中药保留灌肠辅助治疗慢性肾衰竭效果观察

目的观察中药保留灌肠辅助治疗慢性肾衰竭的效果.方法将91例慢性肾衰竭患者随机分为观察组(55例)及对照组(36例).对照组采用常规口服中药治疗,观察组在此基础上加用中药保留灌肠治疗.结果观察组治疗后症状评分及血肌酐、尿素氮显著低于对照组(均P＜0.05),总有效率显著高于对照组(P＜0.01).结论中药保留灌肠辅助治疗有利于排出体内毒素,能提高慢性肾衰竭患者的疗效.     

中药保留灌肠辅助治疗慢性肾衰竭效果观察

目的观察中药保留灌肠辅助治疗慢性肾衰竭的效果。方法将91例慢性肾衰竭患者随机分为观察组（55例）及对照组（36例）。对照组采用常规口服中药治疗，观察组在此基础上加用中药保留灌肠治疗。结果观察组治疗后症状评分及血肌酐、尿素氮显著低于对照组（均P〈0．05），总有效率显著高于对照组（P〈0．01）。结论中药保留灌肠辅助治疗有利于排出体内毒素，能提高慢性肾衰竭患者的疗效。     

尿毒清、爱西特、析清保留灌肠治疗慢性肾衰竭的疗效观察

目的：观察尿毒清、析清、爱西特保留灌肠治疗慢性肾衰竭的临床疗效。方法：将287例慢性肾衰竭患者随机分成4组,即：对照组、尿毒清组、爱西特组、析清组,疗程30 d,观察全部患者治疗前后血肌酐、尿素氮、24 h尿蛋白定量的水平。结果：尿毒清组肌酐、尿素氮、尿蛋白水平较治疗前均明显下降（P〈0.05）,与其他各组比较差异均有统计学意义（P〈0.05）;爱西特组与析清组,肌酐、尿素氮水平明显下降（P〈0.05）,与对照组比较差异有统计学意义（P〈0.05）。结论：灌肠治疗慢性肾衰竭疗效肯定,与析清、爱西特相比,尿毒清灌肠具有独特的优势。     

中药保留灌肠治疗慢性溃疡性结肠炎的疗效观察

目的 探讨中药清热解毒汤保留灌肠治疗慢性溃疡性结肠炎患者的疗效.方法 将96例慢性溃疡性结肠炎患者随机分为观察组(48例),对照组(48例).观察组予以中药清热解毒汤保留灌肠治疗;对照组予以西药保留灌肠治疗.对比两组患者的疗效差异及临床症状平均改善所需时间.结果 观察组在疗效方面明显优于对照组,差异有统计学意义(P＜0.05);观察组临床症状平均改善所需时间明显短于对照组,差异有统计学意义(P ＜0.05).结论 中药清热解毒汤保留灌肠治疗对于慢性溃疡性结肠炎疗效显著、起效快、操作简便,值得临床推广应用.     

中药口服及灌肠治疗慢性肾衰竭临床观察

目的观察中药。肾衰合剂口服、清热解毒灌肠液保留灌肠对慢性肾衰竭患者。肾功能的影响。方法87例慢性。肾衰竭患者,按照。肾功能分层及就诊顺序分为治疗组和对照组。对照组口服爱西特片5～8片,百令胶囊5粒或者金水宝3～6粒,每日3次;治疗组给予。肾衰合剂50ml口服,每日两次,同时给予清热解毒灌肠液保留灌肠,每次100ml,每日1次。两组疗程均为1个月。观察治疗前后患者。肾功能、血浆蛋白、血钙和血磷的变化。结果两组治疗后。肾功能均有显著改善,但是治疗组血肌酐和尿素氮明显低于对照组,治疗组血浆白蛋白上升、血磷下降、血钙恢复正常。结论。肾衰合剂口服,同时给予清热解毒灌肠液保留灌肠可以改善慢性肾衰竭患者。肾功能,血浆白蛋白上升、血磷下降、血钙上升。     

