發(fā)布時間：2018-05-24 12:00

  本文選題：針刺 + 慢性腎臟疾病��； 參考：《濟南大學》2017年碩士論文

【摘要】：目的:評價針刺雙側(cè)曲池和足三里穴位聯(lián)合阿法骨化醇對慢性腎臟疾病(CKD)患者行維持性血液透析(MHD)治療鈣磷代謝及并發(fā)癥的影響。方法:連續(xù)選擇2016年01月至12月入濟南醫(yī)科園腎病醫(yī)院診斷CKD患者行MHD治療并發(fā)皮膚瘙癢或者不安腿綜合征共50例,采用隨機數(shù)字法將其分為對照組和觀察組各25例,其中對照組采用單純西藥阿法骨化醇治療,觀察組同時聯(lián)合針刺雙側(cè)曲池和足三里穴位,每周3次,共計4周。對比治療前、治療后2周和4周的中醫(yī)癥狀臨床積分改善情況,治療有效率和不良反應,生化指標包括外周血鈣、磷及甲狀旁腺激素(iPTH)水平,炎癥指標包括外周血IL-6、TNF-α和CRP水平,生活質(zhì)量采用健康狀況問卷(SF-36)評分。結(jié)果:兩組治療后2周和4周的中醫(yī)癥狀臨床積分均較治療前明顯降低,且觀察組低于對照組,差異有統(tǒng)計學意義(P0.05)。觀察組的治療效果明顯優(yōu)于對照組,差異有統(tǒng)計學意義(P0.05)。兩組均未發(fā)生嚴重不良反應。兩組治療后2周和4周的血鈣水平較治療前明顯升高,血磷及PTH水平明顯降低,且觀察組改善程度大于對照組,差異有統(tǒng)計學意義(P0.05)。對照組治療后2周和4周的血IL-6、TNF-α和CRP水平與治療前比較,差異無統(tǒng)計學意義(P0.05);而觀察組治療后2周和4周的血IL-6、TNF-α和CRP水平較治療前明顯降低,且明顯低于對照組,差異有統(tǒng)計學意義(P0.05)。兩組治療后2周和4周的生理健康總評(PCS)和心理健康總評(MCS)得分均逐漸提高,且觀察組高于對照組,差異有統(tǒng)計學意義(P0.05)。結(jié)論:針刺聯(lián)合阿法骨化醇可進一步提高CKD患者行MHD治療伴發(fā)皮膚瘙癢或不安腿綜合征的臨床效果,與改善血鈣、磷和PTH代謝及炎癥反應有關(guān),改善生活質(zhì)量。
[Abstract]:Objective: to evaluate the effect of acupuncture at Zusanli acupoint and Zusanli acupoint on calcium and phosphorus metabolism and complications in patients with chronic renal disease treated with maintenance hemodialysis (MHD). Methods: from January to December 2016, 50 patients with CKD diagnosed in Jinan Medical Garden Nephropathy Hospital were treated with MHD for skin pruritus or restless leg syndrome. The patients were divided into control group (n = 25) and observation group (n = 25) by random number method. The control group was treated with simple western medicine Alfa osciferol, and the observation group was combined with acupuncture on both sides of zhuchi and Zusanli acupoints, three times a week, for a total of 4 weeks. Before treatment, 2 weeks and 4 weeks after treatment, the clinical scores of TCM symptoms, the effective rate and adverse reactions, the biochemical indexes including the levels of calcium, phosphorus and parathyroid hormone iPTHs in peripheral blood, and the levels of IL-6 TNF- 偽 and CRP in peripheral blood were compared. The quality of life (QOL) was assessed by health status questionnaire (SF-36). Results: the clinical scores of TCM symptoms in the two groups were significantly lower than those in the control group at 2 and 4 weeks after treatment, and the difference between the two groups was statistically significant (P 0.05). The therapeutic effect of the observation group was significantly better than that of the control group, and the difference was statistically significant (P 0.05). There were no serious adverse reactions in both groups. After 2 and 4 weeks of treatment, the levels of serum calcium and serum phosphorus and PTH in the two groups were significantly increased, and the improvement degree of the observation group was higher than that of the control group, the difference was statistically significant (P 0.05). The levels of serum IL-6 TNF- 偽 and CRP in the control group at 2 and 4 weeks after treatment were not significantly different from those before treatment, but the levels of IL-6 TNF- 偽 and CRP in the observation group were significantly lower than those in the control group at 2 and 4 weeks after treatment, and were significantly lower than those in the control group. The difference was statistically significant (P 0.05). Two and four weeks after treatment, the scores of PCS and MCSs of the two groups increased gradually, and the scores of the observation group were higher than those of the control group, and the difference was statistically significant (P 0.05). Conclusion: acupuncture combined with Alfarin can further improve the clinical effect of MHD in patients with CKD associated with skin pruritus or restless leg syndrome, which is related to the improvement of blood calcium, phosphorus, PTH metabolism and inflammatory reaction, and the improvement of quality of life.
【學位授予單位】：濟南大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5

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