本文關鍵詞： 健脾滋腎化瘀湯 氣陰兩虛 瘀熱 腎病綜合征　出處：《云南中醫(yī)學院》2017年碩士論文　論文類型：學位論文

【摘要】：目的:觀察和研究以中醫(yī)健脾滋腎化瘀為治則,擬定的“健脾滋腎化瘀湯”聯(lián)合醋酸潑尼松治療氣陰兩虛為本,瘀熱為標型腎病綜合征的臨床療效,以及對氣陰兩虛為本,瘀熱為標型腎病綜合征患者相關臨床指標的改善,進而客觀科學地評價此法治療氣陰兩虛為本,瘀熱為標型腎病綜合征的綜合臨床療效。方法:1.選取原發(fā)性腎病綜合征脾腎氣陰兩虛型患者68例,采用單盲法,按照隨機分組(按照就診次序隨機分組,規(guī)定奇數(shù)為治療組,偶數(shù)為對照組)、同期對照試驗的原則分為對照組和治療組,其中對照組34例,治療組34例。2.在臨床研究前,對治療組、對照組病人的年齡、性別、病程、臨床癥狀、療效性指標等檢驗分析,確定兩組之間的差別無統(tǒng)計學意義。3.服藥方法:(1)常規(guī)治療:水腫嚴重、存在低蛋白血癥患者建議臥床休息。低鹽(3g/d)、減少動物油脂的攝入、優(yōu)質蛋白飲食(蛋白質攝入量為0.8-1.0g/(kgd))加足夠熱量,補鈣,護胃,防治水、電解質及酸堿失衡。(2)對癥治療:實驗過程中如發(fā)生全身水腫嚴重者予以利尿消腫(注意應用袢利尿劑防止低納低鉀低氯性堿中毒);有感染時予以抗感染治療;有血栓、栓塞、急性腎損傷等并發(fā)癥予積極的對癥治療。對照組:進行上述西醫(yī)常規(guī)對癥治療加口服激素(醋酸潑尼松1mg/kg.d)治療,遵循激素使用原則和方案;治療組:在上述西醫(yī)常規(guī)對癥治療加口服激素(醋酸潑尼松1mg/kg.d)治療的基礎上加用口服中藥(健脾滋腎化瘀湯)。(4)療程:以四周為一個療程,連續(xù)觀察三個療程。(5)達到療程后記錄主要相關臨床表現(xiàn)(包括相關的癥狀、體征、舌象、脈象)、24小時尿蛋白定量、血漿白蛋白、膽固醇、血常規(guī)、尿常規(guī)、腎功、肝功等,對服藥的療效及安全性作出客觀評價。結果:1.68例患者(60例納入本課題研究,8例被剔除),兩組患者治療前在年齡、性別、病程、癥狀等一般性資料方面無明顯性差別(P㧐0.05)。2.經過三個療程治療后,治療組的總有效率為93.33%;對照組總有效率為70.00%,兩組比較有顯著差異(P㩳0.05)。3.治療組在改善面色少華,神疲乏力,或手心足心發(fā)熱,腰酸腰痛或浮腫等中醫(yī)臨床癥狀,以及減少24小時尿蛋白、糾正低蛋白血癥、降低膽固醇等方面,療效均優(yōu)于對照組(P㩳0.05)。4.對安全性指標,如生命體征(T、P、R、BP)、血常規(guī)(HB、RBC、WBC、PLT)、以及肝功(ALT)、腎功(BUN、SCr、Ccr)等,進行統(tǒng)計學分析,用藥前治療組、對照組組間比較無統(tǒng)計學意義(P㧐0.05);用藥后兩組組間比較亦無統(tǒng)計學意義(P㧐0.05)。結論:運用健脾滋腎化瘀湯聯(lián)合醋酸潑尼松治療氣陰兩虛為本,瘀熱為標型腎病綜合征的患者,在改善面色少華,神疲乏力,或手心足心發(fā)熱,腰酸腰痛或浮腫等中醫(yī)臨床癥狀,以及減少24小時尿蛋白、糾正低蛋白血癥、降低膽固醇等方面,治療組療效明顯優(yōu)于單用醋酸潑尼松。
[Abstract]:Objective: to observe and study the clinical effect of "Jianpi Zishen Huayu decoction" combined with prednisone acetate in treating Qi and Yin deficiency and blood stasis heat as standard nephrotic syndrome, and to treat Qi and Yin deficiency. Improvement of clinical indexes in patients with standard nephrotic syndrome, and objective and scientific evaluation of this method for treating deficiency of Qi and Yin. Methods 1. 68 cases of primary nephrotic syndrome with deficiency of spleen and kidney qi and yin were selected and divided randomly according to the single blind method. The control group was divided into control group and treatment group according to the principle of control group and treatment group, 34 cases in control group and 34 cases in treatment group. Before clinical study, the patients in treatment group and control group were treated with age, sex, course of disease, clinical symptoms, The difference between the two groups was not statistically significant. (1) routine treatment: edema was severe, patients with hypoproteinemia were advised to rest in bed, low salt was 3 g / d, and the intake of animal fat was reduced. Quality protein diet (protein intake 0.8-1.0 g / kg? Add enough calories, supplement calcium, protect stomach, prevent and cure water, Electrolyte and acid-base imbalance. 