【作者】 李成银；

【导师】 巴元明；

【作者基本信息】 湖北中医学院 ， 中医内科学， 2009， 硕士

【摘要】 研究目的:主要观察保肾巴布剂穴位敷贴法对慢性肾脏病患者的临床疗效及其对患者生存质量的影响,客观地评价其对慢性肾脏病的治疗作用,为探索保肾巴布剂穴位敷贴法对慢性肾脏病的有效干预方法提供一定的依据;研究生存质量与中医证候之间的相关性,为探索保肾巴布剂穴位敷贴法对慢性肾脏病的有效评价体系提供一定的依据;并观察保肾巴布剂穴位敷贴疗法对慢性肾脏病肾阳虚证肾阴虚证患者的生存质量、临床疗效、不良反应,对其有效性和安全性作出评价,并与单纯西医治疗的对照组比较,探索一种治疗慢性肾脏病肾阳虚证肾阴虚证经济安全、疗效可靠、适宜推广的外治法。研究方法:本研究患者共80例,均来源于湖北省中医院肾内科门诊及住院病人,符合慢性肾脏病西医诊断标准及中医辨证分型标准。随机分为两组:保肾巴布剂穴位敷贴治疗组(简称为A组),西医治疗对照组(简称为B组),每组各40例。A组在西医常规治疗的基础上,予保肾巴布剂敷贴于双肾俞,命门,双复溜穴,隔天敷贴1次,每次6-8个小时,治疗时间定在三伏期间,中医辨证分型为肾阳虚证、肾阴虚证,分别用保肾1号巴布剂、保肾2号巴布剂敷贴。B组仅予西医常规治疗,不予敷贴治疗。两组疗程为一月,治疗前后填写SF-36;查血尿常规、血生化、24小时尿蛋白定量等指标,并记录治疗前后患者临床症状及体征的变化,作出疗效评价。研究结果:(1)肾阳虚患者与肾阴虚患者在生存质量上相比较在躯体功能、情感角色、精神健康及健康变化方面的得分均低于肾阴虚患者,有显著性差异(P＜0.05),在其它方面无差异(P＞0.05)。(2)A组总有效率为82.51%,B组总有效率为65.05%,A组与B组相比均有显著性差异(P＜0.05)。表明A组治疗CKD有较好的临床效果。(3)A组对肾阳虚证有效率为87.02%,与B组(66.76%)相比有显著性差异(P＜0.05),表明A组对肾阳虚证的效果优于B组,A组对肾阴虚证有效率为76.50%,虽较B组(63.23%)相比明显,但无显著性差异(P＞0.05),表明A组对肾阴虚证的效果与B组相近。(4)两组治疗后症状积分较治疗前明显下降,有显著性差异(P＜0.05)。A、B两组分差相比有显著性差异(P＜0.05),表明A、B两组均能有效改善患者临床症状,A组疗效优于B组,其中A组对肾阳虚证疗效优于B组(P＜0.05)。(5)A组对倦怠乏力、畏寒肢冷、腰酸膝软、口干咽燥的疗效与B组比较有显著性差异(P＜0.05),表明A组在改善上述症状方面疗效优于B组。(6)治疗组与对照组治疗前SF-36各项评分无显著差异(P＞0.05)。治疗组治疗后躯体功能、躯体角色、身体疼痛、一般健康、生命力、社会功能、情感角色、精神健康领域的积分较治疗前高(P＜0.05);对照组治疗后躯体功能、躯体角色、身体疼痛、社会功能、精神健康领域的积分较治疗前高(P＜0.05)。两组治疗后相比较在身体疼痛、一般健康、生命力、社会功能、情感角色、精神健康领域的积分有差异(P＜0.05,P＜0.01),从积分上看,治疗组积分较对照组高(P＜0.05)。(7)A、B两组治疗后24hupq、尿RBC计数均明显下降,与治疗前相比有显著性差异(P＜0.05),表明A、B两组均能降低24hupq、尿RBC计数。A组与B组疗效比较仅从下降数值上A组优于B组,但无显著性差异(P＞0.05),表明A组与B组在降低24hupq、尿RBC计数方面疗效接近。(8)A、B两组治疗后BUN、Scr均有明显下降,与治疗前相比有显著性差异(P＜0.05),表明A、B组均能改善患者肾功能。A组与B组疗效比较仅从下降数值上A组优于B组,但无显著性差异(P＞0.05),表明A组与B组在改善患者肾功能方面疗效接近。(9)安全性检测:治疗组与对照组治疗后肝功能、心电图、血常规、粪常规检测均无明显异常变化,治疗前虽有个别项目异常存在,但治疗后无加重;所有患者敷贴处皮肤无发红、水疱、疼痛、破溃等发生;表明保肾巴布剂安全有效,无毒副作用。结论:临床观察表明:在常规治疗的基础上,加用保肾巴布剂穴位敷贴治疗慢性肾脏病肾阳虚证肾阴虚证有较好的疗效。保肾巴布剂穴位敷贴疗法能明显改善慢性肾脏病患者临床症状,提高患者生存质量。临床应用安全有效、无毒副作用,是治疗慢性肾脏病的一种简便有效方法,值得临床推广应用。更多还原

