大黄温阳活血灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭随机平行对照研究

Compound Rhubarb Enema With High Total Colonic Dialysis Combined With Warming Yang,Rescuing Exhaustion,Downbearing The Turbid In The Treatment of Kidney Yang Deficiency Type Chronic Renal Failure Study Random Parallel Controlled Study

[目的]观察自拟灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭疗效。[方法]使用随机平行对照方法,将60例住院患者按随机数字表分为两组;均使用温阳救逆降浊汤（附子20g,干姜10g,炙甘草15g,茯苓30g,姜半夏15g,大黄10g,黄芪、山萸肉、芡实各30g）,1剂/d,水煎200mL,早晚口服,阳虚四肢厥冷、身重困倦、血尿素氮、肌酐偏高,每周逐渐增加附子用量,临证加减。对照组30例大黄温阳活血（大黄、牡蛎各30g,附子20g,肉苁蓉30g,丹参15g,当归20g,等）,1剂/d,水煎200mL,保留灌肠,20~30min/次,1次/d。治疗组30例①结肠透析机,高位结肠透析：洗肠三遍;将纯水与一定比例离子配制成离子水透析液作为结肠透析的透析液放入恒温液箱,将透析液加温至合适的温度并恒温,关闭排污管节制钳,灌注透析液至大肠;肠内注入透析液150~200mL,患者适当保留,排出透析液;②大黄温阳活血灌肠方治疗同对照组。连续治疗7d为1疗程,疗程间休息3d。观测临床症状、血肌酐、尿素氮、血红蛋白、不良反应。连续治疗3疗程,判定疗效。[结果]治疗组显效20例,有效6例,无效4例,总有效率86.67%。对照组显效14例,有效8例,无效8例,总有效率73.33%。治疗组疗效优于对照组（P〈0.05）。生化指标治疗组优于对照组（P〈0.05,P〈0.01）。[结论]大黄温阳活血灌肠方与高位全结肠透析联合温阳救逆降浊汤治疗肾阳虚衰型慢性肾衰竭,疗效满意,无副作用,值得推广。

[Objective] To observe the compound rhubarb enema with high total colonic dialysis combined with warming yang,rescuing exhaustion,downbearing the turbid in the treatment of kidney yang deficiency type chronic renal failure curative effect. [Method] Using randomized controlled methods,will be randomly divided into two groups of 60 cases of hospitalized patients;two groups use Wen Warming yang,rescuing exhaustion,downbearing the turbid（monkshood 20g,Dried ginger 10g,Licorice 15g,Poria 30g,Rhizome Pinelliae Preparata 15g,rheum officinale 10g,Astragalus root,dogwood,Gorgon each 30g）,1 / D,water simmer in water extract 200ml,morning and evening oral,each 100 ml,Yang deficiency,cold limbs, body weight,blood urea nitrogen,creatinine were higher,the weekly increased aconite dosage,clinical addition and subtraction. 30 cases of the control group,rhubarb compound enema（rhubarb 30g,oyster 30g, monkshood 20g,Herba Cistanches 30g,Salvia 15g,angelica 20g,1 /d）agent,water frying take liquid 200mL,retention enema,20 - 30min/,1 times /d. 7 days are 1 period of treatment,3 days rest between treatments,the treatment group of 30 cases of Compound Rhubarb enema,1 doses of /d,water simmer in water 200mL＋ 5000mL＋ concentrated dialysate temperature boiling water 150 ~ 200mL,retention enema, 40min/ time,2 times / week;the use of colon dialysis machine,were high colonic dialysis. Continuous treatment with 7d for 1 courses,rest between treatments 3D. Two sets of continuous 3 courses of treatment, observation of clinical symptoms,blood urea nitrogen,creatinine,haemoglobin,adverse reaction,to judge the curative effect. 20 cases of group therapy [Results]6 cases were effective,4 cases ineffective,the total efficiency of 86.67%. The control group was 14 cases,effective 8 cases,invalid 8 cases,the total efficiency of 73.33%. The treatment group was better than control group（P〈0.05）. Biochemical indexes in treatment group than in control group（P〈0. 05,P〈0. 01）. [Conclusion] Compound Rhubarb enema with high total colonic dialysis combined with warming yang,rescuing exhaustion,downbearing the turbid in the treatment of kidney yang deficiency type chronic renal failure,curative effect,no side effect,is worth promoting.