不同结局血液透析患者中医证型差异研究

Study on the Difference of TCM Syndrome Types in Hemodialysis Patients with Different Outcomes

目的研究血液透析患者的中医证型特点,为临床提高慢性肾功能衰竭生存质量提供一定的参考依据。方法回顾性分析2000年1月~2020年1月在北京市东方医院及天津市和平区中医医院血液透析中心接受血液透析治疗死亡(n=55)及同期维持性血液透析存活(n=55例)的患者临床资料,分别作为死亡组和存活组,对两组患者进行中医辨证分型,比较两组中医证型分布特征及死亡率。结果死亡组中虚实夹杂证候发生率最高,为72.72%,单纯虚证为21.57%、单纯实证为7.27%,其中虚证中脾肾气虚最高(43.13%),实证中湿浊最高(66.59%);两组证型分布比较,差异无统计意义(P>0.05),阴阳两虚型死亡率最高(75.00%),其余从高到低依次为气阴两虚、脾肾阳虚、脾肾气虚;两组各证型分布比较,差异无统计意义(P>0.05),血瘀死亡率最高(62.50%),其余从高到低依次为湿浊、湿热。结论血液透析死亡患者中医证型以虚实夹杂、单纯虚证为主,虚证中以脾肾气虚为主,实证中以湿浊为主。虚证中死亡率最低脾肾气虚,提示脾肾气虚患者透析较为充分,阴阳两虚型透析充分性较差,死亡率最高。临床对于血液透析患者,应给予辨证论治干预,如补肾益气、补肾健脾治疗,以改善患者中医证型,进一步促进血液透析的充分性,降低血液透析患者的死亡率,提高血压透析患者的生存质量。

Objective To study the characteristics of TCM Syndrome types in hemodialysis patients with death,and to provide a basis for improving the quality of life of chronic kidney failure.Method The clinical data of patients who died of hemodialysis(n=55)and survived maintenance hemodialysis(n=55)in Beijing Dongfang Hospital and the hemodialysis center of Tianjin Heping District traditional Chinese medicine hospital from January 2000 to January 2020 were retrospectively analyzed.The two groups were divided into death group and survival group,The distribution characteristics of TCM Syndrome Types and mortality were compared between the two groups.Results In the death group,the incidence of mixed syndrome of deficiency and excess was the highest,72.72%,that of simple deficiency was 21.57%,and that of simple demonstration was 7.27%.Among them,deficiency of spleen and Kidney Qi was the highest(43.13%),and dampness and turbidity was the highest(66.59%);There was no statistical difference in the distribution of syndrome types between the two groups(P>0.05).The mortality of Yin-Yang deficiency type was the highest(75.00%),and the rest were Qi and yin deficiency,spleen and kidney yang deficiency and spleen and kidney qi deficiency from high to low;There was no significant difference in the distribution of syndrome types between the two groups(P>0.05).The mortality of blood stasis was the highest(62.50%),and the rest were dampness turbidity and dampness heat from high to low.Conclusion The TCM syndrome types of hemodialysis dead patients are mainly deficiency and excess mixed with simple deficiency syndrome,deficiency syndrome is mainly spleen and kidney qi deficiency,and dampness and turbidity are mainly in evidence.Deficiency syndrome has the lowest mortality,spleen and kidney qi deficiency,suggesting that patients with spleen and kidney qi deficiency have more adequate dialysis,and the deficiency of yin and Yang has poor dialysis adequacy and the highest mortality.Clinically,hemodialysis patients should be given syndrome differentiation and treatment intervention,such as tonifying the kidney and Qi,tonifying the kidney and strengthening the spleen,so as to improve the TCM syndrome types of patients,further promote the adequacy of hemodialysis,prevent and reduce the incidence of hemodialysis mortality,and improve the quality of life of blood pressure dialysis patients.