耳穴联合针刺对维持性血液透析阳虚水湿型口渴患者的干预研究

发布时间：2018-03-06 09:32

本文选题：维持性血液透析　切入点：口渴　出处：《成都中医药大学》2016年硕士论文　论文类型：学位论文

【摘要】：研究目的：本研究将耳穴贴压联合针刺作为血液透析患者口渴症的整体治疗方法之一,探索改善血液透析患者口渴症状的方法,从而控制其透析间期体重的增加,以期进一步减少心脑血管并发症,提高患者生活质量。研究方法：本研究共分为两部分,前期采用横断面调查方法,选择符合西医诊断标准的规律性血液透析治疗的患者,制作MHD口渴患者中医证候调查表,通过问卷调查,收集MHD口渴患者一般情况、透析龄、原发病、中医证候等临床资料,最终分析得出MHD口渴患者主要的证型分布规律；后期以前期调查所得的MHD口渴患者中证型分布最为广泛的阳虚水湿证为研究对象,共纳入45例患者,并将其分为3组(对照组；单纯耳穴治疗组；耳穴联合针刺组治疗组；每小组各15人)。对照组予以常规治疗,治疗组则在常规治疗的基础上,根据耳穴及针刺选穴原则和尿毒症口渴发生的中西医机制选取有效的主穴及配穴,分别给予耳穴贴压和耳穴联合针刺治疗8周。以口渴程度评分量表评定口渴程度,同时监测平均透析间期体重增加相对值、Kt/V、透析前血Na+浓度、血压等,对比上述指标治疗前后的变化。同时探讨口渴程度评分与透析间期体重增加相对值、KT/V值、透析前平均动脉压、透析前血钠浓度之间的相关性。研究结果：1.122例维持性血液透析伴口渴症患者的中医证型以阳虚水湿为最多(24.59%),其次是气虚血瘀；邪实证型水湿(40.98%)最为多见,其次为血瘀、湿热,多数患者为本虚标实,虚实夹杂(86.06%),单纯正虚者共17例(13.93%)。2.维持性血液透析口渴患者的中医证型分布与患者的性别、年龄、维持透析年限、原发病、口渴程度,其证候分布构成差异无统计学意义(P0.05)。3.治疗组患者口渴程度评分治疗4周、治疗8周与治疗前比较均明显下降(P0.01),治疗8周与治疗4周比较下降明显(P0.01)；治疗组组间比较,耳穴联合针刺组口渴评分下降更明显。4.治疗组患者平均透析间期体重增加相对值治疗4周、8周与治疗前比较均明显下降(P0.01),治疗8周与治疗4周比较下降明显(P0.01)；治疗组组间比较,耳穴联合针刺组平均透析间期体重增加相对值下降更明显。5.3组患者Kt/v值、血钠浓度治疗4周与治疗前比较、治疗8周与治疗前比较、治疗8周与治疗4周比较,差异均无统计学意义(P0.05)。6.口渴程度评分与平均透析间期体重增加相对值呈正相关(P0.01)。7.口渴程度评分与KT/V值、透前血钠浓度及平均动脉压、患者的年龄及平均透析龄均无明显相关性(P0.05)。研究结论1.本研究调查提示本虚标实,虚实夹杂是维持性血液透析口渴患者的主要病机,中医证型中以阳虚水湿证最为常见；邪实证中以水湿、血瘀、湿热最为常见。2.维持性血液透析口渴患者的中医证型与患者的性别、年龄、维持透析年限、原发病与证型分布无明显的相关性。3.耳穴贴压联合针刺治疗能明显改善维持性血液透析患者的口渴症状,其效果优于单纯耳穴贴压,差异有统计学意义(p0.05)。4.耳穴贴压联合针刺治疗能控制血液透析患者透析间期体重增加。5.耳穴贴压联合针刺治疗改善患者口渴症状及控制透析间期体重增加8周疗效均随疗程增加而增强,即疗程越长治疗效果越好。
[Abstract]:Objective: This study will Auricular Pressure Combined with acupuncture treatment as one of the whole blood thirsty in dialysis patients, explore the methods of improving thirst symptoms in hemodialysis patients, so as to control the increase of interdialytic weight, in order to further reduce cardiovascular complications, improve the quality of life of patients. Methods: This study is divided into two in part, previous methods a cross-sectional survey of hemodialysis with the diagnostic standard of Western medicine treatment of patients, MHD patients with TCM syndrome of thirst syndrome questionnaire through the questionnaire survey, collected the general situation, MHD thirst dialysis patients age, primary disease, the clinical data of TCM syndrome, the final analysis card type MHD thirsty patient distribution; in the late prophase survey of MHD in patients with thirst syndrome distribution of the most extensive Yang water dampness as the research object, a total of 45 cases Patients, and divided into 3 groups (control group; simple auricular therapy group; auricular acupuncture group and treatment group; each group of 15 people). The control group was given routine treatment, the treatment group on the basis of conventional treatment, according to the selection of traditional Chinese medicine and Western medicine and acupuncture of auricular points and mechanism of the selection of uremic thirst the main acupoints and acupoints, were treated with auricular plaster combined with acupuncture and auricular point therapy for 8 weeks. The degree of thirst scale thirsty degree, while monitoring the average relative value of interdialysis weight gain, Kt/V, pre dialysis blood Na+ concentration, blood pressure, changes before and after treatment. At the same time, comparing