益肾清利、和络泄浊法治疗慢性肾脏病5期（非透析）的疗效观察

发布时间：2019-03-05 08:45

【摘要】：导师孙伟教授已于临床治疗慢性肾脏疾病多年,并坚持研习古今中外相关文献多年,结合其长期的临床实践及丰富的医学知识,认识到慢性肾脏病的病人应该在该病的早期就进行中医治疗以延缓该病病情的进展,指出该病的基本病机当属"肾虚湿浊(瘀)",并创建了益肾清利、和络泄浊法作为该病的治疗总则,归纳出治疗慢性肾功能衰竭的有效处方,在临床应用中其疗效得到了同行及患者的肯定。目的:观察益肾清利、和络泄浊法治疗慢性肾脏病5期(非透析)的疗效方法:收集整理2014年9月至2014年12月至江苏省中医院肾内科就诊的非透析CKD5期患者30例,所有入组患者均采用西医基础治疗+益肾清利、和络泄浊法治疗,对入选的30例患者,分别于用药满0月、3月、6月、9月、12月随访,复查并记录相关实验室指标(尿素氮、肌酐、eGFR、血红蛋白、白蛋白、二氧化碳结合力、血清钾等),填写生存质量调查表,将这些数据的前后变化作为自身对照,对此进行统计学分析,做临床疗效评价。同时,在随访时点,对患者的服药依从性、营养状况、肾功能及安全性指标进行整体评估,重点评估患者肾功能、是否存在透析指征、是否发生不良事件和(或)严重不良事件,进而评价益肾清利、和络泄浊法治疗慢性肾脏病(CKD5期)的疗效。将随访时点表格交给患者保存。如患者第一年未进入终点,则在第二年随访开始前参照第一年处理。本试验的观察时间为1年。结果:入组的30例病例中,有1例脱落病例,有1例到达透析终点,纳入分析28例。1.治疗后患者尿素氮缓慢下降,治疗12个月末与治疗前比较差异有统计学意义(P0.05)。2.治疗后,在治疗的第3个月,患者的血肌酐升高,在治疗的第6个月、9个月、12个月患者的血肌酐都较治疗前下降,在治疗12个月末统计分析显示血肌酐与治疗前比较差异有统计学意义(P0.05)。3.治疗12个月末,eGFR较治疗前升高,与治疗前比较差异有统计学意义(P0.05)。4.治疗12个月末,Hb升高,与治疗前比较差异具有统计学意义(P0.05)。5.治疗12个月末,白蛋白较治疗前上升,与治疗前比较差异具有统计学意义(P0.05)。6.血钾在治疗期间波动不明显,治疗12个月末较治疗前下降,与治疗前比较差异具有统计学意义(P0.05)。7.二氧化碳结合力在治疗期间波动不明显,治疗12个月末较治疗前上升,与治疗前比较差异具有统计学意义(P0.05)。8.治疗12个月末,患者的生存质量较治疗前升高,与治疗前比较差异有统计学意义(P0.05)。9.1例用药4周后出现高血钾症,无心悸、胸闷等症状,给予对症处理后复查血钾正常。试验期间未发生死亡事件、感染事件、心脑血管事件及其它不良反应。所有纳入观察的患者治疗前后血常规(白细胞分类及计数,血小板计数)、尿常规、大便常规加潜血、心电图等检查与治疗前相比均无明显异常。结论:1.慢性肾脏病5期,肾脏排泄氮质代谢产物功能下降,湿浊内蕴,肾功能下降,益肾清利、和络泄浊法具有较好的疗效,能增加氮质代谢产物的排泄,减轻肾脏的负担,升高其eGFR,保护其残肾功能,延缓肾功能的进一步恶化。2.慢性肾脏病5期患者,由于病程长,临床症状复杂,以及巨大的精神及经济压力,患者的生存质量较低,益肾清利、和络泄浊法能提高慢性肾脏病5期患者的生存质量。3.对于进入慢性肾脏病5期的患者,在其血压、血糖、酸中毒及电解质紊乱得到控制的情况下,采用益肾清利、和络泄浊法治疗该病安全可行,但需密切注意其相关实验室指标的变化。
[Abstract]:Professor Sun Wei, a professor, has been in clinical treatment of chronic kidney disease for many years, and has adhered to the literature for many years in the past and abroad, combining its long-term clinical practice and rich medical knowledge. It is recognized that the patients with chronic kidney disease should be treated with Chinese medicine in the early stage of the disease to delay the progress of the disease. It is pointed out that the basic pathogenesis of the disease is the "Kidney deficiency and dampness and turbid (blood stasis)", and it has created the method of benefiting the kidney and clearing the balance of the kidney, and the method as the general principle of the treatment of the disease. The effective prescription of the treatment of chronic renal failure was concluded, and its curative effect was confirmed by the peer and the patient in the clinical application. Objective: To observe the effect of Yishen Qingli (Yishen Qingli) and the method of the treatment of chronic kidney disease (non-dialysis) in the period from September,2014 to December,2014. All enrolled patients were treated with the basic treatment of western medicine, Yishen Qingli, and the method of the treatment of the collaterals, and the selected 30 patients were followed up for 0 month, March, June, September and December respectively, and the relevant laboratory indexes (urea nitrogen, myoglobin, eGFR, hemoglobin and albumin) were reviewed and recorded. Carbon dioxide binding force (carbon dioxide binding force, serum potassium, etc.), the quality of life questionnaire was filled in, and the changes of these data were used as self-control. At the same time, at the follow-up time point, the patient's medication compliance, nutritional status, renal function and safety index were evaluated as a whole, with a focus on assessing the renal function of the patient, the presence of a dialysis indication, the occurrence of adverse events and/ or serious adverse events, And the curative effect of the method for treating