维持性血液透析下尿毒症性心肌病患者的中医证候学分析及应用心保颗粒的疗效
|
摘要
目的探讨维持性血液透析的尿毒症性心肌病患者中医证型,观察心保颗粒对本病患者慢性肾功能衰竭症状的改善情况。方法纳入余姚地区3个血液净化中心的维持性血液透析尿毒症性心肌病患者共90例(各30例),对患者进行中医辨证分型分析。根据血液净化时间长短将患者分为0~104周、105~208周及209~312周三组。根据慢性肾衰竭症状分级量化表进行症状积分分析。将90例患者采用随机单盲单模拟方法分为治疗组及对照组(各45例),治疗组在常规治疗基础上予心保颗粒,对照组予模拟剂,治疗周期为12周,12周后比较两组慢性肾衰竭症状积分情况。结果尿毒症性心肌病正虚型以脾肾阳虚型为主(占86.67%);邪实证以血瘀证为主(占85.56%);脾肾阳虚型兼血瘀证占总数的80.00%。0~104周、105~208周及209~312周组慢性肾功能衰竭症状积分比较有统计学差异(P<0.001)。治疗12周后治疗组与对照组的慢性肾功能衰竭症状积分比较,差异有统计学意义(P<0.001)。结论维持性血液透析的尿毒症性心肌病患者的中医证型均表现为虚实夹杂型,其中脾肾阳虚型兼血瘀证最为多见。尿毒症性心肌病患者的血液净化时间越长,慢性肾功能衰竭症状积分越高。心保颗粒能改善维持性血液透析的尿毒症性心肌病患者的慢性肾功能衰竭症状,提高患者的生活质量。
Objective To investigate the TCM syndromes of the patients with uremic cardiomyopathy under maintenance hemodialysis and to observe the improvement effect of Xinbao Granules on the symptoms of chronic renal failure in the patients.Methods A total of 90 patients(30 in each center).with uremic cardiomyopathy under maintenance hemodialysis at three blood purification centers in Yuyao area were enrolled.TCM syndrome differentiation was analyzed for patients.According to the length of blood purification,the patients were divided into three groups,namely 0-104 weeks,105-208 weeks and 209-312 weeks,According to the grading and classification table of chronic kidney failure symptoms,the symptom scores were analyzed.90 patients were divided into treatment group and control group(45 cases in each group)by random single-blinded single-simulation method.The treatment group was given Xinbao granules on the basis of routine treatment.The control group was given simulant.The treatment cycle was 12 weeks.After12 weeks,symptom scores of chronic renal failure were compared between the two groups.Results The main type of weakened body resistance in uremic cardiomyopathy was spleen and kidney yang-deficiency(86.67%);the main type of pathogenic excess was blood stasis(85.56%);the yang deficiency of spleen and kidney complicated with blood stasis accounted for 80.00% of the total.The differences of symptom scores of chronic renal failure were statistically significant at 0-104 weeks,105-208 weeks and 209-312 weeks(P<0.001).After 12 weeks of treatment,there were statistically significant differences in symptom scores of chronic renal failure between the treatment group and the control group(P<0.001).Conclusion TCM syndromes of the patients with uremic cardiomyopathy under maintenance hemodialysis are manifested as intermingled deficiency and excess,and the yang deficiency of spleen and kidney complicated with blood stasis is the most common.The longer the length of blood purification in the patients with uremic cardiomyopathy,the higher the symptom scores of chronic renal failure.Xinbao granules can improve the chronic renal failure for the patients with uremic cardiomyopathy under maintenance hemodialysis,so as to improve their quality of life.
Objective To investigate the TCM syndromes of the patients with uremic cardiomyopathy under maintenance hemodialysis and to observe the improvement effect of Xinbao Granules on the symptoms of chronic renal failure in the patients.Methods A total of 90 patients(30 in each center).with uremic cardiomyopathy under maintenance hemodialysis at three blood purification centers in Yuyao area were enrolled.TCM syndrome differentiation was analyzed for patients.According to the length of blood purification,the patients were divided into three groups,namely 0-104 weeks,105-208 weeks and 209-312 weeks,According to the grading and classification table of chronic kidney failure symptoms,the symptom scores were analyzed.90 patients were divided into treatment group and control group(45 cases in each group)by random single-blinded single-simulation method.The treatment group was given Xinbao granules on the basis of routine treatment.The control group was given simulant.The treatment cycle was 12 weeks.After12 weeks,symptom scores of chronic renal failure were compared between the two groups.Results The main type of weakened body resistance in uremic cardiomyopathy was spleen and kidney yang-deficiency(86.67%);the main type of pathogenic excess was blood stasis(85.56%);the yang deficiency of spleen and kidney complicated with blood stasis accounted for 80.00% of the total.The differences of symptom scores of chronic renal failure were statistically significant at 0-104 weeks,105-208 weeks and 209-312 weeks(P<0.001).After 12 weeks of treatment,there were statistically significant differences in symptom scores of chronic renal failure between the treatment group and the control group(P<0.001).Conclusion TCM syndromes of the patients with uremic cardiomyopathy under maintenance hemodialysis are manifested as intermingled deficiency and excess,and the yang deficiency of spleen and kidney complicated with blood stasis is the most common.The longer the length of blood purification in the patients with uremic cardiomyopathy,the higher the symptom scores of chronic renal failure.Xinbao granules can improve the chronic renal failure for the patients with uremic cardiomyopathy under maintenance hemodialysis,so as to improve their quality of life.
