择时艾灸联合保肾汤应用于慢性肾衰临床观察.docVIP

择时艾灸联合保肾汤应用于慢性肾衰的临床观察 　　[摘要]目的 观察择时艾灸联合保肾汤对慢性肾衰患者的临床疗效。方法 选择2014年10月～2015年6月我院肾病科的48例慢性肾衰（脾肾阳虚证）患者，按随机数字表法分成对照组22例和治疗组26例。两组患者均予西医基础治疗，治疗组加用保肾汤和择时艾灸治疗：保肾汤方剂为大黄10 g、黄芪30 g、丹参20 g、枳实10 g，在巳时（9：00～11：00）和酉时（17：00-19：00）各灸悬枢、命门、双足三里、双肾俞、双脾俞一次，每穴灸5 min。治疗30 d后比较两组患者的尿蛋白、肌酐改善水平和疗效。结果 治疗组24 h尿蛋白、血肌酐水平均优于对照组（P?0.05），治疗组总有效率为88.46%，高于对照组的50.00%，差异有统计学意义（P?0.05）。结论 择时艾灸联合保肾汤可保肾护肾、延缓肾脏功能 [关键词]艾灸；保肾汤；慢性肾功能衰竭；子午流注 [中图分类号] R259 [文献标识码] A [文章编号] 1674-4721（2016）10（b）-0126-03 [Abstract]Objective To observe the clinical effects of timing of moxibustion combined with kidney preserving decoction in patients with chronic renal failure.Methods 48 patients with chronic renal failure （yang deficiency of spleen and kidney） in nephrology department of our hospital from October 2014 to June 2015 were selected and divided into control group （n=22） and treatment group （n=26） by random number table.Pateints in two groups were treated with Western medicine as basic treatment，patients in treatment group were added Baoshen Decoction and timing of moxibustion.The prescription of Baoshen Decoction included Chinese rhubarb 10 g，Astragalus membranaceus 30 g，Salvia miltiorrhiza 20 g and Zhishi 10 g.At the time of 9：00-11：00 and 17：00-19：00，Xuanshu，Mingmen，double Zusanli，double Shenshu and double Pishu were cauterized respectively and every moxibustion with 5 minutes.After treatment for 30 days，the improvement level of urine protein and creatinine and effects of two groups were compared.Results The level 24 h urine protein and serum creatinine in treatment group were better than those in control group （P0.05），具有可比性 1.2诊断标准 1.2.1西医诊断标准 参照《肾脏病学（3版）》[1]及美国肾脏基金会2002年制订的K/DOQI“慢性肾脏病临床实践指南”[2]。肾功能不全失代偿期：内生肌酐清除率（CCr）20～50 ml/min，血肌酐（SCr）186～442 μmol/L。 　　1.2.2中医诊断标准 参照中华人民共和国国家标准《中医临床诊疗术语疾病部分》（GB/T16751.1-1997）[3]。脾肾阳虚证的主症：畏寒肢冷，倦怠乏力，气短懒言，食少纳呆，腰膝酸软；次症：腰部冷痛，脘腹胀满，大便烂，夜尿清长，舌淡有齿印，脉沉弱 1.3排除标准 ①不符合上述标准者；②合并感染者；③电解质或凝血功能紊乱者；④合并其他严重疾病者，如恶性肿瘤、重度营养不良等；⑤妊娠期或哺乳期妇女，过敏体质及对本研究所用药品过敏的患者；⑥血压控制不理想者；⑦依从性差，不能配合治