chronic kidney disease (CKD5). The follow-up time-point form was given to the patient for preservation. If the end point is not entered for the first year of the patient, the first year of treatment will be referenced prior to the start of the second year follow-up. The observation time of this test is 1 year. Results: Of the 30 cases enrolled, there were 1 case of shedding, one of which had reached the end of the dialysis and included in the analysis of 28 cases. After the treatment, the urea nitrogen of the patients decreased slowly, and the difference between the end of the treatment and the treatment before treatment was statistically significant (P0.05). After treatment, in the third month of the treatment, the blood muscle strength of the patient increased, and in the first 6 months,9 months and 12 months of the treatment, the blood muscle strength of the patient was decreased, and the statistical significance was found in the statistical analysis at the end of the treatment for 12 months (P0.05). At the end of 12 months, eGFR was higher than that before treatment (P0.05). The difference of Hb in the end of the treatment was statistically significant (P0.05). In the end of 12 months, the albumin was higher than that before treatment, and the difference was statistically significant (P0.05). There was no significant fluctuation of potassium in the treatment period, and the difference in treatment before and after treatment was statistically significant (P0.05). The effect of carbon dioxide binding force on the treatment period was not significant, and the treatment of 12-month-old patients was higher than that before treatment (P0.05). In the end of 12 months, the quality of life of the patients was higher than that before treatment (P0.05). In 9.1 cases, hyperkalemia, no palpitations, chest distress and other symptoms occurred after 4 weeks of treatment, and the blood potassium was normal after the symptomatic treatment. No deaths, infections, cardiovascular and cerebrovascular events and other adverse reactions occurred during the trial. All the patients included in the observation before and after treatment (white blood cell classification and count, platelet count), urine routine, routine urine plus occult blood, electrocardiogram, and the like had no obvious abnormality than before treatment. Conclusion:1. in that phase 5 of chronic kidney disease, the function of the renal excretion of the nitrogen metabolism product is reduced, the presence of the dampness and the turbid liquid, the decrease of the kidney function, the kidney-tonifying and the clear-interest are better, the excretion of the nitrogen-mass metabolite can be increased, the burden of the kidney is reduced, the eGFR is increased, and the residual renal function is protected, To delay the further deterioration of renal function. In patients with chronic kidney disease, the quality of life of patients with chronic kidney disease can be improved due to the long course of the disease, the complex clinical symptoms, and the great mental and economic pressure. With the control of blood pressure, blood sugar, acidosis and electrolyte disturbance in patients with chronic kidney disease, it is safe and feasible to use the method of Yishen Qingli, and the method of using the collaterals to treat the disease, but it is necessary to pay close attention to the changes of relevant laboratory indexes.
【学位授予单位】：南京中医药大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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