【Abstract】 OBJECTIVE:To observe the curative clinical effect of BaoShen’ Cataplasm to treat chronic kidney diseases(CKD) and to explore the impaction of factors related to quality of life of CKD,to objectively evaluate therapeutic effects of CKD,it could provide a basis that BaoShen’ Cataplasm treat CKD in order to explore an effective treatment;Studing the correlation between the quality of life and Chinese medicine syndromes,it could provide a basis that BaoShen’ Cataplasm treat CKD in order to an effective evaluation system;To observe the curative effect and saftly of BaoShen’ Cataplasm to treat CKD,by point application in dog-days,and search an easy economy safe effective method in treating CKD.METHODS:All 80 patients were randomly divided into two groups: therapeutic group of BaoShen’ Cataplasm point application(A Group, n=40),routine medicine control group(B Group,n=40).According to requirement of disease two groups were treated with routine medicine.A group took BaoShen’ Cataplasm point appilication in dog-days,6-8 hours each time,every 2 days.B group took routine medicine.The therapeutic period of two groups was 4 weeks.Filling SF-36 before and after treatment;Examing blood routine,urine routine,blood biochemistry,24hup such as.And then observe the efficacy and safety different indicators of pre-treatment and post-treatment.RESULTS:(1) Comparing kidney-yin deficiency patients between kidneyyang deficiency patients in QOL,the former on PF、HT、RE and MH were lower than the latter,the difference was significant (P＜0.05),there was no difference in other ways(P＞0.05).(2)A group overall efficiency rate was 82.51%,B group overall efficiency rate was 65.05%,and B group were significantly different(P＜0.05).This showed that A group has a better clinical treatment effect of CKD.(3) The total effective rate on insufficiency type of kidneyyang of A group was 87.02%,that of B group was 66.76%.There was significant difference between A group and B group(p＜0.05),which indicated that the effect on insufficiency type of kidney-yang of A group was better than that of B group.The total effective rate on insufficiency type of kidney-yin of A group was 76.50%,that of B group was 63.23%.There was no significant difference between A group and B group(p＞0.05),which indicated that the effect on insufficiency type of kidney-yin of A group was close to that of B group. (4) There was significant difference between before and after treatments in the total scores of two groups(p＜0.05),and there was significant score difference between A group and B group(p＜0.05),which indicated that two groups could improve the symptoms, and A group had better effect than B group.(5) In improving Chinese medicine symptoms,efficacy of treatment group better than of control group.(6) Before treatment,the SF-36 score of two groups was no significant difference(P＞0.05).After treatment,treatment group in the field of the SF-36 score of PF、RP、BP、GH、VT、SF、RE and MH higher than pre-treatment(P＜0.05);control group in the field of the SF-36 score of PF、RP、BP、SF and MH higher than pre-treatment (P＜0.05).Comparing two groups after treatment in the BP,GH,VT, SF,RE and MH was divergence(P＜0.05,P＜0.01);In the integral point of view,the score of treatment group higher than of control group (p＜0.05).(7) Two groups decrease 24hupq and urine RBC count were significantly decreased after treatment,which compared with before treatment were significantly different(P＜0.05).It showed that two groups wereable to reduce the 24hupq and urine RBC count. A group was better than the B group from the decline in value,but no significant difference(P＞0.05).It showed that two groups effect close in the reduction of 24hupq and urinary RBC counts.(8) Two groups could decrease BUN and Scr,which compared with before treatment were significantly different(P＜0.05).It showed that two groups could improve kidney function.A group was better than the B group from the decline in value,but no significant difference(P＞0.05).It showed that two groups effect close in the improving kidney function.(9) Security testing:There was no abnormality between before and after treatments among two groups which indicated that BaoShen’ Cataplasm point application was a safe、effect、no side effect and no toxicity treatment method for CKD.CONCLUSION:The clinical observations showed that Acupoint Application of BaoShen’ Cataplasm had good therapeutic effect on kidney-yin deficiency and Kidney-yang Deficiency of CKD.It could efficiently improve the symptoms,and improve the quality of life in patients. BaoShen’ Cataplasm was safe and effective,and non-toxic side effects in the Clinical application.It was a simple and effective method in the treatment of chronic kidney disease.This method was worthy to be popularized.更多还原