發(fā)布時間：2018-11-29 09:48

【摘要】：目的運(yùn)用觀察刺四縫聯(lián)合營養(yǎng)干預(yù)治療小兒脾失健運(yùn)證厭食的療效。系統(tǒng)觀察其臨床療效,分析對治療前后和治療結(jié)束3個月回訪時患兒的癥狀和營養(yǎng)素攝入情況,最后驗(yàn)證兒童營養(yǎng)門診中針對脾失健運(yùn)證小兒厭食,開展刺四縫聯(lián)合營養(yǎng)干預(yù)方法的療效。方法收集2016年1月至2016年7月期間就診于南京市雨花臺區(qū)婦幼保健所兒童營養(yǎng)門診的脾失健運(yùn)證厭食癥患兒104例,年齡為1～3歲,按照隨機(jī)對照的原則,受試患兒病例共分為三組:刺四縫組36例、營養(yǎng)干預(yù)組37例和聯(lián)合組(刺四縫聯(lián)合營養(yǎng)干預(yù))31例。其中,刺四縫治療是經(jīng)常規(guī)消毒后用5分針?biāo)冱c(diǎn)刺掌側(cè)食指、中指、無名指、小指第二關(guān)節(jié)中部0.1-0.5cm,擠出少量黏液或血液后用消毒棉球擦拭壓迫止血,一周兩次。營養(yǎng)干預(yù)分為膳食指導(dǎo)和飲食行為指導(dǎo):膳食指導(dǎo)是家長填寫3日(2工作日和1休息日)24h膳食調(diào)查表并錄入營養(yǎng)之星膳食調(diào)查系統(tǒng),分析計算出三日各營養(yǎng)素攝入情況,取平均值,并根據(jù)《中國居民膳食指南(2011年)》指導(dǎo)飲食結(jié)構(gòu);飲食行為指導(dǎo)采用愛飯達(dá)飲食行為評估,對厭食幼兒飲食行為習(xí)慣進(jìn)行詢問并評定,評定結(jié)果分為胃口差、對某種食物特別偏好、不良進(jìn)食習(xí)慣、父母過度關(guān)心、害怕進(jìn)食五種,并進(jìn)行對應(yīng)的飲食習(xí)慣養(yǎng)成指導(dǎo)或轉(zhuǎn)診治療,營養(yǎng)干預(yù)一周一次。營養(yǎng)干預(yù)與刺四縫療法均為2周1療程。結(jié)果治療結(jié)束時,聯(lián)合組痊愈10例,占32.26%,顯效19例,占61.29%,進(jìn)步1人,占3.23%,無效1人,占3.23%,愈顯率93.6%;刺四縫組痊愈10例,占27.78%,顯效21例,占58.33%,進(jìn)步3例,占8.33%,無效2例,占5.56%,愈顯率86.11%;營養(yǎng)干預(yù)組痊愈3例,占8.11%,顯效23例,占62.16%,進(jìn)步6例,占16.22%,無效5人,占13.51%,愈顯率70.27%。聯(lián)合組和刺四縫組在療效方面療效優(yōu)于營養(yǎng)干預(yù)組(P0.05);營養(yǎng)干預(yù)組能量和脂肪提升較少(P0.05),聯(lián)合組蛋白質(zhì)提升較多(P0.05)。治療結(jié)束3個月回訪,聯(lián)合組痊愈18例,占58.06%,顯效13例,占41.94%,愈顯率100%;刺四縫組痊愈11例,占30.56%,顯效21例,占58.33%,進(jìn)步2例,占5.56%,無效2例,占5.56%,愈顯率88.89%;營養(yǎng)干預(yù)組痊愈6例,占16.22%,顯效24例,占64.86%,進(jìn)步4例,占10.81%,無效3例,占8.11%,愈顯率81.08%。聯(lián)合組能量、蛋白質(zhì)、脂肪提升療效最好(P0.05),且療效最優(yōu)(P0.01)。三組患兒治療結(jié)束時,厭食癥狀均有改善,具有臨床療效,刺四縫聯(lián)合營養(yǎng)干預(yù)方法治療小兒脾失健運(yùn)證厭食相對于單一運(yùn)用刺四縫或營養(yǎng)干預(yù),治療結(jié)束3個月時回訪結(jié)果療效更佳,整個治療過程中,患兒無不良反應(yīng),說明三種治療方法在營養(yǎng)門診及基層單位均安全,說明刺四縫與營養(yǎng)干預(yù)的聯(lián)合療法具有療效好且持久,便于操作,安全等特點(diǎn),值得在兒童營養(yǎng)門診中推廣。結(jié)論通過本次研究,刺四縫與營養(yǎng)干預(yù)聯(lián)合治療小兒脾失健運(yùn)證厭食的療效優(yōu)于單純使用任一方法,并具有統(tǒng)計學(xué)意義(P0.05),具有療效確切,操作簡便,易被患兒及家長接受等優(yōu)勢,聯(lián)合營養(yǎng)學(xué)方法,充分發(fā)揮祖國醫(yī)學(xué)優(yōu)勢,值得在基層兒童營養(yǎng)門診中推廣。
[Abstract]:Objective To observe the effect of four-slit combined nutrition intervention on the treatment of anorexia of the spleen of children. The clinical effect of the system was observed, and the symptoms and nutrient intake of the children were analyzed before and after treatment and at the end of 3 months. Methods 104 children with anorexia nervosa were collected from January 2016 to July 2016 in the children's nutrition clinic of Yuhua District, Nanjing. The age ranged from 1 to 3 years. According to the principle of randomized control, the cases of children with anorexia were divided into three groups: The nutrition intervention group (37 cases) and the combined group (4-joint nutrition intervention) were used in 31 cases. in which, the four-stitch treatment is carried out by using a 5-minute hand-side index finger, a middle finger, a ring finger and a small finger in the middle of the second joint of the second joint after the conventional disinfection, and the middle finger, the middle finger and the ring finger are used for wiping and pressing the hemostasis with the sterilized cotton ball after the small amount of the mucus or the blood is extruded, and the hemostasis is performed twice a week. The nutrition intervention is divided into the dietary guidance and the