肾七方加大黄灌肠汤联合治疗慢性肾衰竭疗效观察

目的:探讨慢性肾衰竭(CRF)的有效治疗措施.方法:将96例CRF患者随机分为两组.治疗组54例,对照组42例.治疗组在一般治疗(优质低蛋白、低磷饮食及对症治疗)基础上配合口服自拟肾七方及中药大黄灌肠汤保留灌肠,14 d为1疗程,连续2个疗程后观察疗效.对照组为一般治疗.两组均加用及静脉滴注黄芪注射液和川芎嗪注射液.观察对比治疗前后临床症状血肌酐(Scr)、尿素氮(BUN)、血红蛋白(Hb)的变化.结果:治疗组总有效率81.48%,显著优于对照组54.76%.结论:肾七方加大黄灌肠联合治疗CRF疗效明显,能保护肾功能,延缓肾衰竭的发展.     

肾衰康胶囊联合中药保留灌肠治疗慢性肾衰竭效果观察

目的观察肾衰康胶囊口服联合中药保留灌肠治疗慢性肾衰竭的临床疗效。方法按入院顺序将118例慢性肾衰竭患者分为对照组58例,观察组60例。两组均予以常规对症治疗并口服肾衰康胶囊,观察组在此基础上采用中药保留灌肠。治疗1个周期评价效果。结果观察组治疗效果显著优于对照组(P0.01)。结论肾衰康胶囊口服联合中药保留灌肠可显著提高慢性肾衰竭的治疗效果;严谨的疗效观察及适时护理可保障治疗顺利进行。     

辨证分型应用中药结肠透析治疗慢性肾衰竭早中期32例疗效观察

目的：探讨辨证分型应用中药结肠透析对慢性肾衰竭（CRF）早中期患者疗效的影响.方法：选择慢性肾衰竭早中期患者（血肌酐707 μmol/L以下）63例,治疗组32例,对照组31例.治疗组采用电子结肠透析机进行辨证分型中药结肠透析,对照组采用辨证分型传统中药灌肠方法.观察患者治疗前后症状以及肾功能改善情况.结果：症状积分比较显示治疗组效果优于对照组;肾功能比较显示治疗组尿素氮、肌酐、尿酸均较治疗前明显下降,而对照组尿素氮、尿酸下降不明显;临床疗效比较显示治疗组总有效率90.6％,对照组总有效率70.9％,差异有统计学意义.结论：辨证分型应用中药结肠透析治疗慢性肾衰竭早、中期疗效明显.     

肠道清洗、结肠透析联合尿毒清颗粒灌肠治疗慢性肾衰竭

目的：观察肠道清洗、结肠透析联合尿毒清颗粒灌肠治疗慢性肾衰竭（CRF）的临床疗效。方法：将68例CRF患者随机分两组,对照组给予优质低蛋白饮食和对症支持治疗,治疗组在对照组治疗基础上加用肠道清洗、结肠透析联合尿毒清颗粒灌肠,疗程均为2个月;每半月测血肌酐（Scr）、尿素氮（BUN）及内生肌酐清除率（Ccr）,观察两组治疗前后肾功能变化。结果：治疗组在用药前后肾功能变化均值与对照组同期相比有统计学差异。结论：肠道清洗、结肠透析联合尿毒清颗粒灌肠可作为CRF患者延缓肾衰进展的一种有效治疗手段。     

中药结肠透析对慢性肾衰竭的影响

目的：探讨中药辨证处方结肠透析对慢性肾衰竭毒素清除及肾脏保护作用。方法：将60例慢性肾衰竭患者随机分为治疗组30例、对照组30例,两组患者在基础治疗的同时,治疗组采用结肠透析机中药辨证结肠透析治疗,对照组采用中药辨证人工中药保留灌肠治疗。观察两组治疗前后尿素氮、肌酐、血尿酸、电解质、iPTH水平的变化;同时观察其临床症状改善情况。结果：治疗组总有效率为93.33%,对照组总有效率为80.50%,治疗组明显优于对照组（P〈0.05）;其中对Scr、Ccr、UA的改善,降低患者血清iPTH的浓度,治疗组亦优于对照组（P〈0.05）。结论：用结肠透析机中药辨证治疗对慢性肾衰竭患者具有清除毒素及延缓肾功能进展作用,且疗效优于人工中药保留灌肠法。     

