生脉注射液防治血液透析相关性低血压的疗效观察
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摘要
透析相关性低血压严重危害患者的健康,尽管近年来血液透析技术和条件有很大改进,但血液透析低血压的发生率并无明显下降,严重影响了患者的透析效果和生活质量,是导致患者死亡的主要原因之一,因此必须积极加以纠正。目前单纯西医治疗方法治疗透析低血压效果较差,中药在防治透析相关性低血压方面的作用日益受到重视,大量临床实验表明了生脉注射液有升压作用,为了更大地发挥中西医结合治疗本病的优势,寻找有效的预防和治疗方法,本次研究观察了生脉注射液防治血液透析相关性低血压的效果,结果显示生脉注射液能明显升高透析相关性低血压患者的血压。
文献综述包括两个部分:1.血液透析相关性低血压的防治,论述了透析相关性低血压的发病机理临床表现及防治方法。2.生脉注射液的药理作用及临床应用,论述了生脉注射液的临床应用新进展,为临床应用提供了新思路。
临床研究部分包括病例来源:选取2005年1月至2006年12月在我科接受维持性血液透析患者60例,其中男28例,女32例,均为慢性肾衰,年龄18～70岁,平均(61.21±3)岁。原发病为糖尿病肾病,慢性肾小球肾炎、高血压肾病、多囊肾等。分组方法:采用前瞻性、随机对照的方法,按患者就诊顺序以随机数字表进行分组,对符合纳入标准的研究对象按1:1随机分为试验组和对照组。治疗方法:两组患者均给予常规血液透析,治疗组在每次血液透析开始经血路管动脉输液端静脉滴注生脉注射液40ml,疗程4周。观察指标:观察主要临床症状的改善,血压、心率的变化、生化检测及KT/V值。统计分析:用两个独立样本比较的Wilcoxon秩和检验或Ridit分析,两样本均数比较用t检验,计量资料用卡方检验。所有统计计算用SPSS11.5统计分析系统。试验结果:60例患者共透析686例次,发生低血压反应89例次,总发生率12.97%。1.试验组的透析中最低血压和透析后血压明显高于对照组,经t检验,P0.05,有统计学意义。2.试验组患者心率低于对照组,两组方差齐性检验FHemodialysis-related hypotension is seriously dangerous to the health of human. Despiterecent years hemodialysis technique and condition have improved and enhanced greatly. Thecomplication rates of the hemodialysis-related hypotension had not dropped greatly. It has severeinfluence on patients' quality of life and effect of hemodialysis. It is one of the main conditionscausing the death of patient .So it must be corrected actively.At present simple western medicinecure hemodialysis-related hypotension was poor.The effect of Chinese traditional medicines onprevention and cure hemodialysis-related hypotension is increasingly attached importance in recentyears.Agreat deal of clinic experiment indicate that shengmai Injection has an action to rise bloodpression.For the sake of take advantage of TCM and west medicion cure hemodialysis-relatedhypotension.We study the clinical observation of Shengmai Injection for hemodialysis-relatedhypotension.As aresult, Shengmai Injection can rise the blood pressure of the hemodialysispatients.
The literature review including two parts:1.Clinical prevention and treatment of hemodialysisassociated with hypotension., to explore the clinical manifestations, pathogenic mechanisms andtreatment of hemodialysis-related hypotension.2.The Pharmacological Action and ClinicalApplication of Shengmai Injection., The thesis provides a new thinking and method in the clinicresearch..
Clinical study includes:Data sources:Selection 65 maintenance hemodialysis patients in ourdepartment from January 2005 to December 2006. 30 cases were male and 35 cases were female.All patients are chronic renal failure. Their age are from 18 to 70. Their mean age was 61.21±3years. Their primary disease are diabetic nephropathy, chronic glomerulonephritisa, hypertensivenephropathy and polycystic kidney disease. Grouping method : Adopt prospective andrandomized controlled research on method. Based on the selected standard, 60 cases were randomlydivided into treatmentgroup and control group arranged by registration order and random numbertable .30 cases in each group. Therapeuticmethods:The patients in the two groups were all treatedwith convention hemodialysis. Teatment group was given intravenous injection. ShengmaiInjection slowly from dialysis pipe at the beginning of hemodialysis. Treatment lasted for 4weeks.Theindexofobservation:Clinical symptoms,if the clinical symptoms were improved. Thechange of heart rate and blood pressures,biochemical detection value and KT/V value.Statisticanalysis:Two independent sample comparison by wilcoxon rank sum test.The meanscomparison between the two samples was done by the t-test. T-test was used toanalyzemeasurement data and were showed by X±S. Statistical calculation use SPSS 11.5statistical analysis system.The result of the clinical trial : There were 89 times of the hypotensionoccurred in 686 times hemodialysis. The total incidence was 12.97%. 1.Blood pressures ofpatients of trial group increased significantly compared with that of control group (P<0.05). Thedifference was statistically significant after the t-test.2. The heart rate of patients of trial group islower significantly compared with that of control group (P<0.05). The difference was statisticallysignificant after the t-test.3.The overall clinical effective rate on clinic of trial group increasedsignificantly compared with that of control group (P<0.05). The difference was statisticallysignificant after the t-test. 4.The symptom of mental confusion , muscle spasm and sweatingare greatly improved,but there was no effect of dizzy and nausea. 5.The incidence ofhypotension occurred of test group was lower than control group significantly. 6.The effect ofexercise during hemodialysis on adequacy of dialysis , there has no effect on biochemical criterion,haematological indexes and hemodialysis adequacy.Conclusion: There has a good effect intreatment of Shengmai Injectionin treatment for patients with Hemodialysis AssociatedHypotension. It can be used to treat patient with hypotension during hemodialysis. A FurtherStudy and clinical application on Shengmai Injectionin is Valuable.
