【作者】 朱传馨；

【导师】 张英；

【作者基本信息】 湖北中医药大学 ， 中西医结合临床， 2010， 硕士

【摘要】 目的观察耳穴贴压对维持性血液透析患者口渴症状的临床疗效,探寻改善血液透析患者口渴症状的方法以提高其生活质量。方法1.所有入选病例共50例,均为2010.01-2010.03月在武汉市第一医院行规律血液透析治疗的患者,全部伴发口渴症状。50例患者按照随机方法分为两组(耳穴治疗组、咀嚼口香糖对照组),各为25例,两组患者性别、年龄、病程、中医证型等临床资料经统计学分析,差异无统计学意义(P＞0.05),具有可比性。治疗4周为一个疗程,观察两个疗程。2.治疗方法和观察指标2.1治疗方法2.1.1耳穴按压治疗：主穴：渴点、口、零点、神门、脾、内分泌、肾。配穴：阳虚加肾上腺；阴虚加外耳点；阴阳两虚可肾上腺、外耳点共取；夹湿加皮质下、大肠；夹热加外鼻、肺；夹瘀加心、肝。嘱患者每日自行按压4-5次(3-4小时一次),每穴每次按压时间约半分钟,第一次由医师对证确定补泻手法,示范操作,使患者正确掌握。每次取双侧耳穴,3～5天更换胶布贴压,4周为1个疗程,治疗2个疗程。2.1.2咀嚼口香糖对照：口香糖每日3-5次,或每当有口渴时给予,每次1粒,轻轻咀嚼≥10分钟。同时对患者进行宣教,嘱咐治疗期间养成良好的生活习惯及饮水习惯等。2.2观察指标2.2.1收集符合要求的病例,记录透析患者的一般资料：姓名、性别、年龄、透析龄、原发病、中医辨证。2.2.2观察两组患者治疗前、治疗4周及治疗8周的口渴情况调查表、静息唾液流率检测、平均透析间期体重增加相对值等口渴症的临床检查指标。2.2.3收集治疗前及治疗8周后的实验室检测指标：血红蛋白(HGB)、血清白蛋白(ALB)、甲状旁腺激素(PTH)、肾功能(Cr、BUN、TCO2)、血钠(Na)、血钾(K)、血钙(Ca)、血磷(P)等。2.2.4观察治疗前及治疗8周后的透析前平均动脉压及中医各证型分布特点。结果1.耳穴贴压治疗4周、8周与治疗前相比口干渴强度评分均有显著下降,治疗8周比治疗4周的口干渴强度评分下降更显著；且耳穴治疗组与咀嚼口香糖对照组相比耳穴治疗组疗效优于咀嚼口香糖对照组,说明耳穴治疗能更好的改善维持性血液透析患者口渴的症状,且对人体无副作用,价格低廉,不产生依赖,痛苦少、操作简便(耳穴治疗时间与透析时间一致,不需增加治疗时往返时间)、安全,减少感染及出血机会,易为病人接受,值得在临床工作中推广和运用。2.耳穴贴压治疗4周、8周与治疗前相比静息唾液流率差异均有显著统计学意义,两个疗程间差值相比静息唾液流率差异有统计学意义；而咀嚼口香糖对照组患者治疗两个疗程间差值相比,静息唾液流率差异无统计学意义,耳穴治疗组与咀嚼口香糖对照组相比耳穴治疗组疗效优于咀嚼口香糖对照组,说明咀嚼口香糖亦能增加患者的静息唾液流率,但远期疗效较差。有相关试验证明咀嚼口香糖可帮助促进唾液分泌,缓解口渴、口腔干燥。但与耳穴贴压治疗相比,耳穴治疗效果更持久。3.耳穴治疗组患者治疗一个疗程和两个疗程后,与治疗前相比平均透析间期体重增加相对值均有所下降；但两个疗程之间相比平均透析间期体重增加相对值的差异无统计学意义,而咀嚼口香糖对照组患者治疗后与治疗前相比平均透析间期体重增加相对值仅有下降趋势,无统计学意义。这说明耳穴按压治疗后平均透析间期体重增加相对值在治疗后明显下降,但远期疗效不明显。考虑原因,可能是因为口渴只是诱发饮水行为,导致透析间期体重增加的原因之一,而其它因素如环境、心理、饮食等也可以影响患者的饮水量及透析间期体重的增加。4.治疗前后两组患者血生化指标、透析前平均动脉压差异无统计学意义,说明耳穴贴压对患者的生化指标、透析前平均动脉压改善不明显,临床上行耳穴治疗口渴的同时,仍需要其它相应的对症支持治疗。结论血液透析维持了ESRD患者的生命,但维持性血透对液体的摄入有严格的控制。长期血液透析患者的口渴症状严重,口渴感的存在是引起患者透析间期体重增加过多的重要原因之一。耳穴贴压疗法是有效缓解透析患者口渴症状的方法之一,且8周内治疗效果随时间递增,但其缓解口渴感的治疗机理尚需进一步探讨。更多还原

