外敷、针灸、辨证饮食联合护理肾病综合征80例临床观察

Topical, Acupuncture, Diet and Care Syndrome Nephropathy Syndrome in 80 Cases

[目的]观察外敷、针灸、辨证饮食联合护理治肾病综合征疗效。[方法]使用前瞻性设计,将80例门诊及住院患者护理：保持环境干净整洁,注意个人卫生,防止皮肤破溃、感染;限制盐、水分摄入,钠盐摄入量不超过2g/d;糖皮质激素、利尿剂予补钾,预防体位性低血压、晕厥等不良反应。摄入蛋白质1g/（kg·d）,以瘦肉、蛋、鱼等优质蛋白为主,避免摄入过多植物蛋白;长时间使用糖皮质激素补钙。情志护理：七情过极影响脏腑气机,疏导患者抑郁、焦虑等悲观情绪,保持乐观心态,积极治疗。可太极拳、五禽戏等运动提高机体免疫力。外敷：六一散（滑石600g、甘草100g）,6-9g/次,2次/d,以防皮肤溃破;已破溃局部外敷生肌散（寒水石、滑石各15g,密陀僧、海螵蛸、淀粉、枯矾、龙骨各9g,干胭脂6g）,5g/次,每日三次。针刺：低血压选足三里、气海、关元、肾俞、命门、涌泉,行导气手法,即入针和出针速度均匀缓慢的针刺法,是调气法的一种,15min/次,3次/d,以补肾益气、充盈脑髓改善眩晕）。辨证饮食：脾虚湿盛治以健脾渗湿、利水消肿,赤小豆、绿豆、扁豆、茯苓、薏苡仁、西葫芦、冬瓜;脾肾阳虚治以温阳补肾、健脾益胃,羊肉、牛肉、桂圆、鲤鱼、莲子,少佐生姜、桂皮;肾气不足治以补益肾气,枸杞子、芡实、山药、冬虫夏草等。连续治疗14d为1疗程。观测临床症状、SF-36p评分、不良反应。连续治疗3疗程,判定疗效。[结果]痊愈32例,显效35例,无效13例,总有效率83.75%。[结论]外敷、针灸、辨证饮食联合护理治肾病综合征疗效满意,无严重不良反应,值得推广。

[Objective] To observe the topical, acupuncture, diet and care differentiation syndrome cure kidney disease. [Methods] Using a prospective design, 80 cases of outpatient and inpatient care： keep the environment clean, pay attention to personal hygiene to prevent skin ulceration, infection; limit salt, water intake, sodium intake of no more than 2g/d; glucocorticoids, potassium diuretics to prevent orthostatic hypotension, syncope and other adverse reactions. Intake of protein 1g /kg·d-1, lean meat, eggs, fish and other high-quality protein, avoiding excessive intake of vegetable protein; prolonged use of corticosteroids calcium. Emotional care： very impassioned affect organs of air, counseling patients, depression, anxiety and other pessimism, optimistic attitude, active treatment. Can tai chi, five animals and other sports improve immunity. External： six a casual（talc 600 g, licorice 100g）, 6-9g/times, 2 times/d, to prevent skin ulceration; ulceration of local application Shengjisan（calcite, talc 15 g, litharge, cuttlebone, starch, alum, keel 9g, dry rouge 6g）, 5g/times, three times daily. Acupuncture： hypotension selected Zusanli, the sea air, Guan Yuan, Shenshu, Vital, springs, gas lines lead the way, that the needle and the needle acupuncture slow uniform rate, a transfer gas law, 15min/time, 3 times/d, to kidney Qi, filling the brain to improve vertigo）. Syndrome Diet： Spleen wet Sheng rule to Jianpishenshitang, water swelling, red bean, green beans, lentils, Poria, Coix, squash, melon; spleen deficiency treatment to Onyang kidney, spleen and stomach, lamb, beef, longan, carp, lotus seeds, Koro ginger, cinnamon; insufficient kidney treatment to benefit kidney, wolfberry, Gorgon, yam, Chinese caterpillar fungus and so on. 14 d for a course of continuous treatment. Observation of clinical symptoms, SF-36 p score, adverse reactions. Continuous treatment of 3 courses, to determine efficacy. [Results] 32 cases cured, effective in 35 cases, 13 cases ineffective, the total efficiency of 83.75%. [Conclusion] topical, acupuncture, diet and syndrome differentiation treatment of kidney care satisfaction, no side effects, worthy of promotion.