本文關(guān)鍵詞：慢性腎臟病基礎(chǔ)上急性腎損傷影響因素及中醫(yī)證候臨床調(diào)查　出處：《南京中醫(yī)藥大學(xué)》2017年碩士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 慢性腎臟病 急性腎損傷 中醫(yī)證候 臨床調(diào)查

【摘要】：目的:從臨床角度分析影響慢性腎臟病基礎(chǔ)上急性腎損傷(AKI on CKD或A/C)預(yù)后的因素及中醫(yī)證候,探討其中醫(yī)病機及證候規(guī)律,為中醫(yī)藥防治該病提供參考。方法:通過江蘇省中醫(yī)院病例系統(tǒng)查找2013年12月至2016年11月腎內(nèi)科診斷為急性腎損傷(AKI)的住院病例,并查閱診斷為慢性腎臟病(CKD)或慢性腎衰竭(CRF)的病例,根據(jù)病史判斷是否存在AKI。收集符合A/C診斷條件的病例資料,觀察患者腎功能的變化,分析影響腎臟預(yù)后的臨床因素,并觀察中醫(yī)證候及其對腎臟預(yù)后影響。結(jié)果:(1)一般資料:共收集病例66例,其中男性34例(51.52%),女性32例(48.48%);年齡最小的患者18歲,年齡最大的患者84歲,中位年齡58歲,其中40歲的患者22例(33.33%),40～60 歲患者 13 例(19.70%),60 歲患者 31 例(46.97%)。導(dǎo)致 CKD 患者發(fā)生AKI的病因以感染居多,共23例(34.85%),原發(fā)病進(jìn)展15例(22.73%),低血容量共10例(15.15%),惡性高血壓6例(9.09%),服用腎毒性藥物、電解質(zhì)紊亂各4例(6.06%),泌尿道梗阻2例(3.03%),其他病因2例。腎臟基礎(chǔ)病慢性腎炎居多,共26例(39.39%),腎病綜合征22例(33.33%),ANCA相關(guān)小血管炎8例(12.12%),糖尿病腎病、狼瘡性腎病各4例(6.06%),高血壓腎損傷2例(3.03%)。住院期間接受透析治療的共36例(54.54%),其中完全恢復(fù)8例(12.12%),部分恢復(fù)10例(15.15%),未恢復(fù)18例(27.27%)。腎功能完全恢復(fù)的共26例(39.39%),部分恢復(fù)22例(33.33%),未恢復(fù)18例(27.27%)。(2)A/C患者預(yù)后分析:患者基礎(chǔ)腎功能差、A/C時腎功能下降顯著,A/C后腎臟恢復(fù)較差,組間差別有統(tǒng)計學(xué)意義(P0.05);病情加重因素為惡性高血壓A/C后腎臟恢復(fù)較差,組間差別有統(tǒng)計學(xué)意義(P0.05);腎臟基礎(chǔ)病為腎病綜合征A/C后腎臟恢復(fù)較好,組間差別有統(tǒng)計學(xué)意義(P0.05);腎臟基礎(chǔ)病為狼瘡性腎炎、ANCA相關(guān)小血管炎A/C后腎臟恢復(fù)較差,組間差別有統(tǒng)計學(xué)意義(P0.05);患者血紅蛋白、血白蛋白、二氧化碳結(jié)合率等下降,A/C后腎臟恢復(fù)較差,組間差別有統(tǒng)計學(xué)意義(P0.05);CKD3-4患者經(jīng)治療可能擺脫透析。(3)A/C患者中醫(yī)證候特點:本研究A/C患者本虛證以脾腎氣虛證多見,占34例(51.51%)。其余由高到低依次為氣陰兩虛證、肝腎陰虛證、脾腎陽虛證、陰陽俱虛證;標(biāo)實證以濕濁證多見,占24例(21.21%),其余由高到低依次為濕熱證、血瘀證、熱毒證、風(fēng)動證;各標(biāo)實證在本虛證中分布差異,本虛證脾腎氣虛中標(biāo)實證頻率由高到低依次為濕濁證、血瘀證、,濕熱證、熱毒證�；颊咧嗅t(yī)辨證本虛證為氣陰兩虛證,標(biāo)實證為濕濁證、濕熱證患者A/C后腎臟恢復(fù)較差,組間差別有統(tǒng)計學(xué)意義(P0.05)。結(jié)論:(1)感染是導(dǎo)致CKD患者發(fā)生AKI的最常見病因。(2)病情加重因素為惡性高血壓,腎臟基礎(chǔ)病為ANCA相關(guān)小血管炎、狼瘡性腎炎,基礎(chǔ)腎功能差、發(fā)生A/C時腎功能下降顯著、合并代謝性酸中毒、貧血、低蛋白血癥者,A/C后預(yù)后較差。(3)腎臟基礎(chǔ)病為腎病綜合征者A/C后預(yù)后較好,CKD3-4期患者經(jīng)治療可能擺脫透析。(4)A/C屬本虛標(biāo)實證,本虛證以脾腎氣虛證、氣陰兩虛證、肝腎陰虛證多見,標(biāo)實證主要表現(xiàn)為濕濁證、濕熱證、血瘀證,氣陰兩虛證、濕濁證、濕熱證患者A/C后預(yù)后欠佳。
[Abstract]:Objective: to analyze the effects of chronic kidney disease based on acute kidney injury from a clinical perspective (AKI on or A/C CKD) and the prognostic factors of TCM syndrome, explore the TCM syndromes and disease, to provide reference of the disease prevention and treatment of traditional Chinese medicine. Methods: the Jiangsu Province Traditional Chinese Medicine Hospital system find from December 2013 to November 2016 were diagnosed in Department of Nephrology acute kidney injury (AKI) cases, and review the diagnosis for chronic kidney disease (CKD) or chronic renal failure (CRF) patients, according to the history and determine whether there is AKI. collection with A/C diagnostic conditions of the cases, the view change of renal function in patients with observation, analysis of clinical factors affecting prognosis of kidney, and to observe the traditional Chinese medicine the syndrome and its effect on renal prognosis. Results: (1) general information: 66 cases were collected, among which 34 cases were male (51.52%), 32 cases of female (48.48%); the youngest patient was 18 years old, the oldest patient was 84 years old in a year 榫，

本文編號：1409577