the index of thirst degree score and relative value of interdialysis weight gain, KT/V value, the mean arterial pressure before dialysis, the correlation between the serum sodium concentration before dialysis. Results: 1.122 cases of maintenance hemodialysis patients with thirst to Yang Xushui Wet is the most (24.59%), followed by qi deficiency and blood stasis; evilempirical type wet (40.98%) is the most common, followed by blood stasis, damp heat, most of the patients in superficiality, deficiency (86.06%), only 17 cases were false positive (13.93%.2.) to maintain the distribution of TCM Syndromes and patients hemodialysis patients with thirst for sex, age, dialysis age, primary disease, thirst degree, the syndrome distribution constitute no statistically significant difference (P0.05) of.3. patients in the treatment group were thirsty score for 4 weeks, 8 weeks of treatment compared with before treatment were significantly lower (P0.01), for 8 weeks and 4 weeks of treatment comparison decreased significantly (P0.01); treatment groups, auricular acupuncture group and thirst scores declined more obvious.4. patients in the treatment group the average relative value of interdialysis weight gain for 4 weeks, 8 weeks compared with before treatment were significantly lower (P0.01) treatment, 8 weeks and 4 weeks of treatment decreased obviously (P0.01); The treatment groups, auricular acupuncture group with average relative value of interdialysis weight gain decreased significantly in.5.3 group Kt/v, the serum sodium concentration for 4 weeks compared with before treatment, 8 weeks of treatment compared with before treatment, treatment for 8 weeks and 4 weeks of treatment, there were no significant differences (P0.05).6. thirsty score and average relative value of interdialysis weight gain was positively related to.7. score (P0.01) thirst and KT/V value, through the blood sodium concentration and mean arterial pressure, patient age and average dialysis age had no significant correlation (P0.05). Conclusion: 1. this study suggested that the vacuity deficiency is maintained the main pathogenesis of hemodialysis patients with thirst, TCM syndrome type with Yang deficiency dampness syndrome is the most common; empirical evil to water wet, blood stasis, the most common.2. TCM syndrome type and the risk of maintenance hemodialysis patients who thirst for gender heat, age, Dialysis period, primary disease and syndrome distribution had no obvious correlation between.3. Auricular Pressure Combined with acupuncture treatment can significantly improve maintenance hemodialysis patients with thirst symptoms, its effect is better than that of auricular plaster, the difference was statistically significant (P0.05) pressure combined with acupuncture treatment can control the blood dialysis interval of ear weight increase of.5. sticking combined with acupuncture in the treatment of patients with symptoms of thirst and control interdialysis weight gain for 8 weeks with the increase of treatment efficacy of auricular point.4., the longer the course that the curative effect is better.

【学位授予单位】：成都中医药大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R277.5

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