中医药在腹膜透析中应用研究进展

<正>腹膜透析(peritoneal dialysis,PD)是终末期肾病(end stage renal disease,ESRD)患者常用的一种肾脏替代疗法。其基本原理是利用具有半透膜特性的腹膜作为透析膜,向腹腔内注入透析液,借助腹膜毛细血管内血浆与腹腔透析液之间的溶质浓度差和透析压梯度,通过扩散、渗透等原理,达到清除体内代谢废物及潴留水份,纠正水电解质、酸碱平衡紊乱的目的。持续非卧床腹膜透析(continu-CAPD)出现之后,PD取得了很大的进展,因其无须采用特殊的医疗设     

腹膜透析术后并发症发生的原因和预防

腹膜透析（PD）从1932年成功应用以来，已在临床应用70余年的时间，其原理是将腹膜透析液灌入腹腔，保留一段时间，使血液及周围组织的代谢废物通过弥散和超滤作用进入腹膜透析液，然后放出腹膜透析液，以清除机体废物、过多水分和补充有用物质。PD是利用人体自身结构达到血液净化的目的，具有方法简单、方便、所需费用少等优点，适合于家庭透析，尤其是在不发达的国家、地区，开展和推广PD具有实际临床应用价值。但由于各种原因也造成不同的并发症，现结合我们的资料和文献分析如下。     

含中药成分腹膜透析液的疗效及研究现状

腹膜透析(PD)尤其是连续不卧床腹膜透析(CAPD)，目前仍是治疗终末期肾脏病的有效措施。PD是利用人体自身透析膜(腹膜)作为半透膜，向腹腔内注入透析液，借助腹膜两侧的毛细血管内血浆与腹腔内透析液中的溶质浓度差和渗透压梯度，通过主动扩散和渗透，清除机体内的代谢废物和潴留的水分，以期达到清除毒素、超滤水分、纠正酸中毒和电解质紊乱的目的。然而，目前使用的PD液的生物不相容性，     

50例腹膜透析的护理体会

腹膜透析是利用人体腹膜作为半透膜，向腹腔内注入腹膜透析液，借助腹膜毛细血管内血浆及腹腔内透析液的溶质浓度和渗透压梯度差，通过弥散和渗透原理以清除机体代谢废物(包括尿素氮、肌酐、胍类等)和过多的水分，同时从腹透液中补充必要的电解质，从而达到清除毒素及多余水分，纠正酸中毒和电解质紊乱的治疗目的。笔者现将对腹膜透析患者的护理体会介绍如下。     

中药干预的腹膜透析与血液透析的比较

透析是慢性肾功能不全、尿毒症患者维持生命的主要方式，目前我们所行的透析方式主要有两种：血液透析（HD）、腹膜透析（PD），PD技术存活率低于HD，死亡率较高。本文通过在透析液中加入中药成份，提高PD效能，与HD患者进行了观察比较，得出了一些可以借鉴的经验规律。     

腹膜透析的常规护理及心理护理

腹膜透析（Continuous Ambulatory Peritoneal Dialysis简称＂CAPD＂）是利用人体天然的半透膜——腹膜作为透析膜,将一定配方的透析液注入腹腔,依赖透析弥散和超滤的作用,使潴留在内的代谢产物及多余水分得到清除,以维持水、电解质平衡而达到治疗目的,近年来,由于腹透具有减轻心血管负担、纠正贫血、减少交叉感染,保护残余肾功能,以及腹透后感觉更接近正常人等特点,世界上有25万6千人接受腹透。腹膜透析（PD）是慢性。肾衰竭（CKD5期）替代治疗方法之一,具有价格低廉、操作简便,患者可在家白行透析等优点,     

腹膜透析病人的护理

腹膜透析因为操作简单、方便,不影响患者的生活、工作,术后生活质量高,越来越受到尿毒症患者的欢迎。腹膜透析是利用腹膜作为半渗透膜,利用重力作用将配制好的透析液经导管灌入患者的腹膜腔,这样,在腹膜两侧存在溶质的浓度梯度差。高浓度一侧的溶质向低浓度一侧移动（弥散作用）;水分则从低渗一侧向高渗一侧移动（渗透作用）。通过腹腔透析液不断地更换,以达到清除体内代谢产物、毒性物质及纠正水、电解质平衡紊乱的目的。它几乎适用于所有急、慢性肾衰,容量负荷过多,水、电解质平衡紊乱,以及其他肝功能衰竭和中毒性疾病等。近年来,随着透析技术和设备的改进,临床观察发现腹膜透析可减缓残余肾功能的丢失。改善患者肾功能、生活质量,使患者回归社会的机会增多。近一年多的时间我们科为五位患者进行了腹膜透析,术后均效果良好。     