2) symptomatic treatment: if severe systemic edema occurs during the experiment, diuretic swelling should be given (note the use of loop diuretics to prevent hypotonic, low potassium and low chlorine alkalosis; antiinfective treatment when infected; thrombus, embolism, etc.). Acute renal injury and other complications were treated with active symptomatic therapy. Control group: routine western medicine treatment plus oral administration of prednisone acetate (prednisone acetate 1 mg / kg 路d) followed the principle and scheme of hormone use; Treatment group: add oral Chinese medicine (Jianpi Zishen Huayu decoction) course of treatment on the basis of routine treatment of western medicine and oral hormone (prednisone acetate 1 mg / kg 路d): take four weeks as a course, The clinical manifestations (including symptoms, signs, tongue picture, 24 hours urine protein, plasma albumin, cholesterol, blood routine, urine routine, renal function, liver function, etc.) were recorded after three consecutive courses of treatment. Results Sixty out of 1.68 patients were included in this study and 8 patients were excluded. There was no significant difference between the two groups in age, sex, course of disease, symptoms and other general data before treatment. After three courses of treatment, the total effective rate of the treatment group was 93.33, and the total effective rate of the control group was 70.00.There was a significant difference between the two groups. The curative effect of the treatment group is superior to that of the control group in improving the complexion of Shaohua, fatigue, fever of the palms and feet, low back pain or swelling, reducing 24 hours urine protein, correcting hypoproteinemia, lowering cholesterol, etc., the therapeutic effect of the treatment group is better than that of the control group. The safety indexes, such as vital signs, blood routine test (HBT), blood routine test (HBC), and liver function (ALT), renal function (BUNN) SCrCcrs, were analyzed statistically. There was no significant difference between the control group and the treatment group before the treatment. There was no significant difference between the two groups in the treatment group and the control group (P > 0.05), and there was no significant difference between the control group and the treatment group (P > 0.05), and there was no significant difference between the control group and the treatment group before the use of the drug. There was no significant difference between the two groups after treatment. Conclusion: using Jianpi Zishen Huayu decoction combined with prednisone Acetate to treat the patients with deficiency of Qi and Yin and blood stasis and heat as the standard nephrotic syndrome can improve the complexion, fatigue, or fever of the palms and feet. The curative effect of the treatment group was better than that of prednisone acetate alone in the aspects of low back pain or swelling of lumbar acid, reducing 24 hours urine protein, correcting hypoproteinemia and lowering cholesterol.
【學位授予單位】：云南中醫(yī)學院
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R277.5

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