降浊汤治疗慢性肾衰竭失代偿期脾虚湿浊、瘀血阻滞证的临床观察

发布时间：2018-03-27 06:13

本文选题：降浊汤　切入点：慢性肾衰竭失代偿期　出处：《黑龙江省中医药科学院》2017年硕士论文

【摘要】：目的:通过观察降浊汤治疗慢性肾衰竭失代偿期脾虚湿浊、瘀血阻滞证的临床疗效,并为中医药治疗慢性肾衰竭提供一定的依据。方法:选取2015年6月至2016年12月在黑龙江省中医医院肾六科门诊和住院处被确诊为慢性肾衰竭(脾虚湿浊、瘀血阻滞证)的患者,符合中西医纳入标准56例:治疗组(服用降浊汤)28例、对照组(服用尿毒清颗粒)28例。两组以不间断用药60天为一个疗程进行临床观察,观察治疗前后临床症状积分和实验室指标:Scr、BUN、血钾、血钠、血钙、血磷等数值的变化,并在本疗程结束后统计数据结果。结果:1.治疗组患者临床症状治疗总有效率为82.14%,对照组为60.71%,两组相比P0.05,具有显著性差异,治疗组疗效优于对照组。2.两组的中医症候积分治疗前差别无显著性P0.05,治疗后均减少,并且治疗组优于对照组,具有显著性差异P0.05。3.治疗前,治疗组与对照组Scr和BUN经过统计学分析,差别无显著性(P0.05),具有可比性。治疗后与治疗前相比差别具有显著性P0.05,并且治疗后治疗组BUN、Scr呈现明显下降,治疗组明显优于对照组,差别具有显著性P0.05。4.两组治疗前24小时尿蛋白定量、尿常规红细胞计数比较,P0.05,差别无显著性;两组治疗后24小时尿蛋白定量、尿常规红细胞计数比较P0.05,差别具有显著性。对照组治疗前后24小时尿蛋白定量比较,P0.05,差别具有显著性。5.治疗前治疗组与对照组血钾、血钠、血钙、血磷水平经过统计学分析,P0.05,差别无显著性。治疗后与治疗前相比差别具有显著性P0.05,治疗后治疗组血钾、血磷水平明显降低,血钠、血钙明显升高,治疗组优于对照组,差别具有显著性P0.05.结论:1.在中医基础理论的指导下辨证论治,以“健脾利湿、活血化瘀”为治疗原则,运用降浊汤进行为期两个月的治疗并与服用尿毒清颗粒的对照组进行比较分析,在改善患者临床症状方面具有积极地治疗作用。2.经过临床观察,降浊汤对于改善患者肌酐、尿素氮水平,降低24小时尿蛋白定量和尿常规红细胞计数治疗效果显著,治疗后治疗组血钾、血磷明显降低,血钠、血钙明显升高。3.试验结束后,两组患者均没有出现明显的不适症状和异常的实验室指标,所选方药对于机体的安全指标没有显著影响。
[Abstract]:Objective: to observe the clinical effect of Jiangzhuo decoction on spleen deficiency and dampness and blood stasis in the decompensation period of chronic renal failure. Methods: from June 2015 to December 2016, patients with chronic renal failure (spleen deficiency and dampness, blood stasis) were diagnosed as chronic renal failure (spleen deficiency and dampness, blood stasis) in the clinic and inpatient of six departments of traditional Chinese Medicine Hospital of Heilongjiang Province from June 2015 to December 2016. 56 cases were in accordance with the standard of traditional Chinese and western medicine: the treatment group (28 cases taking Jiangzhuo decoction) and the control group (28 cases taking Niaoduqing granule). The two groups were treated continuously for 60 days for a course of clinical observation. To observe the changes of clinical symptom scores and laboratory indexes, such as: Scr-BUN, potassium, sodium, calcium and phosphorus, before and after treatment. Results: 1. The total effective rate of clinical symptom treatment in the treatment group was 82.14 and that in the control group was 60.71. There was a significant difference between the two groups (P 0.05). The curative effect of the treatment group was better than that of the control group .2.There was no significant difference between the two groups before and after treatment (P0.05), and the treatment group was superior to the control group (P0.05.3). There was no significant difference in Scr and BUN between the treatment group and the control group (P 0.05), and there was a significant difference between the treatment group and the control group (P 0.05) after treatment, and after treatment, the bun SCR in the treatment group was significantly lower than that in the control group, and the treatment group was significantly better than the control group. The difference was significant (P0.05.4). The urine protein was measured 24 hours before treatment in the two groups, and there was no significant difference in urine routine erythrocyte count (P0.05) between the two groups, 24 hours after treatment, there was no significant difference in urine protein between the two groups. There was a significant difference in urine routine erythrocyte count between two groups (P 0.05). Before and after treatment, the urine protein in the control group was significantly higher than that in the control group (P 0.05), and the difference was significant. 5. Before treatment, there was a significant difference between the treatment group and the control group in blood potassium, sodium and calcium. There was no significant difference in serum phosphorus level after treatment compared with that before treatment (P 0.05). After treatment, the serum potassium and phosphorus levels in the treatment group were significantly decreased, the serum sodium and calcium levels were significantly increased, and the treatment group was superior to the control group. The difference was significant (P0.05.Conclusion: 1. Under the guidance of the basic theory of TCM, the principle of "invigorating spleen and promoting dampness, promoting blood circulation and removing blood stasis" should be taken as the treatment principle. Compared with the control group taking Niaoduqing granule, Jiangzhuo decoction has positive therapeutic effect in improving the clinical symptoms of patients. 2. After clinical observation, Jiangzhuo decoction can improve the creatinine of patients. Urea nitrogen level, 24 hour urine protein quantity and urine routine red blood cell count were significantly reduced. After treatment, serum potassium and phosphorus were significantly decreased, blood sodium and serum calcium were significantly increased .3.After the end of the trial, There were no obvious symptoms of discomfort and abnormal laboratory indexes in both groups, and the prescription had no significant effect on the safety index of the body.
【学位授予单位】：黑龙江省中医药科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R277.5

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