【摘要】：目的:對(duì)中醫(yī)辨證治療腎病綜合征反復(fù)的患兒進(jìn)行臨床觀察,統(tǒng)計(jì)患兒反復(fù)的因素、特點(diǎn)、辨證分型、常用中藥,總結(jié)分析遣方用藥規(guī)律,以期減少腎病的反復(fù)。方法:搜集山東中醫(yī)藥大學(xué)附屬醫(yī)院兒科門診就診及住院治療的腎病綜合征患兒病歷資料。統(tǒng)計(jì)36例患兒118次反復(fù)就診的資料,將維持激素用量結(jié)合中醫(yī)辨證治療尿蛋白能夠轉(zhuǎn)陰者設(shè)為激素維持組,將提高激素用量結(jié)合中醫(yī)辨證治療尿蛋白方能轉(zhuǎn)陰者設(shè)為激素提高組。統(tǒng)計(jì)患兒反復(fù)的病因、特點(diǎn)、證型分布,常用中藥頻次及其分類,分析總結(jié)中醫(yī)辨證治療起效的方藥規(guī)律。采用spss17.0統(tǒng)計(jì)軟件及中醫(yī)傳承輔助系統(tǒng)對(duì)患兒病歷資料進(jìn)行數(shù)據(jù)統(tǒng)計(jì)分析,所有統(tǒng)計(jì)檢驗(yàn)均采用雙側(cè)檢驗(yàn),P0.05認(rèn)為差異有統(tǒng)計(jì)學(xué)意義。結(jié)果:1.導(dǎo)致腎病反復(fù)的因素82%由感染引起,其中上呼吸道感染占32%,下呼吸道感染占17%,泌尿系感染占10%,胃腸道感染占11%,蟲咬性皮炎占12%,勞累及其他因素亦分別占8%,10%。2.證型分布為濕熱蘊(yùn)結(jié)夾瘀、風(fēng)水相博夾瘀、氣虛濕停夾瘀、陽(yáng)虛濕停夾瘀。激素維持組多濕熱蘊(yùn)結(jié)夾瘀,激素提高組多氣虛濕停夾瘀。3.腎病綜合征患兒反復(fù)后,均給予中醫(yī)辨證治療和對(duì)癥處理,激素維持組占32%,激素提高組占68%。4.中醫(yī)辨證治療的常用藥物,祛濕藥占50%,理氣藥20%,活血化瘀藥14%,溫陽(yáng)藥2%,其他14%,兩組常用藥物分類及歸經(jīng)組間無明顯差別。5.誘導(dǎo)期腎病患兒無反復(fù),激素維持組患兒反復(fù)以維持緩解期居多,占68%,激素提高組患兒反復(fù)以拖尾期居多,占75%。結(jié)論:1.感染是腎病患兒反復(fù)最重要的因素;2.濕邪為腎病綜合征反復(fù)重要的病理因素,祛濕治療是重要的治法,結(jié)合八綱辨證祛邪扶正為宜;3.激素維持組轉(zhuǎn)陰比例以維持緩解期的濕熱蘊(yùn)結(jié)夾瘀證多見,激素提高組未轉(zhuǎn)陰比例以拖尾期的氣虛濕停夾瘀證型多見。激素方案調(diào)整與否和中醫(yī)辨證證型及激素應(yīng)用的不同階段有關(guān)。
[Abstract]:Objective: to make clinical observation on the children with recurrent nephrotic syndrome treated by TCM syndrome differentiation, to count the factors, characteristics, syndrome differentiation, common Chinese medicine, summarize and analyze the law of prescribing drugs in order to reduce the recurrence of nephropathy. Methods: the medical records of children with nephrotic syndrome in pediatrics outpatient clinic of Shandong University of traditional Chinese Medicine were collected. According to the data of 118 repeated visits of 36 cases of children, the maintenance hormone dosage combined with TCM syndrome differentiation treatment of urine protein can turn negative into hormone maintenance group. Increase hormone dosage combined with TCM syndrome differentiation treatment of urine protein can turn negative group as hormone improvement group. The causes, characteristics, distribution of syndromes, frequency and classification of traditional Chinese medicine were analyzed and summarized. Spss17.0 statistical software and traditional Chinese medicine inheritance assistant system were used to analyze the data of children's medical records. All statistical tests were carried out by bilateral test (P0.05) and the difference was statistically significant. The result is 1: 1. 82% of the factors causing recurrent nephropathy were caused by infection, including 32 upper respiratory tract infection, 17 lower respiratory tract infection, 10 urinary tract infection, 11 gastrointestinal tract infection, 12 insect bite dermatitis, 8 tiredness and other factors. The distribution of syndrome type is damp-heat accumulation knot and stasis, geomantic phase, Qi deficiency, dampness and stasis, Yang deficiency and dampness to stop blood stasis. The hormone maintenance group had more dampness and heat accumulation and blood stasis, while the hormone improvement group had more qi deficiency and dampness and stopped clamping blood stasis. 3. Children with nephrotic syndrome were treated with TCM syndrome differentiation and symptomatic treatment. The hormone maintenance group accounted for 32 and the hormone improvement group 68. 4. Traditional Chinese medicine syndrome differentiation treatment commonly used drugs, dispelling dampness medicine account for 50, Qi medicine 20, blood circulation and stasis drugs 14, warming Yang medicine 2, the other 14, the two groups of commonly used drugs classification and return to the meridian group no significant difference. 5. There was no recurrence in induced nephropathy. In the hormone maintenance group, maintenance remission was the most frequently, accounting for 68%. In the hormone improvement group, the delayed stage was the most frequently, accounting for 75%. Conclusion 1. Infection is the most important factor in children with nephropathy. Dampness is an important pathological factor of nephrotic syndrome repeatedly, the treatment of dispelling dampness is an important treatment method. The negative rate of hormone maintenance group was the dampness and heat accumulation and blood stasis syndrome in the remission period, while the non-negative proportion of the hormone increasing group was the Qi deficiency dampness and dampness stagnation syndrome in the tail stage. The adjustment of hormone scheme is related to different stages of TCM syndrome differentiation and hormone application.
【學(xué)位授予單位】：山東中醫(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)】：R272

【參考文獻(xiàn)】

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本文編號(hào)：2198329