【作者】 蔡远薇；

【导师】 罗月中；

【作者基本信息】 广州中医药大学 ， 中医内科学， 2006， 硕士

【摘要】 目的:(1)总结中西医对慢性肾功能衰竭的认识及现代研究进展;(2)观察通腑泄浊,健脾补肾法治疗慢性肾功能衰竭的临床疗效。 方法:(1)文献研究:通过查阅古代和现代中、西医国内外文献,总结近十年慢性肾功能衰竭的中西医发病机制和防治措施研究现状。(2)临床研究:用前瞻性自身前后对照的研究方法,观察中医药治疗40例慢性肾功能衰竭患者。在基本治疗的基础上给予通腑泄浊兼健脾补肾之中药汤剂,并随证加减。观察患者的主要症状、症候(腰膝酸软、疲乏无力、口燥咽干、五心烦热、浮肿、畏寒喜暖、头晕目眩、潮热盗汗、肢冷、夜尿清长、急躁易怒、胸胁胀满、口苦咽干、口唇色暗、身有瘀斑、眼圈发暗、肌肤甲错等)以及实验指标Scr、Bun,连续观察4个月。 结果:(1)文献研究:慢性肾衰是各种肾脏疾病发展的终末阶段,在中医无一个特定的病名,但可在“关格”、“溺毒”、“水肿”、“虚劳”、“癃闭”等篇中找到类似记载。“脾肾衰败致浊邪壅塞三焦”高度概括了本病的基本病机。近年来中医对慢性肾功能衰竭的治疗取得了较大进展,其主要治疗方法包括:活血祛瘀法、健脾益肾法、祛湿化浊法等,也有经验方及单味药物的治疗。中医中药对慢性肾功能衰竭起效的主要机制为:1.通过缓解残余肾单位的高代谢状态以及改善血液流变学状态从而抑制肾小球硬化和间质纤维化。2.改善脂质代谢。3.改善全身营养状态,提高机体免疫力。4.减少尿蛋白。西医治疗慢性肾功能衰竭的非透析疗法主要为口服肠道吸附物,特殊药物的应用如前列腺素、阿魏酸钠、酮酸制剂,以及控制高血压等对症治疗。(2)临床研究:40例患者治疗前后比较,显效的占40%,有效占52.5%,总有效率为92.5%。治疗前症状积分26.58±10.83,治疗后症状积分17.75±12.37,前后症状积分比较有显著性差异(P<0.01)。SCr较治疗前下降70.07±23.23umol/L,P值<0.05;BUN较治疗前下降3.05±0.90mmol/L,P值<0.05。 结论:1.慢性肾功能衰竭是各种肾脏疾病发展的终末阶段,总的来说“脾肾衰败致浊邪壅塞三焦”是本病的基本病机,中医中药治疗在非透析疗法治疗慢性肾功能衰竭方面占有优势。以通腑泄浊兼健脾益肾法这种补泄相结合的方法治疗慢性肾功能衰竭,符合中医辨证论治的基本理论。具有良好的研究及临床应用前景。 2.通腑泄浊兼健脾益肾法治疗慢性肾功能衰竭临床取得了一定的疗效,可在一定程度上降低尿素氮及血肌酐,并能较明显的改善患者的临床症状,延缓慢性肾功能衰竭的进程。更多还原

【Abstract】 Objective:(1)To summary TCM and Modern Medicine in recognizing chronic renal failure and research progression. (2)To observe the release excessive turbid and invigorate the spleen 、 tonifying the kidney on treatment of Chronic Renal Failure (CRF) . Methods:(1)The literature research: To summary and evaluate the pathogenesy and prevention and cure SQ of CRF thought referring to packs of Chinese and foreign literature from ancient times and modern times.(2) Clinical research: To observe 40 cases of CRF patient thought the method of prospective self AP comparison. To observe the release excessive turbid and invigorate the spleen 、 tonifying the kidney on treatment of Chronic Renal Failure (CRF) in the foundation of essential treatment, adjusting the Chinese medicinal materials from the change of the syndrome.. To observe the present symptoms and syndrome (asthenia of lumbar and knees, fatigued and weak, drying of the mesopharynx , burning sensation of five centers, puffiness, chilly and calefactionphile, dizziness and dizzy, hectic fever and night sweat, algor of limbs, multitude of nycturia, restless and tantrum, fullness in chest and hypochondrium, bitter taste of mouth, glooming of labia oris, ecchymosis of body, obfuscation of eye ring, squamous and dry skin) and the experimentation index of Scr and Bun in 4 months. Result: (1)The literature research:CRF is the eventually gr of variouskindsof kidney diseases and hasn’ t a specified name in TCM. But it’ smentioned in the record of such as "Guange" , "Nidu" , "Shuizhong", "Xulao", " Longbi" .The decline of kidney and spleen makes the triple warmer bunged with turbid pathogen" is the basic pathogenesis of CRF. Recent years Traditional Chinese Medicine has made a big progress in treating CRF. Its major treatment is including promoting blood flow and removing blood stasis, invigorate the spleen and tonifying kidney, dispelling dampness and turbid. There are other treatments such as empirical formula and single Chinese medicinal materials. The major mechanisms in treating CRF with Chinese medicinal materials is : l.To relieve the hypermetabolism condition of the remained nephron and improve the hemorrheology condition. As a result to restraint the glomerular sclerosis and interstitial fibrosis;2.To improve the metabolism of fatty substance;3. To improve the sys. Nutritional status and elevate the immunity;4. To decrease the Urine protein. Modern Medicine in treating CRF is peroral intestinal tract adsorbate. And especially drug such as prostaglandin, sodium ferulate, oxoacid preparation and symptomatic treatment like controlling hypertension. (2) Clinical research: To compare the 40 cases of CRF from pretherapy to post-treatment. The result is 40% excellence, 52. 5% utility and the total effective rate is 92. 5%. The complaint integrate in pretherapy is 26.58 + 10.83 while in post-treatment is 17.75 ± 12.37(P<0. OD.SCr decrease 70.07 ± 23.23umol/L comparing to pretherapy(P<0.05). BUN decrease 3.05 ± 0.90 mmol/L comparing to pretherapy(P<0. 05).Conclusion: CRF is the eventually gr of various kinds of kidney diseases and " the decline of kidney and spleen makes the triple warmer bunged with turbid pathogen" is the basic pathogenesis of CRF. TCM is ascenden in treating CRF with indialysis regimen. The release excessive turbid and invigorate the spleen > tonifying the kidney on treatment of Chronic Renal Failure (CRF) is consistent with TCM determination of treatment based in pathogenesis obtained through differentiation of symptoms and signs basic theory. And it has favourable research perspective.2. The release excessive turbid and invigorate the spleen > tonifying the kidney on treatment of Chronic Renal Failure (CRF) has invariably therapeutic effect. And it can depress urea nitrogen and serum creatinine. And it can improve the patients’ clinical symptom. It can also delay the proceeding ofCRF.更多还原