中药在防治腹透相关性腹膜纤维化中的作用

腹膜透析（PD）是治疗终末期肾脏病方法之一,但由于腹膜透析液的生物不相容性,引起腹膜结构功能的破坏,最终导致腹膜纤维化,这是长期腹膜透析治疗的主要并发症,也是患者最终退出腹透治疗的主要原因。现代药理学实验证明,许多中药成分具有抗纤维化作用,某些中药用于腹透患者,可预防或延缓腹膜纤维化的发生和发展。     

首例腹膜透析管植入腹腔术患者的护理

腹膜透析管植入术是通过外科的一个小手术将 腹透管植入腹腔,建立腹透液进入腹腔的通道,然 后向腹腔内灌注透析液,利用腹膜作为透析膜将体内潴留的水、电解质与代谢产物经超滤和渗透作用入腹腔,而透析液中的某些物质经毛细血管进入血液循环,以补充体内的需要,如此间歇不断地更换透析液,达到清除体内代谢产物和水的目的。 我科去年6月收治1名患者,该患者为女性,72岁,因年纪较大,并患有糖尿病,常于血液透析后出现透析失衡综合征,而改为腹膜透析。该患者于去年10月11日行腹膜透析管植入腹腔术。这也是首例在我科施行该手术的患者,以前的患者都是戴透析管住院的。下面谈谈我科对首例腹膜透析管植入术患者的术前、术后护理及出院的指导。     

中医药防治腹膜间皮细胞发生上皮细胞-间质转化的研究进展

腹膜间皮细胞(peritoneal mesothelial cells,PMCs)是人腹膜重要的组成部分,腹膜透析(peritoneal dialysis,PD)期间,高浓度葡萄糖腹膜透析液刺激PMCs分泌促纤维化因子增加,激活TGF-β/Smad等信号通路,使PMCs发生上皮细胞-间质转化(epithelial-mesenchymal transition,EMT),诱发腹膜纤维化,最终导致超滤衰竭,极大的影响了PD患者透析疗效及生活质量。近年研究发现,部分单味中药及部分复方中药可以通过下调促纤维化因子表达,上调抗纤维化因子表达等作用有效的防治EMT的发生和进展,基于此,文章从目前中医药防治EMT的研究进展概况出发,分析论述中医药防治EMT的机制,以期为相关研究的开展提供参考。     

杨淑莲治疗再生障碍性贫血经验探析

再生障碍性贫血(再障)临床以贫血、出血、发热为主要表现,属于中医学"髓劳""虚劳""血证"范畴.多因脏腑虚损,功能失常,复加外邪干扰所致.杨淑莲主任医师系中国中医血液专病医疗中心、河北省廊坊市中医医院血液专科学术带头人,天津中医药大学教授、研究生导师,2008年获首届河北省"名中医"称号;擅长运用中医及中西医结合疗法...     

从阳虚论治糖尿病慢性并发症体会

随着人们生活方式的改变和社会老龄化进程的加速,糖尿病的发病率逐年升高,糖尿病及其并发症严重危害着人类的健康和生活质量,中医药治疗该病越来越受到重视。笔者在临床中注意到糖尿病的发生、发展及并发症的产生与阳气亏虚关系密切,从阳虚辨治糖尿病及其并发症取得了一定疗效,兹略述于下。     

杨金坤运用扶正祛邪法治疗胰腺癌经验举隅

胰腺癌的发生多由正气虚损,阴阳失衡,六淫邪气乘虚入侵,终致气机不畅,血行受阻,津液失于输布,津聚为痰,痰凝气滞,气滞血瘀,痰气瘀毒胶结,日久而成肿块。杨金坤教授从事肿瘤临床工作近40载,悉心钻     

杨霓芝从阴虚湿热论治肾性血尿经验

杨霓芝系广州中医药大学教授、博士生导师、主任医师,国家中医药管理局全国中医肾病重点专科学术带头人,从事内科医疗、教学和科研工作30余年,学验俱丰,对慢性肾脏病诊治造诣颇深。笔者有幸跟师学习,获益良多,现将杨霓芝教授从阴虚湿热论治肾性血尿的经验介绍如下,以飨同道。     

