本文選題：糖尿病腎病 + 李培旭　； 參考：《河南中醫(yī)藥大學》2016年碩士論文

【摘要】：[目的]通過整理導師李培旭主任醫(yī)師糖尿病腎病治療資料,運用計算機收集統(tǒng)計分析導師近三年符合納入標準的糖尿病腎病治療病案,研究探討李培旭主任醫(yī)師治療糖尿病腎病學術(shù)經(jīng)驗,以深化中醫(yī)藥治療糖尿病腎病的認識,繼承發(fā)揚導師治療糖尿病腎病學術(shù)思想與寶貴經(jīng)驗,更好地指導臨床實踐。[方法]在長期跟隨導師李培旭主任醫(yī)師門診臨證抄方基礎(chǔ)上,對導師近三年相對完整的糖尿病腎病治療病案資料進行全面的收集、整理,并嚴格按照診斷標準、納入標準、排除標準進行篩選,將符合標準的45例共345診次門診病案,建立WORD病人數(shù)據(jù)庫,運用EXAL及SPASS進行統(tǒng)計分析、歸納總結(jié)。[結(jié)果]45例患者病案中,男性33例,女性12例,年齡最大患者81歲,最小患者33歲,平均年齡56.91歲�；颊吣挲g分布中,50-59歲、60-69歲年齡段門診糖尿病腎病患者居多,50-59歲共21例,占46.67%,60-69歲共12例,占26.67%。中醫(yī)病名頻率60%的為消渴和水腫,頻率20%的為胃痞病和心悸病,頻率10%的為眩暈病和腰痛病。糖尿病腎病中醫(yī)病名頻率60%的為消渴和水腫均與水液代謝密切相關(guān),腎為主水之臟,脾主運化水濕,論證了糖尿病腎病與脾腎密切相關(guān)。45例糖尿病腎病患者當中,30%DN患者出現(xiàn)了慢性腎功能衰竭,這一結(jié)果符合當今西方發(fā)達國家透析原發(fā)病中DN居首位的情況另外,西醫(yī)病名統(tǒng)計中的高血壓病、冠心病、高脂血癥和腦梗塞等反映了糖尿病心、腦、腎及血管等并發(fā)癥,該結(jié)果與目前的認識一致。患者主要臨床癥狀頻率70%為水腫、肢體困乏和口于,主要臨床癥狀頻率40%為腰部酸困和夜尿次數(shù)多,主要臨床癥狀頻率≥20%為胃痞不舒、心悸不舒和悶,主要臨床癥狀頻率≥10%為視物昏花、腰痛和頭暈。病機中頻率40%的有水濕停留、絡脈瘀阻和脾腎陽虛,病機頻率20%的有氣陰虛弱和濁毒內(nèi)蘊,病機頻率10%的有氣虛絡阻和濕熱毒蘊。在現(xiàn)有的348診次中,用藥頻次50%的有茯苓、澤瀉、土茯苓、澤蘭、干姜,用藥頻次≥40%的有人參、肉桂、當歸、炒白芍、赤芍、麥冬、白術(shù)、附予、絞股藍、炒杜仲、黃芪,用藥頻次30%的有玉米須、炒大黃、砂仁,用藥頻次20%的有豬苓、紅景天、黨參、生地黃、炒蒼術(shù)、藿香、法半夏、炙甘草、荷葉、黃柏、焦山楂、地龍。病情誘發(fā)或加重因素的頻率20%為停藥,頻率10%為感冒感染、不良飲食以及不確定因素。45例糖尿病腎病患者當中,中醫(yī)藥治療有效率達到73.3%。[結(jié)論]1、DN與消渴、水腫中醫(yī)疾病關(guān)系密切,此外與胃痞、心悸、眩暈和腰痛有關(guān)。2、DN與脾腎密切相關(guān),涉及心、肝、胃、肺等臟腑。3、DN以脾腎陽虛、水濕停留、絡脈瘀阻基本病機為主,兼見氣陰虛弱、氣虛、肝腎陰虛、濁毒內(nèi)蘊、濕熱毒蘊、毒熱內(nèi)蘊等。4、停藥是DN病情加重的直接原因,不良飲食和勞累以及其他不確定的因素都是DN病情反復甚至加重的重要因素。5、DN中醫(yī)藥治療有效率達到73.3%,具有臨床指導意義。
[Abstract]:[objective] to collect and analyze the records of diabetic nephropathy treated by tutor Li Peixu in the past three years. To study the academic experience of chief physician Li Peixu in the treatment of diabetic nephropathy in order to deepen the understanding of traditional Chinese medicine in the treatment of diabetic nephropathy, to inherit and carry forward the academic thought and valuable experience of tutor in the treatment of diabetic nephropathy, and to guide the clinical practice better. [methods] on the basis of long-term follow the doctor Li Peixu, chief physician, to collect and arrange the relative complete medical records of diabetic nephropathy treatment in the past three years, and strictly follow the diagnostic standard, and include the standard. The exclusion criteria were used to screen out 345 outpatient cases of 45 patients who were in accordance with the standard. The database of word patients was established. The statistical analysis was made by EXAL and spas, and summarized. [results] among the 45 patients, 33 were male and 12 were female. The oldest patient was 81 years old, the youngest patient was 33 years old, the average age was 56.91 years old. In the age distribution of the patients, there were 21 cases of diabetic nephropathy aged 50-59 years old, 12 cases (26.67%) were 46.67 years old and 60-69 years old. In TCM, 60% of the disease names were dysentery and edema, 20% of the frequency were gastropathy and palpitation, 10% of the frequency were vertigo and low back pain. In diabetic nephropathy, 60% of the disease name frequency was desolation and edema, which was closely related to the metabolism of water and liquid. The kidney was mainly the viscera of water, and the spleen was responsible for removing water dampness. It is demonstrated that there is chronic renal failure in 30 DN patients among 45 cases of diabetic nephropathy and spleen kidney disease. This result is in line with the situation that DN is the first in the primary disease of dialysis in the western developed countries. The statistics of hypertension, coronary heart disease, hyperlipidemia and cerebral infarction in western medicine reflect the complications of diabetes, such as heart, brain, kidney and blood vessel. The main clinical symptom frequency of the patients was edema, limb drowsiness and mouth, the main clinical symptom frequency of 40% was waist acid distress and nocturnal urine frequency, the main clinical symptom frequency 鈮，

本文編號：2065185