益肾清利活络泄浊法改善CKD3-5期肾性贫血的临床疗效观察

发布时间：2018-02-24 06:42

本文关键词： 肾性贫血益肾清利活络泄浊法临床研究　出处：《南京中医药大学》2017年硕士论文　论文类型：学位论文

【摘要】：目的:评价"益肾清利、活络泄浊"法治疗慢性肾脏病3-5期肾性贫血的临床疗效,提高中医对该病理论及诊疗方面的认识。方法:采用临床观察法,纳入的100例患者均是2015.03-2016.12就诊于江苏省中医院肾内科门诊或住院治疗的符合中、西医诊断标准为肾性贫血(非透析)的患者,试验组和对照组各50例。对照组50例除基础治疗外,加用多糖铁复合物胶囊0.3g/d及叶酸片15mg/d口服。治疗组50例在对照组治疗的基础上予"益肾清利、活络泄浊"法辨证治疗,中药每日一剂,三餐后温服;1个月为1个疗程,观察2个疗程。观察治疗前后试验组与对照组的中医证候、血常规指标、肾功能指标,比较临床疗效,并观察和记录不良反应。结果:中医证候积分疗效对比:比较试验组及对照组治疗前后中医证候总积分,试验组总有效率76%,对照组总有效率42%,两组使用经秩和检验,试验组中医总体疗效优于对照组,差异有统计学意义(P0.05)。试验组、对照组治疗前后神疲乏力、腰腿酸软、面色苍白或萎黄、浮肿、纳差、恶心呕吐、肢体麻木等临床症状均有所缓解,其中治疗前后试验组与对照组相比,神疲乏力、腰腿酸软、浮肿、大便干结等症状改善明显,面色萎黄或苍白、纳差、恶心呕吐、肢体麻木等症状改善与对照组相比无明显统计学意义。西医疾病疗效比较:试验组、对照组治疗前后血常规、肾功能等指标均有好转,其中与对照组相比,试验组血常规中的Hb、Hct,肾功能中的Scr、Ccr等指标均有明显改善,两组治疗后血常规、肾功能指标对比有显著差异。试验组和对照组总有效率分别为50%和38%,经秩和检验,P0.05,并不能说明试验组与对照组之间有明显差异。结论:益肾清利活络泄浊法改善肾功能的同时,能够改善肾性贫血,且疗效显著,该法以补肾为先,重视健脾养胃滋养后天,兼顾活血清利,使正气得复,气血得调。尤其在中医证候方面,改善患者神疲乏力、腰腿酸软、浮肿、纳差、大便干结等诸多症状,提高了患者的生存质量。同时,对于提高患者血红蛋白水平,稳定肾功能方面,试验组均高于对照组,表明益肾清利活络泄浊法改善肾性贫血疗效确切。
[Abstract]:Objective: To evaluate the Yishen kiyotoshi, active clinical curative effect of Xiezhuo "treatment of stage 3-5 chronic kidney disease renal anemia, to improve the understanding of the theory of traditional Chinese medicine diagnosis and treatment of the disease. Methods: the clinical observation, 100 cases of patients were 2015.03-2016.12 admitted to Jiangsu Province Traditional Chinese Medicine Hospital Nephrology outpatient or inpatient treatment in accordance with the diagnostic criteria of Western medicine, for renal anemia (non dialysis patients), the experimental group and the control group with 50 cases in each group. The control group of 50 cases in addition to the basic treatment, combined with Iron Polysaccharide Complex Capsules 0.3g/d and Folic Acid Tablets 15mg/d orally. The treatment group of 50 cases in the control group based on the treatment of treated by Yishen kiyotoshi, active relief" the method of syndrome differentiation and treatment, traditional Chinese medicine and twice a day, after meals day; 1 months for 1 courses, 2 courses of treatment. TCM syndromes, experimental group and control group before and after treatment, blood routine, renal function, and to observe the clinical efficacy. And the adverse reactions were recorded. Results: comparison of efficacy of TCM points: a comparison between the experimental group and the control group before and after treatment of TCM syndrome total score, total effective rate of the experimental group 76%, control group total effectiveness 42%, two groups using the rank sum test, the test group was better than that of traditional Chinese medicine the overall efficacy of the control group, the difference was statistically significant (P0.05). The experimental group and control group before and after treatment, lassitude, yaotuisuanruan, pale or sallow complexion, edema, anorexia, nausea and vomiting, numbness and other symptoms were relieved after treatment the experimental group compared with the control group, lassitude, yaotuisuanruan, edema, dry stool symptoms improved significantly. Pale or sallow complexion, anorexia, nausea and vomiting, numbness and other symptoms improved compared with the control group was not statistically significant. Compared with western medicine disease curative effect: the experimental group, the control group before and after treatment, blood routine, renal function indexes were improved, the In the experimental group compared with the control group, routine blood test, Hb, Hct, renal function in Scr, Ccr and other indicators were significantly improved after treatment in the two groups, blood routine, renal function indexes were significantly different between the experimental group and the control group. The total effective rate was 50% and 38%, the rank and inspection, P0.05, and not that there are obvious differences between the experimental group and the control group. Conclusion: Yishen kiyotoshi active Xiezhuo method to improve kidney function at the same time, can improve renal anemia, and the effect is significant, the kidney for the first, pay attention to spleen and stomach nourishing acquired, both Huoxue Qingli, the gas is too complex, and so adjustable. Especially in the TCM syndrome, improve patient lassitude, yaotuisuanruan, edema, anorexia, dry stool and other symptoms, improve the quality of life of the patients. At the same time, to improve the hemoglobin level in patients with stable renal function, the experimental group were higher than the control group, showed Yishen kiyotoshi The method of activating collaterals and relieving turbidity is effective in improving renal anemia.

【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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