DT-13, a saponin of dwarf lilyturf tuber,exhibits anti-cancer activity by down-regulating C-C chemokine receptor type 5 and vascular endothelial growth factor in MDA-MB-435 cells简

AIM： To investigate the anticancer activity of DT-13 under normoxia and determine the underlying mechanisms of action. METHODS： MDA-MB-435 cell proliferation, migration, and adhesion were performed to assess the anticancer activity of DT-13, a saponin from Ophiopogonjaponicus, in vitro. In addition, the effects of DT-13 on tumor growth and metastasis in vivo were evaluated by orthotopic implantation of MDA-MB-435 cells into nude mice; mRNA levels of vascular endothelial growth factor （VEGF）, C-C chemokine receptor type 5 （CCR5） and hypoxia-inducible factor 1a （HIF-1a） were evaluated by real-time quantitative PCR; and CCR5 protein levels were detected by Western blot assay. RESULTS： At 0.01 to 1 umol·L -1, DT-13 inhibited MDA-MB-435 cell proliferation, migration, and adhesion significantly in vitro. DT-13 reduced VEGF and CCR5 mRNAs, and decreased CCR5 protein expression by down-regulating HIF-1 a. In addition, DT-13 inhibited MDA-MB-435 cell lung metastasis, and restricted tumor growth slightly in vivo. CONCLUSION： DT-13 inhibited MDA-MB-435 cell proliferation, adhesion, and migration in vitro, and lung metastasis in vivo by reducing VEGF, CCR5, and HIF-la expression.     

黄煌经方内科医案(二)——消化系统疾病治验3则

1慢性浅表性胃炎案1.1病案记录陆某,女,61岁。初诊日期:2011年6月26日。体貌:身高体瘦,面色黄白相兼,双面颊有黑褐斑,唇色暗淡。主诉:上腹不适10年,加重伴消瘦1年。现病史:近10年来,患者常感上腹部不适,饱食更甚,饥饿时有不适感,伴嗳气频频,治疗乏效。近1年     

Qingkailing injection for the treatment of acute stroke： a systematic review and Meta-analysis

OBJECTIVE: To evaluate systematically the clinical efficacy and safety of Qingkailing(QKL) injection in the treatment of acute stroke.METHODS: Searches for randomized controlled trials into acute stroke treated with QKL injection were performed in the China National Knowledge Infrastructure Database, China Science and Technology Journal Database, Wan fang Database,Chinese Biomedical Literature Database, PubMed and Cochrane Library, from January 1979 to March2013. Two reviewers independently retrieved the RCTs and extracted the information. The Cochrane risk of bias method was used to assess the quality of the included studies, and a Meta-analysis was conducted with Review Manager 5.2 software.RESULTS: A total of 13 studies with 1110participants were included. The quality of the studies was generally low. The Meta-analysis indicated that the combined use of QKL and Western Medicine was significantly superior to control group therapy in terms of the total effective rate. The relative risk(RR) in the acute cerebral hemorrhage(ACH) sub-group was 1.17 [95%confidence interval(CI)(1.08, 1.26), P=0.0001]. In the acute cerebral infarction(ACI) sub-group, RR was 1.27 [95% CI(1.14, 1.42), P0.0001], and in the ACH and ACI mixed sub-group, RR was 1.34 [95% CI(1.20,1.50),P0.00001]. Additionally, QKL promoted the absorption of hematoma [mean difference(MD)=﹣3.73, 95%CI(﹣4.48, ﹣2.98), P0.000 01],decreased neurological damage in ACI [MD=﹣5.60, 95% CI(﹣8.50, ﹣2.70), P=0.0002] and ACH[MD= ﹣ 4.08, 95% CI( ﹣ 8.00, ﹣ 0.16), P=0.04],promoted the recovery of awareness [RR=1.56, 95%CI(1.09, 2.21), P=0.01] and reduced the whole blood viscosity coefficient [MD=﹣ 0.75, 95% CI( ﹣1.47, ﹣0.03), P=0.04]. There were no adverse drug reactions reported in the included studies.CONCLUSION: Based on this systematic review,QKL combined with conventional therapy was effective compared with control treatment.However, because the articles used in the study were not of high quality, further studies should be conducted into the efficacy and safety of QKL in treating acute stroke.     

