血液透析中急性虚证的证候学分析及临床治疗研究

Clinical study on acute deficiency syndrome and treatment in hemodialysis

目的 :分析血液透析中急性并发症的中医证候学特征 ,建立辨证分型要点 ;观察中药临床疗效 ,并探讨其作用的机制。方法 :1以血液透析出现急性并发症患者为观察对象 ,采用流行病学方法 ,对临床症状进行分析 ,归纳确立血液透析患者急性虚证分型特征。2对临床症状与血压关系进行直线回归分析。3随机分组 ,观察中药参麦注射液的临床疗效 ,观察即刻及治疗 5、10、15分钟临床症状及血压变化。结果 :1急性气阴两虚最多见 (4 4.3%) ,单纯急性阴虚可以存在 ,而急性气虚、急性阳虚总是伴有阴虚情况 ,急性阴虚又以急性肝阴虚和急性胃阴虚最常见。肝阴虚以抽搐痉挛为主证 ,胃阴虚以呕吐为主证。急性气阴两虚、阴阳两虚临床症状积分与平均动脉压相关系数 r=0 .90 92 (P<0 .0 1) ,显示临床症状与血压有较好相关性。 2选择参麦注射液作为观察药物 ,并设西药作对照观察 ,结果表明前者临床症状及血压的改善均明显优于对照组 (P<0 .0 1或 P<0 .0 5 )。结论 :1急性虚证是血液透析过程中最基本的证候学特点 ,同时 ,其分型的辨证要点与其它疾病的急性虚证亦有不同之处。急性气阴两虚、阴阳两虚临床症状与血压有较好相关性。 2应用参麦注射液治疗血液透析急性虚证优于传统常规方法。

Objective:To analyse the characteristic of traditional Chinese medical syndrome of acute complication in hemodialysis(HD) to establish syndrome differentiation and typing,and observe the clinically curative effects to investigate the pathogenesis.Methods:①Clinical symptoms were analysed to establish characteristic of acute deficiency syndrome by way of epidemiologic observation.②Relations between clinical symptoms and blood pressure(BP) were analysed on the basis of linear regression.③Patients with acute complications in HD were randomly divided into two groups to observe the clinically curative effects of Shenmai injection(参麦注射液).The changes of both symptomatic and BP at different times(immediate and 5,10,15 minutes after therapy)were observed.Results:①Acute deficiency of both Qi and Yin(急性气阴两虚) was the most(44.3%),but both acute deficiency of Qi (急性气虚) and acute deficiency of Yang(急性阳虚) were always accompanied by deficiency of Yin(阴虚).Main symptoms were convulision and spasm in deficiency of the liverYin(急性肝阴虚) and vomitus in deficiency of the stomachYin(胃阴虚).The symptomatic scores of acute deficiency of both Qi and Yin and acute deficiency of Yin and Yang(急性阴阳两虚) had a direct correlation with BP(r=0.909 2,P<0.01).②The improvements of clinical symptoms and BP in the group treated with Shenmai injection were superior to those in western medicine group(P<0.01 or P<0.05). Conclusions:①Acute deficiency syndrome is fundamental characteristic of syndrome caused by HD.Its syndrome differentiation and typing is different from other disease.Acute deficiency of both Qi and Yin and acute deficiency of Yin and Yang has a direct correlation with the average BP.②The therapeutic method of treating with Shenmai injection is better strategy for acute deficiency syndrome caused by HD.