基于中医辨证分型探讨终末期肾病患者透析前后精神状态变化  

Discussion on the changes of mental state of ESRD patients before and after hemodialysis based on syndrome differentiation of traditional Chinese medicine

作　　者：周胜元[1] 刘玥[2] 侯长青[1] 孟祥震[1] 杨洪涛[3] ZHOU Sheng-yuan;LIU Yue;HOU Chang-qing;MENG Xiang-zhen;YANG Hong-tao(Department of Nephrology and Rheumatology,The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300250,China;Tianjin People's Hospital,Tianjin 300121,China;Department of Nephrology,The First Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300381,China)

机构地区：[1]天津中医药大学第二附属医院肾病风湿科,天津300250 [2]天津市人民医院,天津300121 [3]天津中医药大学第一附属医院肾病科,天津300381

出　　处：《中华中医药杂志》2020年第9期4746-4749,共4页China Journal of Traditional Chinese Medicine and Pharmacy

基　　金：国家自然科学基金项目(No.81774065)。

摘　　要：目的:调查终末期肾病(ESRD)患者透析前后焦虑及抑郁状态的变化,为给予ESRD透析患者早期配合心理干预,良好的宣教提供理论基础,并为临床治疗提供客观依据。方法:采集2012年10月至2016年10月在天津中医药大学第一及第二附属医院透析中心最新确诊ESRD并行维持性血液透析治疗的患者201例,将虚证分为脾肾气虚证、脾肾阳虚证、肝肾阴虚证、阴阳两虚证、气阴两虚证;实证分为水湿证、湿热证、风动证、血瘀证,检测肾功能,用SAS及PHQ-9量表采集患者的焦虑及抑郁评分,分析透析前后评分的变化。结果:ESRD患者透析后SAS及PHQ-9评分均较透析前降低,SAS评分除了脾肾阳虚组以外,PHQ-9评分除了脾肾气虚以外,其余各组透析后较透析前均显著降低(P<0.05,P<0.01)。结论:ESRD维持性血液透析患者大多存在抑郁状态,并有焦虑的趋势,血液透析能够缓解ESRD患者的焦虑及抑郁情绪,但应该在早期即给予心理疏导,并在辨证分型治疗疾病的基础上加用疏肝解郁药物以提高治疗效果。Objective:To investigate the changes of anxiety and depression state in patients with end-stage renal disease(ESRD)before and after dialysis,and then provide theoretical basis for giving ESRD dialysis patients early psychological intervention,disease propaganda and education,as well as clinical treatment.Methods:A total of 201 ESRD patients who underwent hemodialysis and were willing to cooperate were selected from October 2012 to October 2016 at the First and Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine.A total of 201 cases of patients were divided into different study groups:The deficiency syndromes were divided into qi deficiency of spleen and kidney,yang deficiency of spleen and kidney,yin deficiency of liver and kidney,liver-kidney yin deficiency syndrome,deficiency of both yin and yang,and deficiency of both qi and yin syndrome.The excessive syndromes were divided into dampness syndrome,dampness-heat syndrome,moving wind syndrome and blood stasis syndrome.At the same time,renal functions were measured.The patients were evaluated by Patien Health Questionnare-9(PHQ-9)and Self-Rating Anxiety Scale(SAS)and the changes of anxiety and depression scores before and after dialysis were analyzed.Results:The scores of SAS and PHQ-9 in ESRD hemodialysis patients were lower than those before dialysis whether in the deficiency group or in the excessive group.With the exception of the SAS score in yang deficiency of spleen and kidney group,the PHQ-9 score in qi deficiency of spleen and kidney,the SAS and PHQ-9 score in each group were significantly lower after dialysis than those before dialysis(P<0.05,P<0.01).Conclusion:Most patients with ESRD hemodialysis have depressive state,and there is a tendency to form anxiety.Hemodialysis can relieve anxiety and depression in ESRD patients,but we should give them psychological guidance in the early stages of the disease,and add drugs of dispersing stagnated liver qi for relieving qi stagnation in order to improve the treatment effect based on

关 键 词：终末期肾病 中医辨证分型 SAS评分 PHQ-9评分 血液透析 

分 类 号：R277.5[医药卫生—中医学]