【Abstract】 ObjectiveObservation of the Auricular on hemodialysis patients with clinical symptoms are thirsty, seeking improvement in hemodialysis patients with symptoms of thirst to improve their quality of life. Methods1. all wins a total of 50 cases, cases are the 2010.01-2010.03-in the first row of the city of Wuhan hemodialysis patients, all with thirsty symptoms.50 patients follow the random method is divided into two groups (Auricular acupuncture in the treatment group, chewing gum control group), each of 25 cases, two groups of patients with gender, age, disease, syndrome, etc., the clinical data with statistical analysis, differential no statistically (P＞0.05),. For 4 weeks for a course, observation of two course of treatment.2. treatment methods and indicators2.1 treatment method2.1.1 antivomit treatment:the main point:thirsty point, mouth, snacks, God door, spleen, endocrine, renal. Points:Yang and Yin with adrenal; plus the external ear point; yin to adrenal, external ear points; clip wet with Subcortical, large intestine; clip heat plus external nose, lungs; clip stasis and heart and liver. Ask patients daily to press on 4-5 times (3-4 hours), each of the points each time you press time, about 30 seconds, first by physicians on card determine reinforcing, demonstration to grasp. Each time you take a two-sided ear,3 to 5 days to replace the blanket plaster, 4-week course for 1,2 courses.2.1.2 chewing gum:chewing gum daily 3ˉ5 times, or whenever there is a thirst when, each 1 grain, lightly chewing≥10 minutes. While on mission, charging patients for treatment during the adoption of a healthy lifestyle and drinking habits, etc.2.2 index2.2.1 collection meet the requirements of the case, the records of the General information in dialysis patients:name, gender, age, duration, primary disease and differentiation.2.2.2 observation of two groups of patients before treatment, treatment for 4 weeks and the treatment of 8 weeks of thirsty questionnaire, resting salivary flow rates, average relative value interdialytic weight increase, and so thirsty with indexes.2.2.3 collection before treatment and treatment of 8 weeks of laboratory testing of indicators:hemoglobin (HGB), serum albumin (ALB), parathyroid hormone (PTH), renal function (Cr, BUN, TC02), blood sodium (Na), potassium (K), blood calcium (Ca), serum phosphorus (P), etc.2.2.4 observation before treatment and therapy for 8 weeks after the predialysis mean arterial pressure and the distribution of all types of traditional Chinese medicine.Results1. the Auricular for 4 weeks,8 weeks before the treatment of dry strength ratings than are very sharply declined, for 8 weeks than for 4 weeks of mouth dry strength ratings dropped more dramatically; and ear treatment group and a control group of chewing gum and ear treatment group compared to outperform chewing gum control group, the ear treatment can better improve hemodialysis patients with symptoms of thirsty, and no side effects on the human body, low-cost, no dependency, pain, user-friendly and convenient (ear treatment time and dialysis time consistent, without increasing the treatment round-trip time), safety and reduce the chance of infection and bleeding, easy for patients, patient compliance is high, it is worth in clinical work in the promotion and application.2. the Auricular for 4 weeks,8 weeks and before treatment resting salivary flow rate compared to the differences are very significant statistical significance, the difference between the two treatment compared to a resting salivary flow rate differences are statistically, while chewing gum control group patients in the treatment of the difference between the two treatment compared to a resting salivary flow rate differences no statistically, ear treatment group and a control group of chewing gum and ear treatment group compared to outperform chewing gum control group, description of chewing gum can increase resting salivary flow rate, but the long-term effects of the poor. There is a related test proved that the chewing gum can help promote saliva secretion, relieve thirst, mouth dry. But unlike the Auricular treatment compared to ear treatment more durable.3. the treatment of ear treatment group and two a course of treatment, and treatment compared to the average before interdialytic weight increase relative values are dropped; but two treatment compared to average between interdialytic weight increase relative differences no statistically, while chewing gum control group patients after treatment and treatment compared to the average before interdialytic weight increase relative values only on a downward trend, no statistical significance. This shows that the average ear after thirty interdialytic weight increase relative to the treatment of a noticeable decline, but after long-term effect is not evident. Consider the reasons, it may be because the thirsty just evoked drinking behavior, causing the interdialytic weight increase of one of the reasons, while other factors such as environment, psychology, diet, etc can also affect the amount of drinking water and interdialytic weight increase.4. two groups of patients before and after treatment with blood biochemical parameters, predialysis mean arterial pressure differences no statistically, Auricular on patients of biochemical parameters, predialysis mean arterial pressure to improve non-obvious, clinical treatment of thirsty ear uplink while still need other appropriate support for the treatment of disease.ConclusionHemodialysis patients with ESRD maintained a life, but through the liquid intake has strict control. Long-term hemodialysis patients with severe symptoms of thirst, thirst sensation of existence is causing interdialytic weight gain too much important. Auricular therapy is effective in relieving the symptoms of dialysis patients was one of the methods, and 8 weeks therapy increases over time, but its mitigation mechanism are thirsty would need further discussion.更多还原