加味桂枝茯苓丸治疗带隧道和涤纶套的透析导管功能不良肾虚血瘀证  

Modified Guizhi Fuling Pill in Treating Tunnel Cuffed Catheter Malfunction with Kidney Deficiency and Blood Stasis Syndrome

作　　者：苗少博 刘浩飞[1] 冯睿[1] 刘玲玉 李俊 陈影[1] 马继伟[1,3] MIAO Shaobo;LIU Haofei;FENG Rui;LIU Lingyu;LI Jun;CHEN Ying;MA Jiwei(Nephrology Department Zone Two,the First Affiliated Hospital to Henan University of Chinese Medicine,Zhengzhou Henan China 450000;Zhumadian Hospital of Traditional Chinese Medicine,Zhumadian Henan China 463000;The First Clinical Medical College of Henan University of Chinese Medicine,Zhengzhou Henan China 450000)

机构地区：[1]河南中医药大学第一附属医院肾病科二区,河南郑州450000 [2]驻马店市中医院,河南驻马店463000 [3]河南中医药大学第一临床医学院,河南郑州450000

出　　处：《中医学报》2024年第10期2239-2245,共7页Acta Chinese Medicine

基　　金：河南省中医药科学研究专项课题项目(2023ZXZX1020)。

摘　　要：目的:观察加味桂枝茯苓丸治疗肾虚血瘀型带隧道和涤纶套的透析导管(tunnel cuffed catheter,TCC)功能不良患者的临床疗效及安全性。方法:52例肾虚血瘀型TCC功能不良患者随机平均分为试验组和对照组各26例。对照组发生导管功能不良时给予常规尿激酶溶栓治疗,试验组在此基础上口服加味桂枝茯苓丸(颗粒剂),两组均治疗8周。治疗后,比较两组患者临床疗效,导管功能不良发生率,血红蛋白(hemoglobin,HB)、血小板计数(platelet,PLT)、白蛋白(albumin,ALB)、总胆固醇(total cholesterol,TC)、三酰甘油(triglyceride,TG)、血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)水平,凝血功能,中医证候积分及不良反应发生情况。结果:(1)试验组与对照组有效率分别为91.33%、66.83%,试验组有效率高于对照组(P<0.05)。(2)治疗后,两组导管功能不良发生率分别为36.67%、52.67%,试验组发生率低于对照组(P<0.05);且试验组治疗8周后导管功能不良发生率(25.33%)低于4周后(36.67%)(P<0.05)。(3)治疗后,试验组BUN(14.07±3.31)mmol·L^(-1)、Scr(431.85±111.89)μmmol·L^(-1)、TC(3.52±0.89)mmol·L^(-1)低于同期对照组(P<0.05),且低于治疗前(P<0.05)。(4)治疗后,试验组Hb(119.48±21.48)g·L^(-1)高于同期对照组(P<0.05);治疗后,两组PLT及凝血功能各指标比较,差异无统计学意义(P>0.05)。(5)治疗后,试验组中医证候积分为(14.00±3.71)分,显著低于同期对照组(P<0.01),且试验组中医证候有效率高于对照组(P<0.01)。(6)安全性评价:两组患者均无不良事件发生。结论:加味桂枝茯苓丸可降低肾虚血瘀型TCC功能不良的发生率,提高临床有效率,减少体内毒素的积累,改善血液黏滞状态,缓解血液高凝,减轻毒素对红细胞的影响,提高导管功能不良患者透析时长,减少导管完全堵塞率,且有较好的安全性。Objective:To observe the clinical efficacy and safety of Jiawei Guizhi Poria Cocos Pill in the treatment of patients with renal deficiency and blood stasis type with tunnel cuffed catheter(TCC)dysfunction.Methods:A total of 52 patients with TCC dysfunction of Kidney deficiency and blood stasis syndrome were randomly divided into the experimental group and the control group,with 26 cases in each group.The control group was given conventional urokinase thrombolytic therapy when catheter dysfunction occurred,and the experimental group was treated orally with Jiawei Guizhi Fuling Pill(granules)for 8 weeks.After treatment,the clinical efficacy,incidence of catheter dysfunction,hemoglobin(HB),platelets(PLT),albumin(ALB),total cholesterol(TC),triglyceride(TG),serum creatinine(Scr)and blood urea nitrogen(blood)were compared between the two groups blood urea nitrogen(BUN)level,coagulation function,TCM syndrome score and occurrence of adverse reactions.Results:(1)The effective rates of the experimental group and the control group were 91.33%and 66.83%,respectively,and the effective rates of the experimental group were significantly higher than those of the control group(P<0.05).(2)The incidence of catheter dysfunction in the two groups was 36.67%and 52.67%after treatment,respectively,and the incidence rate of catheter dysfunction in the experimental group was significantly lower than that in the control group(P<0.05),and the incidence of catheter dysfunction in the experimental group after 8 weeks of treatment(25.33%)was significantly lower than that after 4 weeks(36.67%)(P<0.05).(3)After treatment,the experimental group had a BUN(14.07±3.31)mmol·L^(-1),Scr(431.85±111.89)μmmol·L^(-1),TC(3.52±0.89)mmol·L^(-1) was significantly lower than that of the control group(P<0.05)and significantly lower than that before treatment(P<0.05).(4)Hb(119.48±21.48)g·L^(-1) in the experimental group after treatment·L^(-1) was significantly higher than that of the control group(P<0.05),and there was no significant;there was no signif

关 键 词：透析导管功能不良 加味桂枝茯苓丸 血液透析 肾虚血瘀证 

分 类 号：R277.592.5[医药卫生—中医学]