扶正降浊方改善慢性肾衰竭患者营养不良的临床观察

目的观察扶正降浊方（又称肾病2号方）改善慢性肾衰竭患者营养不良和肾功能的临床疗效。方法将96例慢性肾衰竭患者随机分为扶正降浊方组（治疗组）49例和尿毒清颗粒组（对照组）47例。分别采用在基础治疗的基础上加汤剂或颗粒。观察两组治疗前后的改良SGA评分、血清前白蛋白（PA）、血清白蛋白（Alb）、血红蛋白（Hb）、24h尿蛋白定量、血肌酐（Scr）及尿素氮（BUN）等指标。结果治疗组治疗后改良SGA评分、PA、Alb、Hb较治疗前明显升高,Scr明显下降,（P〈0．05）;治疗组治疗后与对照组治疗后比较,改良SGA评分、PA、Alb差异有统计学意义（P〈0．05）;治疗组与对照组中医证候疗效及中医症侯积分比较,均有统计学意义（P〈0．01）。结论扶正降浊方能有效改善慢性肾衰竭患者的营养不良,缓解临床症状,保护肾功能,延缓疾病进展。     

Fever in uremia: production of leukocytic pyrogen by chronic dialysis patients

Uremic patients frequently have low baseline temperatures and a blunted febrile response to infection. We investigated the first step in the generation of a febrile response, the production of leukocytic pyrogen (LP) by blood monocytes, in 12 patients on chronic hemodialysis, five patients on continuous ambulatory peritoneal dialysis (CAPD), and 17 control subjects. No significant differences were found in the amount of LP produced by hemodialysis patients, CAPD patients, and control subjects. Uremic serum did not decrease LP production by monocytes from control subjects. Hemodialysis patients who were consistently hypothermic (mean oral predialysis temperature less than or equal to 35.6 degrees F) produced as much LP as those with more normal oral temperatures (mean oral predialysis temperature greater than or equal to 36.8 degrees F). Decreased production of LP does not explain the blunted febrile response noted in patients with chronic renal failure.     

结肠透析联合尿毒清颗粒保留灌肠治疗慢性肾衰竭疗效的Meta分析

目的 评价结肠透析联合尿毒清颗粒保留灌肠治疗慢性肾衰竭疗效.方法 计算机检索Cochrane图书馆资料库、MEDLINE（美国国立医学图书馆）、EMbase（荷兰医学文摘数据库）、万方数据、中国知网（CNKI）、中国生物医学文献数据库（CBM）.同时手工检索结肠透析联合尿毒清颗粒保留灌肠治疗慢性肾衰竭疗效的随机对照试验,检索时限均为建库至2013年11月,并追溯纳入研究的参考文献.由两位研究者按照纳入与排除标准独立筛选文献、提取资料和评价质量后,采用RevMan 5.1软件进行Meta分析.结果 共纳入9篇文献.其中8篇文献质量评价为C级,1篇文献评为B级.Meta分析显示,慢性肾衰竭患者经过结肠透析联合尿毒清颗粒保留灌肠治疗后：①血肌酐水平明显降低,差异有统计学意义（MD=-122.28,95％ CI：-172.43～-72.14,P＜0.01）;②血尿素氮水平明显降低,差异有统计学意义（MD=-4.08,95％ CI：-5.88～-2.27,P＜0.01）;③肌酐清除率明显升高,差异有统计学意义（MD=-2.79,95％ CI：1.82～3.75,P＜0.01）.结论 结肠透析联合尿毒清颗粒保留灌肠治疗慢性肾衰竭疗效确切.但由于目前的临床研究质量总体偏低,尚需进行严格的、多中心的随机双盲对照实验研究进一步证实.     

