尿毒清颗粒灌肠治疗CKD4-5期患者临床疗效观察

发布时间：2018-10-07 18:00

【摘要】：目的：在常规治疗的基础上,观察尿毒清颗粒灌肠治疗CKD4-5期的近期疗效,比较尿毒清灌肠与通腑泄浊方灌肠的疗效差别,随访半年内各组患者进入透析的情况。方法：(1)文献研究：检索EMbase、PubMed、CNKI、VIP、Wanfang、sinoMed数据库,纳入尿毒清灌肠治疗CKD的随机对照试验,以采用尿毒清灌肠治疗作为干预组,未采用尿毒清灌肠治疗为对照组,经剔重文献,提取数据,评价质量等步骤后,采用RevMan 5.2软件进行分析,观察治疗后两组总有效率,及Scr. BUN的水平。(2)临床研究：选取2015.4至2016.2江苏省中医院肾内科的符合纳入标准的CKD4-5期住院患者共115例,尿毒清组39例、中药组39例及对照组37例,对照组仅采用西医基础及中医辨证治疗,尿毒清组在对照组基础上应用尿毒清颗粒灌肠治疗,中药组在对照组基础上应用通腑泄浊方灌肠治疗,疗程14天,观察治疗前后三组疾病疗效、实验室指标、中医证侯积分及症状、不良反应的变化,随访半年内各组患者进入透析的情况。结果：(1)文献研究：①干预组治疗后总有效率高于空白对照组,两者差异具有统计学意义[OR=3.30,95% CI (1.81,6.03),P=0.0005,I2=0%]; ②干预组治疗后Scr、BUN低于空白对照组及爱西特组,差异均具有统计学意义[Scr:MD=-40.03,95%CI (-64.55,-15.50), P=0.005,I2=82%(与空白对照组比较)；MD=-66.74,95%CI(-101.47.04,-32.01), P=0.0002,I2=17%(与爱西特组比较)]；[BUN:MD=-1.99,95%CI (-3.33,-0.65), P=0.004,I2=88%(与空白对照组比较)；MD=-5.35,95%CI (-6.45,-4.25), P=0.0001,I2=0%(与爱西特组比较)]。(2)临床研究：①尿毒清组治疗后疾病总有效率高于对照组,差异有统计学意义(P0.05),与中药组比较差异无统计学意义(P0.05)；亚组分析：非湿浊证患者尿毒清组治疗后有效率与对照组相当,差异无统计学意义(P0.05)②尿毒清组治疗后BUN、Scr、UA水平下降,与对照组比较差异有统计学意义(P0.05),与中药组比较差异无统计学意义(P0.05)；③尿毒清组治疗后证候积分减少,与对照组比较差异有统计学意义(P0.05),与中药组比较差异有统计学意义(P0.05)；④尿毒清组治疗后乏力、腰膝酸软、纳差、头晕、恶心呕吐等症状改善,中药组纳差、恶心呕吐等症状改善,与对照组比较差异均有统计学意义(P0.05)；⑤随访半年内,尿毒清组、中药组与对照组进入透析的人数相当,差异无统计学意义(P0.05)；三组进入透析常见诱因依次为感染、心衰、高血钾；⑥尿毒清组、中药组常见的不良反应为轻度腹泻、腹痛,未见便血、恶心呕吐等不良反应。结论：(1)短程应用具有益气健脾,通腑泄浊,活血化瘀功效的尿毒清颗粒灌肠有助于清除尿毒症毒素、稳定肾功能,近期疗效为71.8%,与通腑泄浊方相当,但不能延缓中晚期CKD患者进入透析的时间。(2)尿毒清灌肠可改善中晚期CKD患者乏力、腰膝酸软、纳差、头晕及恶心呕吐等症状,疗效优于通腑泄浊方,短期应用无明显不良反应。(3)尿毒清为临床应用多年的颗粒剂型,用于灌肠疗法时较水煎剂更为便利。
[Abstract]:Objective: On the basis of routine treatment, observe the short-term curative effect of treating CKD4-5, compare the difference between the curative effect of urine-clearing enema and the enema of Tongfu, and follow up the situation of dialysis in each group during the half-year follow-up. Methods: (1) Literature research: search of EMbase, PubMed, CNKI, VIP, Wanfang, sinoMed database, and included urotoxin cleaning enema for CKD in randomized controlled trial. After the procedure of evaluating the quality and so on, the RevMan 5.2 software was used to analyze the total effective rate of the two groups after treatment and the level of Scr. 044. (2) Clinical study: From 2015. 4 to 2016. 2, there were 115 cases of renal internal medicine in Jiangsu Province, including 115 cases of CKD4-5 hospitalized patients, 39 cases of urine toxicity clear group, 39 cases of traditional Chinese medicine group and 37 cases of control group. The control group only adopted the western medicine basis and TCM syndrome differentiation treatment. On the basis of the control group, urine toxicity clear granule enema treatment was applied, and the traditional Chinese medicine group was used to treat the three groups of diseases before and after treatment, the laboratory indexes, the syndrome of TCM syndrome and symptoms and the change of adverse reactions on the basis of the control group. The patients were followed up for half a year for dialysis. Results: (1) Literature study: The total effective rate after treatment was higher than that of blank control group (OR = 3.30, 95% CI (1.81, 6.03), P = 0. 0005, I2 = 0%]. MD =-40. 03, 95% CI (-64. 55, -15. 50), P = 0. 005, I2 = 82% (compared with blank control group); MD =-66. 74, 95% CI (-101. 47. 04, -32. 01), P = 0. 0002, I2 = 17% (compared with Aixt group)];[mu: MD =-1.99, 95% CI (-3.33,-0.065), P = 0.00004, I2 = 88% (compared with blank control group); MD =-5.35, 95% CI (-6. 45, -4. 25), P = 0. 0001, I2 = 0% (compared to the Group of Love)]. (2) Clinical study: The total effective rate of post-treatment disease was higher than that in the control group (P0.05). There was no statistical significance (P0.05). Compared with the control group, there was no statistical significance (P0.05). Compared with the control group, the difference was statistically significant (P0.05). Compared with the traditional Chinese medicine group, the difference was statistically significant (P0.05). Compared with the control group, the difference was statistically significant (P0.05). The common adverse reactions in the traditional Chinese medicine group were mild diarrhea, abdominal pain, and no adverse reactions such as hematochezia, nausea and vomiting. Conclusion: (1) The short-range application has the effects of invigorating qi, invigorating spleen, clearing away the turbid, promoting blood circulation and removing blood stasis, helping to remove uremic toxin, stabilizing renal function, and the short-term curative effect is 70.8%, which is comparable to that of Tongfu, but can not delay the time for patients with intermediate and advanced CKD to enter dialysis. (2) Urease-clearing enema can improve the symptoms of asthenia, soreness of waist and knees, anorexia, dizziness, nausea and vomiting, etc. (3) Fuqing is a kind of granule for clinical application for many years. It is more convenient to use water decoction in enema therapy.
【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】：2016
【分类号】：R277.5

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