李培旭主任医师治疗糖尿病肾病经验

发布时间：2018-06-25 07:41

  本文选题：糖尿病肾病 + 李培旭　； 参考：《河南中医药大学》2016年硕士论文

【摘要】：[目的]通过整理导师李培旭主任医师糖尿病肾病治疗资料,运用计算机收集统计分析导师近三年符合纳入标准的糖尿病肾病治疗病案,研究探讨李培旭主任医师治疗糖尿病肾病学术经验,以深化中医药治疗糖尿病肾病的认识,继承发扬导师治疗糖尿病肾病学术思想与宝贵经验,更好地指导临床实践。[方法]在长期跟随导师李培旭主任医师门诊临证抄方基础上,对导师近三年相对完整的糖尿病肾病治疗病案资料进行全面的收集、整理,并严格按照诊断标准、纳入标准、排除标准进行筛选,将符合标准的45例共345诊次门诊病案,建立WORD病人数据库,运用EXAL及SPASS进行统计分析、归纳总结。[结果]45例患者病案中,男性33例,女性12例,年龄最大患者81岁,最小患者33岁,平均年龄56.91岁。患者年龄分布中,50-59岁、60-69岁年龄段门诊糖尿病肾病患者居多,50-59岁共21例,占46.67%,60-69岁共12例,占26.67%。中医病名频率60%的为消渴和水肿,频率20%的为胃痞病和心悸病,频率10%的为眩晕病和腰痛病。糖尿病肾病中医病名频率60%的为消渴和水肿均与水液代谢密切相关,肾为主水之脏,脾主运化水湿,论证了糖尿病肾病与脾肾密切相关。45例糖尿病肾病患者当中,30%DN患者出现了慢性肾功能衰竭,这一结果符合当今西方发达国家透析原发病中DN居首位的情况另外,西医病名统计中的高血压病、冠心病、高脂血症和脑梗塞等反映了糖尿病心、脑、肾及血管等并发症,该结果与目前的认识一致。患者主要临床症状频率70%为水肿、肢体困乏和口于,主要临床症状频率40%为腰部酸困和夜尿次数多,主要临床症状频率≥20%为胃痞不舒、心悸不舒和闷,主要临床症状频率≥10%为视物昏花、腰痛和头晕。病机中频率40%的有水湿停留、络脉瘀阻和脾肾阳虚,病机频率20%的有气阴虚弱和浊毒内蕴,病机频率10%的有气虚络阻和湿热毒蕴。在现有的348诊次中,用药频次50%的有茯苓、泽泻、土茯苓、泽兰、干姜,用药频次≥40%的有人参、肉桂、当归、炒白芍、赤芍、麦冬、白术、附予、绞股蓝、炒杜仲、黄芪,用药频次30%的有玉米须、炒大黄、砂仁,用药频次20%的有猪苓、红景天、党参、生地黄、炒苍术、藿香、法半夏、炙甘草、荷叶、黄柏、焦山楂、地龙。病情诱发或加重因素的频率20%为停药,频率10%为感冒感染、不良饮食以及不确定因素。45例糖尿病肾病患者当中,中医药治疗有效率达到73.3%。[结论]1、DN与消渴、水肿中医疾病关系密切,此外与胃痞、心悸、眩晕和腰痛有关。2、DN与脾肾密切相关,涉及心、肝、胃、肺等脏腑。3、DN以脾肾阳虚、水湿停留、络脉瘀阻基本病机为主,兼见气阴虚弱、气虚、肝肾阴虚、浊毒内蕴、湿热毒蕴、毒热内蕴等。4、停药是DN病情加重的直接原因,不良饮食和劳累以及其他不确定的因素都是DN病情反复甚至加重的重要因素。5、DN中医药治疗有效率达到73.3%,具有临床指导意义。
[Abstract]:[objective] to collect and analyze the records of diabetic nephropathy treated by tutor Li Peixu in the past three years. To study the academic experience of chief physician Li Peixu in the treatment of diabetic nephropathy in order to deepen the understanding of traditional Chinese medicine in the treatment of diabetic nephropathy, to inherit and carry forward the academic thought and valuable experience of tutor in the treatment of diabetic nephropathy, and to guide the clinical practice better. [methods] on the basis of long-term follow the doctor Li Peixu, chief physician, to collect and arrange the relative complete medical records of diabetic nephropathy treatment in the past three years, and strictly follow the diagnostic standard, and include the standard. The exclusion criteria were used to screen out 345 outpatient cases of 45 patients who were in accordance with the standard. The database of word patients was established. The statistical analysis was made by EXAL and spas, and summarized. [results] among the 45 patients, 33 were male and 12 were female. The oldest patient was 81 years old, the youngest patient was 33 years old, the average age was 56.91 years old. In the age distribution of the patients, there were 21 cases of diabetic nephropathy aged 50-59 years old, 12 cases (26.67%) were 46.67 years old and 60-69 years old. In TCM, 60% of the disease names were dysentery and edema, 20% of the frequency were gastropathy and palpitation, 10% of the frequency were vertigo and low back pain. In diabetic nephropathy, 60% of the disease name frequency was desolation and edema, which was closely related to the metabolism of water and liquid. The kidney was mainly the viscera of water, and the spleen was responsible for removing water dampness. It is demonstrated that there is chronic renal failure in 30 DN patients among 45 cases of diabetic nephropathy and spleen kidney disease. This result is in line with the situation that DN is the first in the primary disease of dialysis in the western developed countries. The statistics of hypertension, coronary heart disease, hyperlipidemia and cerebral infarction in western medicine reflect the complications of diabetes, such as heart, brain, kidney and blood vessel. The main clinical symptom frequency of the patients was edema, limb drowsiness and mouth, the main clinical symptom frequency of 40% was waist acid distress and nocturnal urine frequency, the main clinical symptom frequency 鈮，

本文编号：2065185