引文
[1]尹燕方.曲美他嗪对心肌病伴心力衰竭患者疗效观察[J].中西医结合心脑血管病杂志,2011,9(9):1117-1118.
[2]陈灏珠.临床心肌病学[M].湖南:湖南科技出版社,2012:503-507.
[3]麻鹏磊,王祥,李冰,等.尿毒症心肌病的研究及临床治疗进展[J].中国老年学杂志,2016,5(36):2295-2296.
[4]覃莲香,张雪潇,于春洋,等.不同剂量左旋肉毒碱治疗维持性血液透析合并心力衰竭疗效观察[J].中国血液净化,2017,16(5):314-315.
[5]王质刚.血液净化学[M].北京:北京科学技术出版社,2016:353.
[6]门雯瑾,丁致民,王晓飞.在线尿素清除率监测对血液透析充分性评价的研究[J].中国血液净化,2011,10(12):649.
[7]季星利,王丽.尿毒症心肌病临床治疗新进展[J].实用医学杂志,2016,32(8):1209-1210.
[8]陈琪.真武汤对大部分肾切除术所致尿毒症心肌病小鼠心脏保护作用的研究[D].广州:南方医科大学,2016.
[9]刘淑娟.尿毒症心肌病中医证候学回顾性调查[J].山西中医,2009,24(6):50.
[10]张泽金.基于古今药方纵横的桂枝应用及配伍研究[D].济南:山东中医药大学,2009.
[11]刘萍,王平.甘草化学成分及其对心血管系统影响的机理[J].世界科学技术-中医药现代化,2011,13(1):97.
[12]周炜炜,王朋倩,戴丽,等.辛热药附子调节心血管作者和机制研究进展[J].中南药学,2017,(5):615-619.
[13]胡一冰.附子甘草药对组分配伍减毒机理研究[D].成都:成都中医药大学,2005.
[14]吴发宝,陈希元.黄芪药理作用研究综述[J].中药材,2004,27(3):232-233.
[15]王永忠,童树洪.川芎的传统用法与现代药理研究[J].中国药业,2012,21(7):95-96.
[16]高波.丹参的药理分析及临床应用研究[J].中国卫生标准管理,2016,7(9):120.
[17]万晓青.三七及其制剂在心血管疾病的应用[J].浙江中西医结合杂志,2008,18(12):776.
[18]张荒生,王进军.中药全蝎的药理研究进展[J].中国中医急诊,2007,16(2):224-225.
[19]陈俊荣,陈俊红,宋翠荣,等.酒大黄对动脉粥样硬化兔PAI-1及其基因的调节作用[J].中国实验方剂学杂志,2010,16(17):209.
[20]方鉴.肉苁蓉的药理研究进展[J].光明中医,2017,32(14):2140.
[2]陈灏珠.临床心肌病学[M].湖南:湖南科技出版社,2012:503-507.
[3]麻鹏磊,王祥,李冰,等.尿毒症心肌病的研究及临床治疗进展[J].中国老年学杂志,2016,5(36):2295-2296.
[4]覃莲香,张雪潇,于春洋,等.不同剂量左旋肉毒碱治疗维持性血液透析合并心力衰竭疗效观察[J].中国血液净化,2017,16(5):314-315.
[5]王质刚.血液净化学[M].北京:北京科学技术出版社,2016:353.
[6]门雯瑾,丁致民,王晓飞.在线尿素清除率监测对血液透析充分性评价的研究[J].中国血液净化,2011,10(12):649.
[7]季星利,王丽.尿毒症心肌病临床治疗新进展[J].实用医学杂志,2016,32(8):1209-1210.
[8]陈琪.真武汤对大部分肾切除术所致尿毒症心肌病小鼠心脏保护作用的研究[D].广州:南方医科大学,2016.
[9]刘淑娟.尿毒症心肌病中医证候学回顾性调查[J].山西中医,2009,24(6):50.
[10]张泽金.基于古今药方纵横的桂枝应用及配伍研究[D].济南:山东中医药大学,2009.
[11]刘萍,王平.甘草化学成分及其对心血管系统影响的机理[J].世界科学技术-中医药现代化,2011,13(1):97.
[12]周炜炜,王朋倩,戴丽,等.辛热药附子调节心血管作者和机制研究进展[J].中南药学,2017,(5):615-619.
[13]胡一冰.附子甘草药对组分配伍减毒机理研究[D].成都:成都中医药大学,2005.
[14]吴发宝,陈希元.黄芪药理作用研究综述[J].中药材,2004,27(3):232-233.
[15]王永忠,童树洪.川芎的传统用法与现代药理研究[J].中国药业,2012,21(7):95-96.
[16]高波.丹参的药理分析及临床应用研究[J].中国卫生标准管理,2016,7(9):120.
[17]万晓青.三七及其制剂在心血管疾病的应用[J].浙江中西医结合杂志,2008,18(12):776.
[18]张荒生,王进军.中药全蝎的药理研究进展[J].中国中医急诊,2007,16(2):224-225.
[19]陈俊荣,陈俊红,宋翠荣,等.酒大黄对动脉粥样硬化兔PAI-1及其基因的调节作用[J].中国实验方剂学杂志,2010,16(17):209.
[20]方鉴.肉苁蓉的药理研究进展[J].光明中医,2017,32(14):2140.