【摘要】：目的:通過檢測慢性腎衰竭各中醫(yī)分型患者中血鈣、磷在大黃牡蠣湯灌腸前、后的變化,以研究灌腸治療對鈣磷代謝的影響,從而為慢性腎衰竭不同證型的患者提供一種新型而有效的升鈣、降磷的方法。方法:選擇慢性腎衰竭患者70例,其西醫(yī)臨床診斷符合《中藥新藥臨床研究指導(dǎo)原則(試行)》[9],其中醫(yī)辨證分型符合《慢性腎衰竭的診斷、辨證分型及療效評定》(試行方案)(中華中醫(yī)藥學(xué)會(huì)腎病分會(huì))[10]。根據(jù)設(shè)定的方案,采用隨機(jī)分組分為治療組(用大黃牡蠣湯進(jìn)行灌腸)和對照組,清晨空腹抽取每組患者的靜脈血,記錄下治療前各組血液中鈣、磷的值,對照組給予一些基礎(chǔ)病的治療,治療組在治療基礎(chǔ)病的前提下,還要采用大黃牡蠣湯灌腸治療(1次/日),療程都為1月,再次抽取患者空腹時(shí)的靜脈血,記錄下治療后各組血液中鈣、磷的數(shù)值。同時(shí)選擇10例健康志愿者,清晨空腹抽血,記錄下血鈣、磷的值,以比較治療前慢性腎衰竭患者與健康志愿者之間鈣磷的代謝情況。結(jié)果:各中醫(yī)分型的慢性腎衰竭患者血Ca均下降,血P均升高(P0.01),不同中醫(yī)證型的患者與正常組比較均存在顯著差異。脾腎氣虛證組中治療組的患者血鈣顯著升高(P0.05),統(tǒng)計(jì)有明顯差異,血磷下降不明顯,統(tǒng)計(jì)無明顯差異;脾腎陽虛組治療組的患者血鈣明顯升高,血磷明顯下降(P0.05),統(tǒng)計(jì)均有明顯差異;氣陰兩虛組血磷顯著下降(P0.05),統(tǒng)計(jì)有明顯差異,血鈣升高不明顯,統(tǒng)計(jì)無明顯差異;肝腎陰虛和陰陽兩虛的患者血鈣、血磷變化均不明顯,統(tǒng)計(jì)無明顯差異。結(jié)論:大黃牡蠣湯灌腸對脾腎陽虛患者血鈣、血磷的調(diào)節(jié)有明顯作用,而對脾腎氣虛證患者升高血鈣有作用,對氣陰兩虛證患者有明顯降磷作用,對肝腎陰虛證和陰陽兩虛證的患者血鈣和血磷的影響不明顯。
[Abstract]:Objective: to detect the changes of serum calcium and phosphorus in patients with chronic renal failure before and after enema by rhubarb Oyster soup, and to study the effect of enema on calcium and phosphorus metabolism. So as to provide a new and effective method to increase calcium and reduce phosphorus for patients with different syndromes of chronic renal failure. Methods: 70 patients with chronic renal failure were selected. The clinical diagnosis of western medicine was in accordance with the guiding principles of clinical research of new traditional Chinese medicine (trial). [9]. The syndrome differentiation of traditional Chinese medicine was in accordance with the diagnosis of chronic renal failure. Syndrome differentiation and curative effect Evaluation (trial Scheme) (Chinese Society of traditional Chinese Medicine Nephropathy Branch) [10]. According to the set plan, the patients in the treatment group (enema with rhubarb Oyster soup) and the control group were randomly divided into treatment group (rhubarb Oyster soup enema) and control group. The venous blood of each group was taken on an empty stomach in the morning, and the values of calcium and phosphorus in the blood of each group before treatment were recorded. The control group was given the treatment of some basic diseases, and the treatment group was treated with rhubarb Oyster soup enema (once a day) on the premise of the treatment of basic diseases. The course of treatment was 1 month. The venous blood of the patients on an empty stomach was taken again. The values of calcium and phosphorus in blood of each group after treatment were recorded. At the same time, 10 healthy volunteers were selected and fasting blood samples were taken in the morning to record the values of blood calcium and phosphorus in order to compare the metabolism of calcium and phosphorus between patients with chronic renal failure and healthy volunteers before treatment. Results: the blood Ca of patients with chronic renal failure was decreased and the blood P was increased (P 0.01). There were significant differences between the patients with different TCM syndromes and the normal group. In the spleen and kidney qi deficiency syndrome group, the blood calcium of the patients in the treatment group was significantly increased (P 0.05), and there was significant difference in statistics, but there was no significant difference in the decrease of blood phosphorus and no significant difference in statistics. In the spleen and kidney yang deficiency group, the blood calcium and phosphorus in the treatment group were significantly higher than those in the control group (P 0.05), and there were significant differences in statistics. In the group of deficiency of both qi and yin, blood phosphorus decreased significantly (P 0.05), and there was significant difference in statistics, but there was no significant difference in serum calcium and blood phosphorus in patients with deficiency of yin and kidney and deficiency of yin and yang, and there was no significant difference in statistics between patients with deficiency of yin and kidney and deficiency of both yin and yang, and there was no significant difference in blood phosphorus between patients with deficiency of yin and kidney. Conclusion: rhubarb Oyster soup enema has obvious effect on the regulation of blood calcium and blood phosphorus in patients with deficiency of spleen and kidney yang, but also on the increase of blood calcium in patients with deficiency of spleen and kidney qi and deficiency of qi and yin, and has obvious effect on reducing phosphorus in patients with deficiency of both qi and yin. There was no significant effect on blood calcium and phosphorus in patients with yin deficiency of liver and kidney and deficiency of yin and yang.
【學(xué)位授予單位】：山西醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R277.5

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