虫草制剂联合复方α酮酸对腹膜透析患者微炎症状态的影响

目的探讨虫草制剂联合复方α酮酸治疗对维持性腹膜透析患者全身微炎症状态的影响。方法选择江苏省沭阳县人民医院肾内科和黑龙江省佳木斯大学附属第一临床医学院肾内科确诊慢性肾衰竭尿毒症期并行持续非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）治疗1个月以上的患者46例,随机分成对照组和治疗组,每组23例。对照组行CAPD治疗（CAPD治疗方案为：患者使用由美国百特公司生产的1．5％及2．5％腹膜透析液2L／袋,白天用1．5％腹膜透析液3袋,每袋留腹4h,夜间使用2．5％腹膜透析液1袋保留过夜约10h,第2天清晨放出）治疗;治疗组在CAPD治疗的同时给予虫草制剂与复方α酮酸口服,分别于治疗前及治疗后第3个月采用乳胶凝集反应法检测患者血清超敏C反应蛋白（hypersensitive C reaction protein,hs-CRP）、采用（enzyme-linked immunosorhent assay,ELISA）法测定肿瘤坏死因子a（tumornecrosisfactoralpha-α,TNF-α）和白细胞介素6（interleukin6,IL-6）水平,并比较2组之间的差异。结果治疗组治疗后第3个月时hs-CRP和IL-6较治疗前显著降低,差异有统计学意义（P〈0．05）。与对照组比较,对照组患者存在全身微炎症状态,血清hs-CRP、TNF-α、IL-6水平明显高于治疗组,差异有统计学意义（P〈0．05）。结论虫草制剂与复方α酮酸联合应用能减轻维持性腹膜透析患者的全身微炎症状态。     

Anemia of chronic renal failure: inhibition of erythropoiesis by uremic serum

The pathogenesis of anemia in patients with end-stage renal disease was studied by assessing the effect of uremic serum on the proliferation and maturation of erythroid progenitor cells, BFU-E and CFU-E, into colonies in vitro. Nucleated peripheral blood cells from 10 anemic patients produced normal or increased numbers of BFU-E colonies in response to added erythropoietin when cultured in control serum, but declined a mean of 63% when autologous uremic serum was substituted. Uremic sera from 90 patients cultured with normal human marrow produced a mean decrease in BFU-E colony growth of 72%, and of CFU-E colony growth of 82%, compared to control serum. Neither hemodialysis nor peritoneal dialysis was effective in removing the inhibitor. We conclude that patients with uremia have adequate circulating erythroid progenitors that respond to erythropoietin normally when removed from the uremic environment, and that uremic serum is toxic and inhibitory to erythropoiesis. This may be an important mechanism in the anemia of chronic renal failure.     

尿毒症脑病腹膜透析前后神经胶质纤维酸性蛋白变化与影像学评价

目的 通过检测腹膜透析前后血清神经胶质纤维酸性蛋白（glial fibrillary acidic potein,GFAP）水平的变化联合头颅磁共振（MRI）影像学比较评估腹膜透析治疗尿毒症脑病（uremic encephalopathy,UE）的疗效和预后.方法 将未进行过透析治疗的慢性肾功能衰竭（chronic renalfailure,CRF）患者按有无中枢神经系统异常分为UE组和尿毒症对照组,并选择来自同期门诊健康体检的人群作为健康对照组.UE组和尿毒症对照组在腹膜透析治疗前及治疗后1周、2周、4周分别测定血清GFAP水平和行头颅MRI检查.结果 治疗前,UE组血清GFAP水平高于尿毒症对照组和健康对照组（均P＜0.01）;UE组中检出MRI异常信号灶的患者占18/38（47.4％）,尿毒症对照组中检出MRI异常信号灶的患者占2/40（5％）,2组比较差异具有统计学意义（P＜0.01）.随着腹膜透析的进行,UE组血清GFAP水平逐渐下降,头颅MRI异常信号逐渐减轻.至治疗后4周,UE组血清GFAP水平基本降至正常水平,大部分患者中枢神经系统损害的症状完全消失,仅有5例患者遗留有轻度的认知功能减退,5例中其中4例（占10.5％）患者遗留有长T1长T2信号.结论 血清GFAP水平联合头颅MRI影像学比较可以作为临床上评估UE患者神经系统损害程度及透析治疗的疗效和预后的有效手段之一.     

