【摘要】：目的：在常規(guī)治療的基礎(chǔ)上,觀(guān)察尿毒清顆粒灌腸治療CKD4-5期的近期療效,比較尿毒清灌腸與通腑泄?jié)岱焦嗄c的療效差別,隨訪(fǎng)半年內(nèi)各組患者進(jìn)入透析的情況。方法：(1)文獻(xiàn)研究：檢索EMbase、PubMed、CNKI、VIP、Wanfang、sinoMed數(shù)據(jù)庫(kù),納入尿毒清灌腸治療CKD的隨機(jī)對(duì)照試驗(yàn),以采用尿毒清灌腸治療作為干預(yù)組,未采用尿毒清灌腸治療為對(duì)照組,經(jīng)剔重文獻(xiàn),提取數(shù)據(jù),評(píng)價(jià)質(zhì)量等步驟后,采用RevMan 5.2軟件進(jìn)行分析,觀(guān)察治療后兩組總有效率,及Scr. BUN的水平。(2)臨床研究：選取2015.4至2016.2江蘇省中醫(yī)院腎內(nèi)科的符合納入標(biāo)準(zhǔn)的CKD4-5期住院患者共115例,尿毒清組39例、中藥組39例及對(duì)照組37例,對(duì)照組僅采用西醫(yī)基礎(chǔ)及中醫(yī)辨證治療,尿毒清組在對(duì)照組基礎(chǔ)上應(yīng)用尿毒清顆粒灌腸治療,中藥組在對(duì)照組基礎(chǔ)上應(yīng)用通腑泄?jié)岱焦嗄c治療,療程14天,觀(guān)察治療前后三組疾病療效、實(shí)驗(yàn)室指標(biāo)、中醫(yī)證侯積分及癥狀、不良反應(yīng)的變化,隨訪(fǎng)半年內(nèi)各組患者進(jìn)入透析的情況。結(jié)果：(1)文獻(xiàn)研究：①干預(yù)組治療后總有效率高于空白對(duì)照組,兩者差異具有統(tǒng)計(jì)學(xué)意義[OR=3.30,95% CI (1.81,6.03),P=0.0005,I2=0%]; ②干預(yù)組治療后Scr、BUN低于空白對(duì)照組及愛(ài)西特組,差異均具有統(tǒng)計(jì)學(xué)意義[Scr:MD=-40.03,95%CI (-64.55,-15.50), P=0.005,I2=82%(與空白對(duì)照組比較)；MD=-66.74,95%CI(-101.47.04,-32.01), P=0.0002,I2=17%(與愛(ài)西特組比較)]；[BUN:MD=-1.99,95%CI (-3.33,-0.65), P=0.004,I2=88%(與空白對(duì)照組比較)；MD=-5.35,95%CI (-6.45,-4.25), P=0.0001,I2=0%(與愛(ài)西特組比較)]。(2)臨床研究：①尿毒清組治療后疾病總有效率高于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05),與中藥組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；亞組分析：非濕濁證患者尿毒清組治療后有效率與對(duì)照組相當(dāng),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)②尿毒清組治療后BUN、Scr、UA水平下降,與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),與中藥組比較差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；③尿毒清組治療后證候積分減少,與對(duì)照組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05),與中藥組比較差異有統(tǒng)計(jì)學(xué)意義(P0.05)；④尿毒清組治療后乏力、腰膝酸軟、納差、頭暈、惡心嘔吐等癥狀改善,中藥組納差、惡心嘔吐等癥狀改善,與對(duì)照組比較差異均有統(tǒng)計(jì)學(xué)意義(P0.05)；⑤隨訪(fǎng)半年內(nèi),尿毒清組、中藥組與對(duì)照組進(jìn)入透析的人數(shù)相當(dāng),差異無(wú)統(tǒng)計(jì)學(xué)意義(P0.05)；三組進(jìn)入透析常見(jiàn)誘因依次為感染、心衰、高血鉀；⑥尿毒清組、中藥組常見(jiàn)的不良反應(yīng)為輕度腹瀉、腹痛,未見(jiàn)便血、惡心嘔吐等不良反應(yīng)。結(jié)論：(1)短程應(yīng)用具有益氣健脾,通腑泄?jié)?活血化瘀功效的尿毒清顆粒灌腸有助于清除尿毒癥毒素、穩(wěn)定腎功能,近期療效為71.8%,與通腑泄?jié)岱较喈?dāng),但不能延緩中晚期CKD患者進(jìn)入透析的時(shí)間。(2)尿毒清灌腸可改善中晚期CKD患者乏力、腰膝酸軟、納差、頭暈及惡心嘔吐等癥狀,療效優(yōu)于通腑泄?jié)岱?短期應(yīng)用無(wú)明顯不良反應(yīng)。(3)尿毒清為臨床應(yīng)用多年的顆粒劑型,用于灌腸療法時(shí)較水煎劑更為便利。
[Abstract]:Objective: On the basis of routine treatment, observe the short-term curative effect of treating CKD4-5, compare the difference between the curative effect of urine-clearing enema and the enema of Tongfu, and follow up the situation of dialysis in each group during the half-year follow-up. Methods: (1) Literature research: search of EMbase, PubMed, CNKI, VIP, Wanfang, sinoMed database, and included urotoxin cleaning enema for CKD in randomized controlled trial. After the procedure of evaluating the quality and so on, the RevMan 5.2 software was used to analyze the total effective rate of the two groups after treatment and the level of Scr. 044. (2) Clinical study: From 2015. 