文献综述包括两个部分:1.血液透析相关性低血压的防治,论述了透析相关性低血压的发病机理临床表现及防治方法。2.生脉注射液的药理作用及临床应用,论述了生脉注射液的临床应用新进展,为临床应用提供了新思路。
临床研究部分包括病例来源:选取2005年1月至2006年12月在我科接受维持性血液透析患者60例,其中男28例,女32例,均为慢性肾衰,年龄18～70岁,平均(61.21±3)岁。原发病为糖尿病肾病,慢性肾小球肾炎、高血压肾病、多囊肾等。分组方法:采用前瞻性、随机对照的方法,按患者就诊顺序以随机数字表进行分组,对符合纳入标准的研究对象按1:1随机分为试验组和对照组。治疗方法:两组患者均给予常规血液透析,治疗组在每次血液透析开始经血路管动脉输液端静脉滴注生脉注射液40ml,疗程4周。观察指标:观察主要临床症状的改善,血压、心率的变化、生化检测及KT/V值。统计分析:用两个独立样本比较的Wilcoxon秩和检验或Ridit分析,两样本均数比较用t检验,计量资料用卡方检验。所有统计计算用SPSS11.5统计分析系统。试验结果:60例患者共透析686例次,发生低血压反应89例次,总发生率12.97%。1.试验组的透析中最低血压和透析后血压明显高于对照组,经t检验,P0.05,有统计学意义。2.试验组患者心率低于对照组,两组方差齐性检验F
The literature review including two parts:1.Clinical prevention and treatment of hemodialysisassociated with hypotension., to explore the clinical manifestations, pathogenic mechanisms andtreatment of hemodialysis-related hypotension.2.The Pharmacological Action and ClinicalApplication of Shengmai Injection., The thesis provides a new thinking and method in the clinicresearch..
Clinical study includes:Data sources:Selection 65 maintenance hemodialysis patients in ourdepartment from January 2005 to December 2006. 30 cases were male and 35 cases were female.All patients are chronic renal failure. Their age are from 18 to 70. Their mean age was 61.21±3years. Their primary disease are diabetic nephropathy, chronic glomerulonephritisa, hypertensivenephropathy and polycystic kidney disease. Grouping method : Adopt prospective andrandomized controlled research on method. Based on the selected standard, 60 cases were randomlydivided into treatmentgroup and control group arranged by registration order and random numbertable .30 cases in each group. Therapeuticmethods:The patients in the two groups were all treatedwith convention hemodialysis. Teatment group was given intravenous injection. ShengmaiInjection slowly from dialysis pipe at the beginning of hemodialysis. Treatment lasted for 4weeks.Theindexofobservation:Clinical symptoms,if the clinical symptoms were improved. Thechange of heart rate and blood pressures,biochemical detection value and KT/V value.Statisticanalysis:Two independent sample comparison by wilcoxon rank sum test.The meanscomparison between the two samples was done by the t-test. T-test was used toanalyzemeasurement data and were showed by X±S. Statistical calculation use SPSS 11.5statistical analysis system.The result of the clinical trial : There were 89 times of the hypotensionoccurred in 686 times hemodialysis. The total incidence was 12.97%. 1.Blood pressures ofpatients of trial group increased significantly compared with that of control group (P<0.05). Thedifference was statistically significant after the t-test.2. The heart rate of patients of trial group islower significantly compared with that of control group (P<0.05). The difference was statisticallysignificant after the t-test.3.The overall clinical effective rate on clinic of trial group increasedsignificantly compared with that of control group (P<0.05). The difference was statisticallysignificant after the t-test. 4.The symptom of mental confusion , muscle spasm and sweatingare greatly improved,but there was no effect of dizzy and nausea. 5.The incidence ofhypotension occurred of test group was lower than control group significantly. 6.The effect ofexercise during hemodialysis on adequacy of dialysis , there has no effect on biochemical criterion,haematological indexes and hemodialysis adequacy.Conclusion: There has a good effect intreatment of Shengmai Injectionin treatment for patients with Hemodialysis AssociatedHypotension. It can be used to treat patient with hypotension during hemodialysis. A FurtherStudy and clinical application on Shengmai Injectionin is Valuable.
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