爱西特灌肠联合口服治疗慢性肾功能衰竭疗效观察

目的 观察爱西特灌肠联合口服治疗慢件肾功能衰竭(CRF)的疗效.方法 70例CRF病人随机分为两组,对照组36例口服爱西特,治疗组34例爱西特灌肠联合口服治疗.观察治疗前后病人病情的改善情况,有无治疗中及治疗后的不适,治疗前后血尿素氮(BUN)、肌酐(Scr)、血尿酸(UA)及血红蛋白(Hb)、血清总蛋白(TP)、血清白蛋白(ALb)的变化.结果 治疗前后两组间的BUN、Scr、UA下降有显著性差异(p<0.05).结论 爱西特灌肠结合口服治疗慢性肾功能衰竭疗效显著,且优于单纯口服爱西特组.     

Vitamins and continuous ambulatory peritoneal dialysis (CAPD)

The authors assessed vitamin A, and its protein carriers vitamins C and E in serum and dialysis fluid of 10 patients with chronic renal failure during 6–12 months of continuous ambulatory peritoneal dialysis.Vitamin A and its protein carriers and serum vitamin E were elevated throughout the long-term investigation of continuous ambulatory peritoneal dialysis despite the fact that vitamin A and its protein carriers have a relatively great peritoneal transfer and loss into the dialysis fluid. The oral dose of 200 mg of vitamin C per day, despite the great peritoneal transfer and loss into the dialysis fluid, prevented the development of hypovitaminosis C. Assessment of vitamins B₁, B₂ and B₆ revealed that the supplementation with these vitamins is adequate for patients during continuous ambulatory peritoneal dialysis.     

Clinical outcomes and peritoneal histology in patients starting peritoneal dialysis are related to diabetic status and serum albumin levels

Peritoneal morphological changes seem to be related to dialysis solutions bioincompatibility and to infections, but the uremic milieu per se may also contribute to peritoneal changes. The influence of diabetes and diabetes-associated comorbidities on peritoneal histological changes in the pre-dialysis stage have been insufficiently studied. The aim of this study is to analyze the effect of diabetes and serum albumin levels on peritoneal histology and certain clinical variables such as peritoneal permeability, technique failure, and general mortality in patients starting peritoneal dialysis (PD) treatment. Eighteen PD patients without diabetes (uremic non-diabetic group, U-ND) and 65 with diabetes (uremic diabetic group, U-D) were studied prospectively. Clinical and biochemical variables were registered, and a parietal peritoneum biopsy was obtained at the time of the peritoneal catheter placement. Peritoneal histology was evaluated by light microscopy and immunohistochemistry. A control group of 15 non-uremic, non-diabetic (NU-ND) patients who underwent non-complicated elective abdominal surgery was also studied and used as control. The proportion of patients with peritoneal morphological changes as evaluated by light microscopy was higher in the two groups of uremic patients than in the control. The U-D group had higher mesothelial loss (40.9 vs 29.4%), higher mesothelial basement membrane thickening (45.5 vs 23.5%), higher proportion of vascular wall thickening/sclerosis (39.7 vs 11.1%), and higher proportion of inflammatory infiltrate (45.4 vs 23.6%) than the U-ND group. Uremic patients had lower density of mesothelial cells and higher density of inflammatory cells than the control, as evaluated by immunohistochemistry. These changes were even more striking in the U-D group than in the U-ND group. On the other hand, inflammatory infiltration to the peritoneum, mesothelial cell loss, and mesothelial basement membrane thickening were associated with higher technique failure and mortality. However, when the serum albumin level was introduced into the model, the aforementioned associations became nonsignificant. In conclusion, uremia and diabetes were associated with important peritoneal histological changes before starting PD treatment. Diabetes associated with uremia was more strongly related to the peritoneal changes than uremia per se. Hypoalbuminemia and peritoneal inflammatory infiltrate were markedly associated with technique failure and mortality in patients starting PD treatment.