【摘要】：目的：觀察不同證型利尿劑治療的效果,一方面研究中醫(yī)證型與利尿劑的療效關(guān)系,另一方面佐證中醫(yī)證型與疾病發(fā)展的關(guān)聯(lián)性。 方法：收集乙型肝炎肝硬化腹水且經(jīng)限鈉休息治療無效的患者,共182名患者,其中90例滿足納入標(biāo)準(zhǔn),根據(jù)肝硬化腹水中醫(yī)證型診斷標(biāo)準(zhǔn),氣滯濕阻型25例,濕熱蘊(yùn)結(jié)型23例,脾腎陽虛型24例,肝腎陰虛型18例。記錄每位患者的體重、腹圍、尿量、癥狀、體征、舌脈象,檢測各證型肝硬化腹水患者的肝功能、腎功能、電解質(zhì),觀察證型與電解質(zhì)和腎功能的關(guān)系。按照利尿劑治療方案治療,每周復(fù)查各項(xiàng)指標(biāo),調(diào)整利尿劑劑量,總療程為4周,觀察各證型利尿劑治療的效果。 結(jié)果：1)電解質(zhì)方面中醫(yī)各證型血鈉變化趨勢為氣滯濕阻型濕熱蘊(yùn)結(jié)型脾腎陽虛型肝腎陰虛型有統(tǒng)計(jì)學(xué)意義,氣滯濕阻型比其他三型高(P0.05)。血鉀比較,氣滯濕阻型高于其他三型,無統(tǒng)計(jì)學(xué)意義。腎功能方面肌酐比較,中醫(yī)各證型肌酐變化趨勢為肝腎陰虛型脾腎陽虛型濕熱蘊(yùn)結(jié)型氣滯濕阻型,有統(tǒng)計(jì)學(xué)意義。肝腎陰虛型比其他三型高(P0.05)。中醫(yī)各證型尿素氮變化趨勢為氣滯濕阻型濕熱蘊(yùn)結(jié)型脾腎陽虛型肝腎陰虛型有統(tǒng)計(jì)學(xué)意義,其中氣滯濕阻型低于脾腎陽虛型、肝腎陰虛型(P0.05),濕熱蘊(yùn)結(jié)型低于肝腎陰虛型(P0.05)。2)利尿劑治療后四組患者體重均有下降,與治療前自身比較,有統(tǒng)計(jì)學(xué)意義。其中治療后氣滯濕阻型體重減少量明顯高于其他三型(P0.05)。3)利尿劑治療氣滯濕阻型痊愈5例,顯效16例,有效3例,無效1例,有效率96%。濕熱蘊(yùn)結(jié)型痊愈1例,顯效7例,有效12例,無效3例,有效率87%。脾腎陽虛型痊愈1例,顯效9例,有效10例,無效4例,有效率83%。肝腎陰虛型痊愈0例,顯效1例,有效5例,無效10例,有效率38%。利尿劑療效從氣滯濕阻型向肝腎陰虛型遞減有統(tǒng)計(jì)學(xué)意義,肝腎陰虛型有效率明顯低于其他三型(P0.05)。 結(jié)論：肝硬化腹水疾病發(fā)展趨勢為氣滯濕阻型向脾腎陽虛型、肝腎陰虛型發(fā)展。肝硬化腹水利尿劑療效由氣滯濕阻型向肝腎陰虛型遞減。
[Abstract]:Objective: to observe the effect of diuretics in different syndromes, to study the relationship between TCM syndromes and diuretics on the one hand, and the relationship between TCM syndromes and disease development on the other. Methods: a total of 182 patients with liver cirrhosis ascites were collected, 90 of whom met the inclusion criteria. According to the criteria of traditional Chinese medicine diagnosis of cirrhosis and ascites, 25 cases were qi stagnation and dampness obstruction type, 23 cases were damp-heat accumulation type. There were 24 cases with deficiency of spleen and kidney yang and 18 cases with deficiency of liver and kidney yin. The body weight, abdominal circumference, urine volume, symptoms, signs and tongue pulse were recorded. The liver function, renal function, electrolyte and the relationship between the syndrome type and electrolytes and renal function were measured. According to the diuretic treatment plan, every index was reviewed every week and the dosage of diuretic was adjusted. The total course of treatment was 4 weeks. Results: 1) the change trend of blood sodium in each syndrome type of traditional Chinese medicine was that the type of stagnation of qi and dampness and heat accumulation of spleen and kidney yang deficiency type had statistical significance, the type of qi stagnation and dampness resistance was higher than that of other three types (P0.05). Compared with other three types of potassium, qi stagnation and dampness resistance type were higher than other three types, and there was no statistical significance. Compared with creatinine in renal function, the creatinine change trend of TCM syndrome type is liver and kidney yin deficiency type spleen and kidney yang deficiency type damp-heat accumulation type Qi stagnation dampness obstruction type, which has statistical significance. Liver and kidney yin deficiency type was higher than other three types (P0.05). The change trend of urea nitrogen in each syndrome type of TCM was that the type of Qi stagnation dampness and damp-heat accumulation type had statistical significance, in which the type of Qi stagnation and dampness obstruction was lower than that of the type of deficiency of spleen and kidney yang, the type of deficiency of liver and kidney yin was lower than that of type of deficiency of spleen and kidney (P0.05). The damp-heat accumulation syndrome was lower than the liver and kidney yin deficiency type (P0.05). 2) after the treatment of diuretics, the weight of the patients in the four groups were all decreased, compared with before treatment, there was statistical significance. After treatment, the weight loss of Qi-stagnation and dampness resistance type was significantly higher than that of other three types (P0.05). Diuretics were used to cure 5 cases of Qi stagnation dampness obstruction type, 16 cases were effective, 3 cases were effective, 1 case was ineffective, and the effective rate was 96.1%. One case was cured with damp-heat accumulation knot, 7 cases were effective, 12 cases were effective, 3 cases were ineffective, and the effective rate was 87 cases. One case was cured with deficiency of spleen and kidney yang, 9 cases were effective, 10 cases were effective, 4 cases were ineffective, and the effective rate was 83%. There were 0 cases of liver and kidney yin deficiency, 1 case of remarkable effect, 5 cases of effective, 10 cases of ineffective, and 38 cases of effective rate. The curative effect of diuretics from stagnation of qi and dampness to yin deficiency of liver and kidney was decreased significantly, and the effective rate of yin deficiency of liver and kidney was significantly lower than that of other three types (P0.05). Conclusion: the development trend of liver cirrhosis ascites disease is qi stagnation and dampness obstruction to spleen and kidney yang deficiency and liver and kidney yin deficiency. The curative effect of ascites diuretic on liver cirrhosis decreased from qi stagnation and dampness obstruction to liver and kidney yin deficiency.
【學(xué)位授予單位】：福建中醫(yī)藥大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2

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