dietary behavior guidance: the dietary instruction is that the parent fills in the meal questionnaire of 3 days (2 working days and 1 day of rest) and enters the nutrient star dietary survey system, and the analysis and calculation of the three-day nutrient intake conditions, taking the average value, according to the dietary guidelines of the Chinese residents (2011)> to guide the diet structure, Parents care about, fear to eat five, and carry on the corresponding eating habits to develop the guidance or referral treatment, the nutrition intervention once a week. Both the nutrition intervention and the four-slit therapy were two weeks and one treatment course. Results At the end of the treatment, the combined group was cured in 10 cases, accounting for 32.26%, markedly effective 19 cases (61.29%), progressive 1 (3.23%), invalid 1 (3. 23%), more effective rate (93.6%), healing of the four-slit group (27. 78%), effective 21 (58. 33%), progressive 3 cases (8.33%), and invalid 2 cases. The rate of treatment was 5.56%, the more obvious rate was 81.11%, and in the nutrition intervention group, 3 cases were cured, 8. 11%, 23 cases were effective, 62. 16%, 6 cases in progress, 16. 22%, 5 were invalid, 13. 51%, and the more obvious rate was 70. 27%. The curative effect of the combined group and the four-suture group was superior to that of the nutrition intervention group (P0.05). The energy and fat of the nutrition intervention group were less (P0.05), and the protein of the combined group was higher (P0.05). At the end of the 3-month follow-up, the combined group was cured in 18 cases, accounting for 58. 06%, effective 13 cases, 41. 94%, the more obvious rate was 100%. The four-slit group was cured in 11 cases, accounting for 30. 56%, effective 21 cases, 58. 33%, progress 2 cases, 5. 56%, invalid 2 cases, 5. 56%, the more obvious rate 88. 89%; In the nutrition intervention group, 6 cases, 16. 22%, 24 cases, 64. 86%, 4 cases, 10.81%, 3 cases, 8.11% and 81.08%, were cured. The effect of energy, protein and fat in the combined group was the best (P0.05), and the curative effect was optimal (P0.01). at the end of the treatment of the three groups of children, the symptoms of the anorexia are improved, The patient has no adverse reaction, and the three treatment methods are safe in the nutrition clinic and the grass-root unit, and the combination therapy of the four-stitch and the nutrition intervention has the characteristics of good curative effect and lasting, convenient operation, safety and the like, and is worthy of being popularized in the pediatric nutrition clinic. Conclusion The results of this study indicate that the curative effect of the combination of the four-stitch and the nutrition intervention on the anorexia of the spleen of the child is superior to that of the simple method, and has the statistical significance (P0.05). It has the advantages of definite curative effect, simple and convenient operation, easy to be accepted by the child and the parent, and the combined nutrition method. giving full play to the medical advantage of the motherland, and is worthy of being popularized in the nutrition clinic of the grass-roots children.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R246.4

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