【摘要】：導(dǎo)師孫偉教授已于臨床治療慢性腎臟疾病多年,并堅(jiān)持研習(xí)古今中外相關(guān)文獻(xiàn)多年,結(jié)合其長期的臨床實(shí)踐及豐富的醫(yī)學(xué)知識(shí),認(rèn)識(shí)到慢性腎臟病的病人應(yīng)該在該病的早期就進(jìn)行中醫(yī)治療以延緩該病病情的進(jìn)展,指出該病的基本病機(jī)當(dāng)屬"腎虛濕濁(瘀)",并創(chuàng)建了益腎清利、和絡(luò)泄?jié)岱ㄗ鳛樵摬〉闹委熆倓t,歸納出治療慢性腎功能衰竭的有效處方,在臨床應(yīng)用中其療效得到了同行及患者的肯定。目的:觀察益腎清利、和絡(luò)泄?jié)岱ㄖ委熉阅I臟病5期(非透析)的療效方法:收集整理2014年9月至2014年12月至江蘇省中醫(yī)院腎內(nèi)科就診的非透析CKD5期患者30例,所有入組患者均采用西醫(yī)基礎(chǔ)治療+益腎清利、和絡(luò)泄?jié)岱ㄖ委?對(duì)入選的30例患者,分別于用藥滿0月、3月、6月、9月、12月隨訪,復(fù)查并記錄相關(guān)實(shí)驗(yàn)室指標(biāo)(尿素氮、肌酐、eGFR、血紅蛋白、白蛋白、二氧化碳結(jié)合力、血清鉀等),填寫生存質(zhì)量調(diào)查表,將這些數(shù)據(jù)的前后變化作為自身對(duì)照,對(duì)此進(jìn)行統(tǒng)計(jì)學(xué)分析,做臨床療效評(píng)價(jià)。同時(shí),在隨訪時(shí)點(diǎn),對(duì)患者的服藥依從性、營養(yǎng)狀況、腎功能及安全性指標(biāo)進(jìn)行整體評(píng)估,重點(diǎn)評(píng)估患者腎功能、是否存在透析指征、是否發(fā)生不良事件和(或)嚴(yán)重不良事件,進(jìn)而評(píng)價(jià)益腎清利、和絡(luò)泄?jié)岱ㄖ委熉阅I臟病(CKD5期)的療效。將隨訪時(shí)點(diǎn)表格交給患者保存。如患者第一年未進(jìn)入終點(diǎn),則在第二年隨訪開始前參照第一年處理。本試驗(yàn)的觀察時(shí)間為1年。結(jié)果:入組的30例病例中,有1例脫落病例,有1例到達(dá)透析終點(diǎn),納入分析28例。1.治療后患者尿素氮緩慢下降,治療12個(gè)月末與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。2.治療后,在治療的第3個(gè)月,患者的血肌酐升高,在治療的第6個(gè)月、9個(gè)月、12個(gè)月患者的血肌酐都較治療前下降,在治療12個(gè)月末統(tǒng)計(jì)分析顯示血肌酐與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。3.治療12個(gè)月末,eGFR較治療前升高,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.治療12個(gè)月末,Hb升高,與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。5.治療12個(gè)月末,白蛋白較治療前上升,與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。6.血鉀在治療期間波動(dòng)不明顯,治療12個(gè)月末較治療前下降,與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。7.二氧化碳結(jié)合力在治療期間波動(dòng)不明顯,治療12個(gè)月末較治療前上升,與治療前比較差異具有統(tǒng)計(jì)學(xué)意義(P0.05)。8.治療12個(gè)月末,患者的生存質(zhì)量較治療前升高,與治療前比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)。9.1例用藥4周后出現(xiàn)高血鉀癥,無心悸、胸悶等癥狀,給予對(duì)癥處理后復(fù)查血鉀正常。試驗(yàn)期間未發(fā)生死亡事件、感染事件、心腦血管事件及其它不良反應(yīng)。所有納入觀察的患者治療前后血常規(guī)(白細(xì)胞分類及計(jì)數(shù),血小板計(jì)數(shù))、尿常規(guī)、大便常規(guī)加潛血、心電圖等檢查與治療前相比均無明顯異常。結(jié)論:1.慢性腎臟病5期,腎臟排泄氮質(zhì)代謝產(chǎn)物功能下降,濕濁內(nèi)蘊(yùn),腎功能下降,益腎清利、和絡(luò)泄?jié)岱ň哂休^好的療效,能增加氮質(zhì)代謝產(chǎn)物的排泄,減輕腎臟的負(fù)擔(dān),升高其eGFR,保護(hù)其殘腎功能,延緩腎功能的進(jìn)一步惡化。2.慢性腎臟病5期患者,由于病程長,臨床癥狀復(fù)雜,以及巨大的精神及經(jīng)濟(jì)壓力,患者的生存質(zhì)量較低,益腎清利、和絡(luò)泄?jié)岱芴岣呗阅I臟病5期患者的生存質(zhì)量。3.對(duì)于進(jìn)入慢性腎臟病5期的患者,在其血壓、血糖、酸中毒及電解質(zhì)紊亂得到控制的情況下,采用益腎清利、和絡(luò)泄?jié)岱ㄖ委熢摬“踩尚?但需密切注意其相關(guān)實(shí)驗(yàn)室指標(biāo)的變化。
[Abstract]:Professor Sun Wei, a professor, has been in clinical treatment of chronic kidney disease for many years, and has adhered to the literature for many years in the past and abroad, combining its long-term clinical practice and rich medical knowledge. It is recognized that the patients with chronic kidney disease should be treated with Chinese medicine in the early stage of the disease to delay the progress of the disease. It is pointed out that the basic pathogenesis of the disease is the "Kidney deficiency and dampness and turbid (blood stasis)", and it has created the method of benefiting the kidney and clearing the balance of the kidney, and the method as the general principle of the treatment of the disease. The effective prescription of the treatment of chronic renal failure was concluded, and its curative effect was confirmed by the peer and the patient in the clinical application. Objective: To observe the effect of Yishen Qingli (Yishen Qingli) and the method of the treatment of chronic kidney disease (non-dialysis) in the period from September,2014 to December,2014. All enrolled patients were treated with the basic treatment of western medicine, Yishen Qingli, and the method of the treatment of the collaterals, and the selected 30 patients were followed up for 0 month, March, June, September and December respectively, and the relevant laboratory indexes (urea nitrogen, myoglobin, eGFR, hemoglobin and albumin) were reviewed and recorded. Carbon dioxide binding force (carbon dioxide binding force, serum potassium, etc.), the quality of life questionnaire was filled