维持性血液透析合并慢性便秘患者中医证候分布特点研究

Study on the Characteristics of TCM Syndrome Distribution in Patients with Maintenance Hemodialysis and Chronic Constipation

目的探讨维持性血液透析合并慢性便秘患者中医证候特点及其分布规律,为中医临床辨证论治该病提供依据。方法收集150例维持性血液透析合并慢性便秘患者的一般情况、中医四诊信息等资料,通过双人双机、背靠背式核对录入导出数据,分析患者中医证候总体分布、中医证候在不同年龄及性别中的分布以及中医证候在不同透析龄及原发病的分布等情况。结果①150例维持性血液透析合并慢性便秘患者中虚秘者较多,共116例,占比总人数77.33%;其中气虚秘34例(22.67%),阳虚秘40例(26.67%),阴虚秘28例(18.67%),血虚秘14例(9.33%);实秘者共34例,相对较少,仅占22.67%;其中热积秘10例(6.67%),寒积秘16例(10.67%),气滞秘8例(5.33%)。②维持性血液透析合并慢性便秘患者男性实秘证型以热积秘(70.00%)为主,虚秘证型以阴虚秘(57.14%)为主;女性实秘证型则以气滞秘(75.00%)最多见,虚秘证型以血虚秘(64.29%)为主。③不同年龄段中18~44岁(青年组)患者以实秘为主,45~59岁(中年组)和60~75岁(老年组)则均以虚秘为主;维持性血液透析合并慢性便秘患者透析龄集中在12~60个月(64例)、61~120个月(38例)两个区间。④原发病为糖尿病肾病的维持性血液透析合并慢性便秘患者有38例(25.33%),居病因首位;慢性肾小球肾炎为第二原发病病因,共31例(20.67%);二者中医证候以阳虚秘、气滞秘为主;高血压肾病28例(18.67%),居第三位原发病病因,其中医证候以阴虚秘为主。结论维持性血液透析合并慢性便秘患者中医证型以虚秘者居多,实秘者相对较少,虚秘中又以阳虚秘最为多见。性别、年龄、原发病等因素均影响便秘证型分布,临床辨证当先分清虚实,并根据患者临床症状准确辨证。

Objective To explore the distribution characteristics of TCM syndrome in patients with maintenance hemodialysis and chronic constipation,and to provide basis for TCM clinical diagnosis and treatment of the disease.Methods A toal of 150 cases of maintenance hemodialysis patients with chronic constipation were collected.The information of general situation,TCM four diagnostic methods were collected.The data were entered and derived by two-person,double-machine and back-to-back check.The overall distribution of TCM syndrome,the distribution of TCM syndrome in different ages and genders,and the distribution of TCM syndrome in different dialysis ages and primary diseases were analyzed.Results①Among 150 patients,a total of 116 cases were deficient constipation,accounting for 77.33%;including 34 cases of qi deficiency(22.67%),40 cases of yang deficiency(26.67%),28 cases of yin deficiency(18.67%),14 cases of blood deficiency(9.33%).There were 34 cases of excessive constipation,accounting for 22.67%;including 10 cases of heat accumulation(6.67%),16 cases of cold accumulation(10.67%),and 8 cases of qi stagnation(5.33%).②The excessive constipation TCM syndrome of male patients with maintenance hemodialysis and chronic constipation were mainly heat accumulation(70.00%),while yin deficiency(57.14%)was common in deficient constipation.In female patients,qi stagnation(75.00%)was the most common type of excessive constipation,and blood deficiency(64.29%)was the most common type of deficient constipation.③In different ages,the patients of 18~44 years old(youth group)were mainly excessive constipation,45~49 years old(middle-aged group)and 60~75 years old(old-aged group)were mainly deficient constipation.The dialysis ages of patients with chronic constipation of maintenance hemodialysis were concentrated in two intervals:12~60 months(64 cases)and 61~120 months(38 cases).④There were 38 cases(25.33%)of maintenance hemodialysis and chronic constipation patients with primary disease of diabetic nephropathy,which was the first cause.Chronic glomerulonephritis was the second primary cause of disease,with 31 cases(20.67%).Both TCM syndrome types were mainly yang deficiency and qi stagnation.Hypertensive nephropathy was the third primary cause,with 28 cases(18.67%).And the TCM syndrome type was mainly yin deficiency.Conclusion The TCM syndrome of maintenance hemodialysis with chronic constipation patients is mostly deficiency constipation.Excessive constipation is relatively rare.And yang deficiency constipation is the most common.Sex,age,primary disease and other factors have effects on the distribution of constipation syndrome types.The clinical syndrome differentiation should be base on distinguishing the deficiency and excess first,and then according to the patient’s clinical symptoms.