90例血液透析患者中医证候分布规律分析

Analysis of TCM Syndromes Distribution of 90 Patients with Hemodialysis

目的观察终末期肾病维持性血液透析患者中医证候分布,总结其分布规律,了解中医证候与透析时间的关系。方法选择不同透析时间的患者共90例,通过制订系统调查问卷结合专家评价的方式,对入选患者进行证候调查及辨证分型。结果病机表现为虚实夹杂,脾肾气虚、阳虚兼湿浊、脾肾阳虚兼血瘀多见。初期多见脾肾气虚,随着透析时间的延长,脾肾阳虚呈增长趋势。实证证型最初以湿热或湿浊多见,随着透析时间的延长,血瘀证逐渐增多。血透时间<3年,以湿热或湿浊为主,血瘀证较少;血透时间>3年,湿热或湿浊明显减少,血瘀证患者逐渐增长,差异有统计学意义(χ2=13.14,P=0.041)。结论维持性血液透析患者,更应注重脾肾的固护,治疗中应注重补气健脾,温阳补肾,活血化瘀。

Objective To observe TCM syndromes distribution of ESRD patients undergoing maintenance hemodialysis and to summarize the relationship between TCM syndromes and dialysis age. Methods Ninety dialysis patients of different age were selected to be investigated and distributed by systematic questionnaires and expert evaluation. Results Intermingled deficiency and excess,spleen and kidney Qi deficiency,Yang deficiency and dampness,spleen kidney Yang deficiency and blood stasis were mostly seen in the pathogenesis. At the early stage,spleen and kidney Qi deficiency syndromes were mostly seen. Along with the duration of dialysis,the syndromes of spleen and kidney Yang deficiency,in which damp- heat and damp-pathogen syndromes were initially seen most,and of blood stasis increased. Patients with dialysis age less than3 years often had more damp- heat syndromes and fewer blood stasis syndromes while those with dialysis year more than 3 years often developed more blood stasis syndromes. The differences had statistical significance( Chi- square value 13. 14,P = 0. 041). Conclusion ESRD patients undergoing maintenance hemodialysis shall pay attention to protect spleen and kidney,and focus on tonifying Qi and invigorating spleen,warming Yang and tonifying kidney,and activating blood circulation and removing blood stasis.