自拟参芪地黄汤治疗终末期肾病维持性血液透析患者顽固性透析相关性低血压的临床研究  

Clinical Effect of Self-designed Shenqi Dihuang Decoction on Refractory Intradialytic Hypotension in Patients Undergoing Maintenance Hemodialysis for End-Stage Renal Disease

作　　者：杨永超[1] 孙晨[1] 冯颖 孔琳[1] 王春丽[1] YANG Yong-chao;SUN Chen;FENG Ying;KONG Lin;WANG Chun-li(Department of Nephrology,Baoji Hospital of Traditional Chinese Medicine,Baoji Shaanxi 721001)

机构地区：[1]陕西省宝鸡市中医医院肾内科,陕西宝鸡721001

出　　处：《世界中西医结合杂志》2024年第11期2198-2202,2207,共6页World Journal of Integrated Traditional and Western Medicine

基　　金：陕西省科技厅资助项目(2023-YBSF-512)。

摘　　要：目的观察自拟参芪地黄汤治疗终末期肾病接受维持性血液透析(Maintenance hemodialysis,MHD)患者顽固性透析相关性低血压(Intradialytic hypotension,IDH)的临床疗效。方法选取2022年1月—2023年10月期间于陕西省宝鸡市中医医院实施MHD过程中出现顽固性IDH的终末期肾病患者81例,按随机数字表法分为观察组40例和对照组41例。对照组接受常规西医干预,观察组在对照组基础上给予自拟参芪地黄汤干预。治疗8周后,观察比较两组患者临床疗效,治疗前后中医证候积分、血压指标[收缩压(Systolic blood pressure,SBP)、舒张压(Diastolic blood pressure,DBP)、动脉压(Mean arterial pressure,MAP)]、统计两组患者透析期间IDH、肌肉痉挛、提前终止透析和透析后直接起床的比例;并评估两组患者透析充分性。结果治疗后观察组临床总有效率90.00%(36/40)明显高于对照组的68.29%(29/41),差异有统计学意义(P<0.05)。治疗后两组患者中医证候评分均较治疗前降低,差异有统计学意义(P<0.05);且观察组中医证候评分较对照组明显降低,差异有统计学意义(P<0.05)。治疗前两组患者透析前、透析中SBP、DBP和MAP水平比较,差异无统计学意义(P>0.05)。治疗前两组患者透析中SBP、DBP和MAP水平均较透析前下降,差异有统计学意义(P<0.05)。治疗后观察组透析中SBP、DBP和MAP水平均高于治疗前同期水平,差异有统计学意义(P<0.05);且观察组明显高于对照组同期水平,差异有统计学意义(P<0.05)。治疗后观察组IDH、肌肉痉挛、提前终止透析发生率均低于对照组,透析后直接起床的比例高于对照组,差异有统计学意义(P<0.05)。治疗后两组患者Kt/V、URR、超滤量指标均较治疗前升高,差异有统计学意义(P<0.05);且观察组Kt/V、URR、超滤量指标均较对照组明显升高,差异有统计学意义(P<0.05)。结论自拟参芪地黄汤可显著降低终末期肾病维持性血液透析患者顽固�Objective To observe the clinical efficacy of Shenqi Dihuang Decoction in the treatment of refractory intradialytic hypotension(IDH)in the patients undergoing maintenance hemodialysis for end-stage renal disease.Methods A total of 81 patients with end-stage renal disease who were prone to refractory IDH during maintenance hemodialysis in Baoji Hospital of Traditional Chinese Medicine from January 2022 to October 2023 were assigned with the random number table method into a control group(n=41)and an observation group(n=40).The control group received conventional Western medicine intervention,and the observation group was treatment with self-designed Shenqi Dihuang Decoction on the basis of the therapy in the control group.After 8 weeks of treatment,the clinical efficacy was compared between the two groups.The TCM symptom score and blood pressure indicators[systolic blood pressure(SBP),diastolic blood pressure(DBP),and mean arterial pressure(MAP)]were determined before and after treatment.The proportions of IDH,muscle cramps,early termination of dialysis,and getting up directly after dialysis in the two groups were statistically analyzed.The adequacy of dialysis in both groups was assessed.Results The total response rate in the observation group was 90.00%(36/40),which was higher than that(68.29%,29/41)in the control group(P<0.05).After treatment,the TCM symptom score declined in both groups(P<0.05),and the score in the observation group was lower than that in the control group(P<0.05).There was no statistically significant difference(P>0.05)in the SBP,DBP,and MAP between the two groups before and during dialysis.Before treatment,the SBP,DBP,and MAP during dialysis in both groups were lower than those before dialysis(P<0.05).After treatment,the SBP,DBP,and MAP during dialysis in the observation group were higher than those in the same period before treatment and also higher than those in the control group(P<0.05).The observation group had lower proportions of IDH,muscle cramps,and early termination of dialysis and

关 键 词：参芪地黄汤 终末期肾病 维持性血液透析 透析相关性低血压 气阴两虚证 左卡尼汀 

分 类 号：R692[医药卫生—泌尿科学] R459.5[医药卫生—外科学]