Hypercoagulability in cancer patients grouped by syndromes differentiated with the theory of abnormal hilit in traditional Uyghur medicine

OBJECTIVE： To investigate the relationship in ma- lignant-neoplasm patients of hypercoagulability between syndromes differentiated with the theory of abnormal hilit in traditional Uyghur medicine（TUM）. METHODS： A total of 248 patients with malignant tumors were enrolled. Based on the theory of TUM they were divided into two groups： abnormal Sav- da and abnormal Non-Savda（including abnormal Khan, abnormal Sepra and abnormal Belghem types）; fifty healthy volunteers were selected as controls. Platelet（PLT）, prothrombin time（PT）, plas- ma fibrinogen（FIB）, thrombin time（TT）, activated partial thromboplastin time（aPTT） and D-Dimer（D-D） were measured in both groups. RESULTS： Compared with the control and abnor-mal Non-Savda groups, in the abnormal Savda group the PLT count increased（P0.05）, the PT was lengthened（P0.01）, and the FIB significantly in- creased（P0.01）. D-Ds in the three groups were sig- nificantly different（P0.05）. No significant differ- ence was found inTT and aPTT values（P0.05）. CONCLUSION： Hypercoagulability existed in pa- tients with malignant tumors in the different types of TUM syndromes, especially in the abnormal Sav- da group; this was characterized by increased blood viscosity, platelet aggregation and thrombo- sis. D-D appears to be a significant predictor for the therapeutic effect of TUM in relation to malignant tumor therapies.     

Effects of feeding tyrosine and phenylalanine on the accumulation of phenylethanoid glycosides to Cistanche deserticola cell suspension culture

AIM： To investigate the effects of feeding phenylalanine （Phe） and tyrosine （Tyr） on the accumulation of total phenolic compounds and four phenylethanoid glycosides （PeGs） to a cell suspension culture of the parasitic plant Cistanche deserticola.METHOD： A cell suspension culture of C. deserticola was established and precursors of different concentrations were fed. In each group, the cell was sampled at the 24^th day after inoculation. The content of total phenolic compounds and four PeGs compounds were determined using the Folin-Ciocalteu method and an HPLC method, respectively.RESULTS： In the Phe fed cells, the maximum PeGs yield was achieved when Phe was fed at 1.5 mmol·L^-1 and the yield reached 1.13 times the control cell concentration. In the Tyr fed cells, the maximum yield of PeGs was 1.60 times of control when 0.75 mmol·L^-1 Tyr was fed to the cells. Furthermore, it was found that the salidroside yield was 4.01 times of control group when 5 mmol·L^-1 Tyr was fed.CONCLUSION： Tyr is a better precursor for PeGs accumulation compared with Phe, and the rate limiting enzymes might be involved in the Tyr branch.     

Capillary blood flow in patients with dysmenorrhea treated with acupuncture

OBJECTIVE; To observe capillary blood flow at acu- points during acupuncture treatment of primary dysmenorrhea and gain new insights into its anal- gesic mechanism. METHODS： Patients with primary dysmenorrhea were enrolled and randomly assigned to a treat- ment or control group. Subjects＇ symptoms were differentiated into various Traditional Chinese Medi- cine （TCM） syndromes and treated for 10 sessions with puncturing acupuncture or self-pressing right-hand Hegu （LI 4）, adding other acupoints based on syndrome. Laser speckle was used tocompare the change in the vasomotor amplitude and perfusion of the capillaries in Hegu （LI 4） be- fore and during the treatment. Each subject was re- quired to finish the period pain symptoms observa- tion form, verbal rating scales, numerical rating scale, pain rating index, face rating scale, Zung self-rating depression scale, Zung self-rating anxi- ety scale, and numerical rating scale before and af- ter treatments. RESULTS： After 10 sessions, the symptom scores, pain index （PI）, and visual analog scale （VAS） de- creased significantly in treatment group. The vol- ume of blood flow in Hegu （LI 4） declined slightly. No significant evidence supported that needling caused capillary contraction, but the capillary vaso- motor amplitude at Hegu （LI 4） increased remark- ably. CONCLUSION： Acupuncture can increase the capil- lary blood flow, thus promoting the flow of Qi and blood in terms of TCM theory, which facilitates pain relief.