in, and the changes of these data were used as self-control. At the same time, at the follow-up time point, the patient's medication compliance, nutritional status, renal function and safety index were evaluated as a whole, with a focus on assessing the renal function of the patient, the presence of a dialysis indication, the occurrence of adverse events and/ or serious adverse events, And the curative effect of the method for treating chronic kidney disease (CKD5). The follow-up time-point form was given to the patient for preservation. If the end point is not entered for the first year of the patient, the first year of treatment will be referenced prior to the start of the second year follow-up. The observation time of this test is 1 year. Results: Of the 30 cases enrolled, there were 1 case of shedding, one of which had reached the end of the dialysis and included in the analysis of 28 cases. After the treatment, the urea nitrogen of the patients decreased slowly, and the difference between the end of the treatment and the treatment before treatment was statistically significant (P0.05). After treatment, in the third month of the treatment, the blood muscle strength of the patient increased, and in the first 6 months,9 months and 12 months of the treatment, the blood muscle strength of the patient was decreased, and the statistical significance was found in the statistical analysis at the end of the treatment for 12 months (P0.05). At the end of 12 months, eGFR was higher than that before treatment (P0.05). The difference of Hb in the end of the treatment was statistically significant (P0.05). In the end of 12 months, the albumin was higher than that before treatment, and the difference was statistically significant (P0.05). There was no significant fluctuation of potassium in the treatment period, and the difference in treatment before and after treatment was statistically significant (P0.05). The effect of carbon dioxide binding force on the treatment period was not significant, and the treatment of 12-month-old patients was higher than that before treatment (P0.05). In the end of 12 months, the quality of life of the patients was higher than that before treatment (P0.05). In 9.1 cases, hyperkalemia, no palpitations, chest distress and other symptoms occurred after 4 weeks of treatment, and the blood potassium was normal after the symptomatic treatment. No deaths, infections, cardiovascular and cerebrovascular events and other adverse reactions occurred during the trial. All the patients included in the observation before and after treatment (white blood cell classification and count, platelet count), urine routine, routine urine plus occult blood, electrocardiogram, and the like had no obvious abnormality than before treatment. Conclusion:1. in that phase 5 of chronic kidney disease, the function of the renal excretion of the nitrogen metabolism product is reduced, the presence of the dampness and the turbid liquid, the decrease of the kidney function, the kidney-tonifying and the clear-interest are better, the excretion of the nitrogen-mass metabolite can be increased, the burden of the kidney is reduced, the eGFR is increased, and the residual renal function is protected, To delay the further deterioration of renal function. In patients with chronic kidney disease, the quality of life of patients with chronic kidney disease can be improved due to the long course of the disease, the complex clinical symptoms, and the great mental and economic pressure. With the control of blood pressure, blood sugar, acidosis and electrolyte disturbance in patients with chronic kidney disease, it is safe and feasible to use the method of Yishen Qingli, and the method of using the collaterals to treat the disease, but it is necessary to pay close attention to the changes of relevant laboratory indexes.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R277.5

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