中医整体排毒疗法对终末期肾功能衰竭的治疗作用

Effect of Comprehensive Toxin-Eliminating Therapy in Treating Terminal Renal Failure

[目的]观察张琪“保元降浊八法”等中医整体排毒疗法对终末期肾功能衰竭(简称肾衰)的治疗作用及对其预后影响。[方法]对肾小球滤过率小于10 mL/min、未进行维持性透析的终末期肾衰患者32例采用中医整体排毒疗法,包括口服中药汤剂、口服中药制剂、中药结肠透析以及对症处理和必要时给予临时透析治疗。观察患者存活情况、中医征候和证型变化情况,检测患者的血生化等指标,并对其中尚存活者与已死亡病例进行对比分析。[结果]终末期肾衰患者未能进行透析等替代治疗者,中医证侯属本虚标实、寒热错杂,病变过程中其证候不断发生改变。经中医整体排毒疗法治疗后,患者3个月存活率为90.6％,半年存活率81.3％,1年存活率71.9％。将其中尚存活病例(存活组)和已病死病例(死亡组)比较,两组年龄、病程、血清肌酐、尿素氮、血红蛋白均无显著性差异(P>0.05),但存活组尿量多于死亡组(P<0.01),血清白蛋白也较高(P<0.05)。[结论]中医整体排毒疗法对于因经济等原因不能接受维持性透析的终末期肾衰患者仍有改善临床症状,稳定血肌酐、尿素氮、血红蛋白、血清白蛋白等作用,是维持终末期患者继续生存的有效疗法;终末期患者的尿量、血清白蛋白水平与能否长期存活有一定的关系。如能有意识地改善这类患者的尿量和营养状况,对延长他们?

[Objective] To investigate the effect of comprehensive toxin-eliminating therapy, a regimen of tonifying kidney and purging turbidness founded by Professor Zhang Qi, in treating terminal renal failure and on its prognosis. [ Methods ] Thirty-two cases of terminal renal failure with glomerular filtration rate (GFR) less than 10 mL/min and not receiving sustained supportive dialysis were treated with comprehensive toxin-eliminating therapy which included oral use of herbal medicine decoction and preparation, colonic dialysis with herbal medicine and symptomatic treatment, and temporary dialysis was applied if necessary. Survival rate, the changes of symptoms and signs and syndrome patterns in the treatment were observed and blood biochemical parameters were detected. A comparative analysis was conducted between the survival cases and the dead cases. [Results] Terminal renal failure cases not receiving sustained supportive dialysis were characterized as principal deficiency and secondary excess and manifested as the syndrome of cold and heat complex; the syndrome patterns changed with the progress. After treatment, the 3-month survival rate was 90.6% , 6-month survival rate 81.3% and one-year survival rate 71.9% . No significant differences of age, disease course, serum creatine (SCr) , blood urea nitrogen (BUN) and serum hemoglobin were showed between the survival cases and the dead cases ( P > 0.05) . However, urine volume was more ( P < 0.01) and serum albumin level higher ( P < 0.05) in the survival cases than those in the dead cases. [Conclusion] Comprehensive toxin-eliminating therapy is effective in relieving the symptoms of terminal renal failure patients who can not afford the supportive dialysis and can prolong the survival time by stabilizing serum SCr, BUN and albumin levels. A certain relationship between the urine volume and serum albumin level indicates that maintaining the urine volume and improving nutrient status of the patients may be beneficial to the prolongation of survival time.