【作者】 陈二军；

【导师】 孙伟；

【作者基本信息】 南京中医药大学 ， 中医内科学， 2011， 硕士

【摘要】 目的：通过对比对慢性肾衰竭的同一中医证型病例在结肠透析的基础上,分别采用两种不同中药组方保留灌肠的疗效,来探讨辨证施治理论在结肠透析联合中药保留灌肠疗法中的实际意义。方法：将40例慢性肾衰竭脾肾阳虚证型患者随机分为治疗组20例,对照组20例。在西医基本治疗(包括控制饮食,控制血压,控制血糖,纠正贫血,纠正水、电解质、酸碱失衡等)的基础上,治疗组采用结肠透析机进行结肠透析联合自拟中药方“补气温阳泄浊汤”保留灌肠,对照组将治疗组“补气温阳泄浊汤”易为“尿毒清颗粒”,余同治疗组。主要观察指标：尿素氮(BUN)、血肌酐(Scr)、肌酐清除率(Ccr)、血尿酸(UA)、中医证候积分。14天1疗程,治疗2个疗程后作疗效评估。采用SPSS16.0统计软件处理数据,计量资料结果以均数±标准差表示。p<0.05为有统计学意义。结果：①治疗组BUN、Scr、Ccr、UA均有显著改善(p<0.01),对照组Ser、UA有显著性改善(p<0.01), BUN、Ccr有改善,但无统计学意义(p>0.05)；组间比较,两组Scr、UA改善程度均无显著性差异(p>0.05), BUN、Ccr改善程度有显著性差异,治疗组优于对照组(p<0.01)。②治疗组FT4、TT4有显著增高(p<0.01、p<0.05), FT3、TT3有增高,但无统计学意义(p>0.05), TSH有所降低,但无统计学意义(p>0.05)；对照组FT3、FT4、TT3、TT4、TSH变化均无统计学意义(p>0.05)。③治疗组疾病总有效率为85%,对照组为65%,经检验,两组之间无显著性差异(p>0.05)。④治疗组证候总有效率为85%,对照组为50%,经检验,两者有显著性差异,治疗组优于对照组(p<0.01)。结论：①结肠透析联合补气温阳泄浊汤或尿毒清颗粒保留灌肠治疗慢性肾衰竭脾肾阳虚证均有显著临床疗效。尤其对于证候的影响,前者明显优于后者。②辨证论治在结肠透析联合中药保留灌肠疗法中仍有重要意义。更多还原

【Abstract】 Objective:Through comparing the treatment effect of the same of chronic renal failure in chinese medical science syndrome type cases, on the basis of colon dialysis respectively by means of two different of TCM formula retention enema, to discuss the practical significance of syndrome differentiation theory in colon dialysis joint Chinese medicine retention enema treatments.Methods:Patients with chronic renal failure of spleen-kidney yang deficiency type will be 40 cases were randomly divided into the treatment group 20 cases and the control group 20 cases. On the basis of the western medicine basic therapy (including control diet, control blood pressure, control blood sugar, correct anemia, correct the water, electrolyte, acid-base imbalances, etc), and the treatment group were colon dialysis with dialysis machine joint retention enema treatments with own Bu-qi-wen-yang-xie-zhuo prescription and the control group with Niao-du-qing granules. The primary observation index:urea nitrogen (BUN), creatinine (Scr), creatinine clearance (Ccr), uric acid (UA), syndromes points.14 days 1 treatment, assess the effect after 2 treatment. Using the SPSS16.0 statistical software test data processing. With p<0.05 says statistical significance.Results:(1) The treatment group BUN, Scr, Ccr, UA got obvious improvement (p<0.01); The control group Scr, UA also got obvious improvement (p<0.0), but BUN, Ccr no obvious improvement (p>0.05); Comparison between groups, two groups of Scr and UA improve no significant differences(p>0.05), BUN, Ccr improved significantly, the treatment group was better than control group (p<0.01). (2) The treatment group FT4, TT4 have significantly increase (p<0.01,p<0.05), FT3, TT3, no significant increase (p>0.05), TSH decreases, but this was not statistically significant (p>0.05); The control group FT3, FT4, TT3, TT4, TSH change, no statistical significance (p>0.05). (3) The disease total effective rate in treatment group for 85%, the control group for 65%, comparison between the treatment two groups no significant differences (p>0.05). (4) The syndrome total effective rate in treatment group for 85% and the control group for 50%, comparison between groups was significant difference, the treatment group was better than the control group (p<0.01).Conclusion:(1) The treatment for chronic renal failure of Yang-deficiency of spleen and kidney type, the colon dialysis joint Bu-qi-wen-yang-xie-zhuo prescription or Niao-du-qing granules retention enema were significantly clinical curative effect. Especially for the symptoms, the former obviously better than the latter. (2) The treatment based on syndrome differentiation in the colon dialysis joint TCM retention enema treatment still reflect actual significance.更多还原