關(guān)觀察指標:(1)血液指標:血紅蛋白(HGB)、紅細胞(RBC)及血小板(PLT);(2)免疫指標:T淋巴細胞亞群(CD3+、CD4+、CD8+、CD4+/CD8+)及NK細胞;(3)營養(yǎng)指標:血清總蛋白(TP)、前白蛋白(PA)及白蛋白(ALB)。結(jié)果:1.臨床觀察指標:在腸內(nèi)營養(yǎng)干預(yù)試驗中,兩組患者各項生命體征保持平穩(wěn),胃腸道不良反應(yīng)發(fā)生率無明顯差異(P0.05)。與對照組患者相比,干預(yù)組患者的精神及睡眠狀況在試驗期間較穩(wěn)定,惡心的發(fā)生情況也較輕(P0.05);食欲下降及嘔吐的發(fā)生情況雖有所減輕,但組間差異無統(tǒng)計學(xué)意義(P0.05)。2.血液指標:試驗前,干預(yù)組與對照組患者的血液指標組間無明顯差異(P0.05)。在干預(yù)的第2周末及第4周末,干預(yù)組患者的HGB、RBC及PLT較干預(yù)前均明顯升高(P0.05)。且與對照組患者相比,干預(yù)組患者的HGB、RBC及PLT在干預(yù)的第2周末及第4周末升高更為顯著(P0.05)。3.免疫指標:試驗前,干預(yù)組與對照組患者的免疫指標組間均衡可比(P0.05)。與對照組患者相比,干預(yù)組患者的NK細胞含量在干預(yù)的第2周末及第4周末均高于對照組(P0.05)。而干預(yù)組患者的CD3+、CD4+、CD8+及CD4+/CD8+僅在干預(yù)的第4周末明顯優(yōu)于對照組(P0.05)。在干預(yù)的第2周末,干預(yù)組患者的T淋巴細胞亞群指標雖均高于對照組,但無統(tǒng)計學(xué)意義(P0.05)。4.營養(yǎng)指標:試驗前,干預(yù)組與對照組患者的營養(yǎng)指標組間差異無統(tǒng)計學(xué)意義(P0.05)。在干預(yù)的第2周末及第4周末,干預(yù)組患者的TP、PA及ALB較干預(yù)前均明顯升高(P0.05)。且與對照組患者相比,干預(yù)組患者的TP、PA及ALB在干預(yù)的第2周末及第4周末升高更為顯著(P0.05)。5.平均住院治療時間:在腸內(nèi)營養(yǎng)干預(yù)試驗中,干預(yù)組患者的平均住院治療時間與對照組相比縮短(P0.05)。結(jié)論:天然腸內(nèi)營養(yǎng)支持物復(fù)方環(huán)磷酸腺苷可減輕患者的胃腸道負擔。應(yīng)用復(fù)方環(huán)磷酸腺苷的腸內(nèi)營養(yǎng)支持可糾正患者的貧血狀況,增強機體免疫防御功能,改善患者的營養(yǎng)狀況,且有助于改善患者的胃腸道功能、精神及睡眠狀況,減輕化療的毒副反應(yīng),縮短患者的住院治療時間。
[Abstract]:Objective: to use compound cyclic adenosine monophosphate enteral nutrition intervention, observe the clinical symptoms of patients with acute leukemia chemotherapy anemia, intervention effect of immune function and nutritional status, to explore suitable for patients with acute leukemia and enteral nutrition intervention methods, in order to improve the nutritional status of patients with acute leukemia. Alleviate the clinical symptoms, correct anemia, enhance the immune defense ability, shorten the time of hospitalization. Methods: 73 patients with acute leukemia by the second hospital of Shanxi Medical University Department of Hematology diagnosed cases, 37 cases were randomly divided into intervention group, 36 cases in the control group. Two groups of patients on the basis of routine clinical treatment, in accordance with the standard per kg of body weight. Heat (105K J/d) and nitrogen (1.5g/d) dietary principles were given routine intestinal individualized nutritional guidance and enteral nutrition diet nutrition support, patients in the intervention group Based on the conventional enteral nutrition support with compound camp 40ml/d, using for 4 weeks. In the intervention process, observe the patient's vital signs, record the gastrointestinal function, changes of sleep status of spirit and the time of hospitalization, respectively, before the intervention, the intervention of second and fourth weeks from two groups fasting venous blood (fasting 12h), observe the relevant indexes: (1) blood hemoglobin (HGB), red blood cell (RBC) and platelet (PLT); (2) immune index: T lymphocyte subsets (CD3+, CD4+, CD8+, CD4+/CD8+) and NK cells (3); nutrition index serum total protein (TP), prealbumin (PA) and albumin (ALB). Results: 1. clinical observation indexes: in enteral nutrition intervention trials, two groups of patients with various vital signs, gastrointestinal adverse reaction incidence rate had no significant difference (P0.05). Compared with the control group, intervention groups of patients The spirit and sleep status was stable during the experiment, the incidence of nausea was lower (P0.05); loss of appetite and vomiting is mitigated, but no significant difference between the groups (P0.05):.2. blood test before the intervention group and the control group had no significant difference between groups of patients with blood index (P0.05). In the second and 4 weekend weekend intervention, the intervention group of HGB, RBC and PLT were significantly higher than those before intervention (P0.05). Compared with control group, intervention group were HGB, RBC and PLT in the second week and 4 week intervention were higher (P0.05).3. immune index: before the test, the intervention group and the control group of patients with immune index between equallycomparable (P0.05). Compared with the control group, the intervention group of patients with NK cells were second and 4 in the intervention weekend weekend were higher than the control group (P0.05). The patients in the intervention group CD3+, CD4+, and CD8+ CD 4+/CD8+ only in the intervention fourth weeks was significantly better than the control group (P0.05). In the second week intervention, intervention index of T lymphocyte subsets in patients was higher than that of the control group, but no statistical significance (P0.05).4. nutrition index: before the test, the intervention group and the control group of patients with nutritional index group no significant difference meaning (P0.05). In the second week and 4 week intervention, the intervention group of TP, PA and ALB were significantly higher than those before intervention (P0.05). Compared with control group, intervention group were TP, PA and ALB in the second week and 4 week intervention is more significant rise (P0.05).5.: the average time of hospitalization in enteral nutrition intervention trials, the average hospitalization time of intervention group and control group were shortened (P0.05). Conclusion: natural enteral nutrition compound camp can reduce the gastrointestinal burden. Application of compound cyclic adenosine monophosphate Enteral nutrition support can correct the anemia of patients, enhance the immune defense function, improve the nutritional status of patients, and help improve gastrointestinal function, mental and sleep status, reduce the toxic and side effects of chemotherapy, and shorten the hospitalization time of patients.

【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R733.71;R459.3

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