4 to 2016. 2, there were 115 cases of renal internal medicine in Jiangsu Province, including 115 cases of CKD4-5 hospitalized patients, 39 cases of urine toxicity clear group, 39 cases of traditional Chinese medicine group and 37 cases of control group. The control group only adopted the western medicine basis and TCM syndrome differentiation treatment. On the basis of the control group, urine toxicity clear granule enema treatment was applied, and the traditional Chinese medicine group was used to treat the three groups of diseases before and after treatment, the laboratory indexes, the syndrome of TCM syndrome and symptoms and the change of adverse reactions on the basis of the control group. The patients were followed up for half a year for dialysis. Results: (1) Literature study: The total effective rate after treatment was higher than that of blank control group (OR = 3.30, 95% CI (1.81, 6.03), P = 0. 0005, I2 = 0%]. MD =-40. 03, 95% CI (-64. 55, -15. 50), P = 0. 005, I2 = 82% (compared with blank control group); MD =-66. 74, 95% CI (-101. 47. 04, -32. 01), P = 0. 0002, I2 = 17% (compared with Aixt group)];[mu: MD =-1.99, 95% CI (-3.33,-0.065), P = 0.00004, I2 = 88% (compared with blank control group); MD =-5.35, 95% CI (-6. 45, -4. 25), P = 0. 0001, I2 = 0% (compared to the Group of Love)]. (2) Clinical study: The total effective rate of post-treatment disease was higher than that in the control group (P0.05). There was no statistical significance (P0.05). Compared with the control group, there was no statistical significance (P0.05). Compared with the control group, the difference was statistically significant (P0.05). Compared with the traditional Chinese medicine group, the difference was statistically significant (P0.05). Compared with the control group, the difference was statistically significant (P0.05). The common adverse reactions in the traditional Chinese medicine group were mild diarrhea, abdominal pain, and no adverse reactions such as hematochezia, nausea and vomiting. Conclusion: (1) The short-range application has the effects of invigorating qi, invigorating spleen, clearing away the turbid, promoting blood circulation and removing blood stasis, helping to remove uremic toxin, stabilizing renal function, and the short-term curative effect is 70.8%, which is comparable to that of Tongfu, but can not delay the time for patients with intermediate and advanced CKD to enter dialysis. (2) Urease-clearing enema can improve the symptoms of asthenia, soreness of waist and knees, anorexia, dizziness, nausea and vomiting, etc. (3) Fuqing is a kind of granule for clinical application for many years. It is more convenient to use water decoction in enema therapy.
【學(xué)位授予單位】：南京中醫(yī)藥大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2016
【分類(lèi)號(hào)】：R277.5

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