腹膜透析液联合尿毒清保留灌肠对非透析患者肾功能及电解质的影响

谢明媚 吴军 郑晓敏

摘要 目的：探究腹膜透析液聯合尿毒清颗粒保留灌肠对非透析患者电解质的影响。方法：选取2018年1月至2019年12月安庆市第一人民医院收治的慢性肾脏病非透析患者68例作为研究对象，按照随机数字表法分为对照组和观察组，每组34例。2组均参照KDOQI和KDIGO指南给予西医治疗，对照组患者每天1.5%腹膜透析液1 000 mL清洁灌肠，观察组先用1.5%腹膜透析液1 000 mL冲洗肠道，然后用尿毒清颗粒2包加入生理盐水200 mL保留灌肠40 min，比较2组患者治疗效果、中医证候积分、肾功能及血清磷（P）、钾（K）。结果：观察组治疗有效率较对照组高（P<0.05）。治疗前，2组患者食少纳呆、倦怠乏力、腰膝酸软、四肢困重、脘腹胀满比较差异无统计学意义（P>0.05），治疗后2组患者5项中医证候积分均下降，而且观察组下降幅度大于对照组（P<0.05）。治疗后2组患者血肌酐（Scr）、血尿素氮（BUN）、尿酸（UA）均下降，估算肾小球滤过率（eGFR）均显著提高，而且观察组Scr、BUN、UA下降幅度大于对照组，eGFR提高幅度大于对照组（P<0.05）。治疗后，观察组血磷、血钾表达水平低于对照组（P<0.05）。结论：腹膜透析液联合尿毒清颗粒保留灌肠对CKD5期非透析患者病情控制具有积极作用，操作简单，改善电解质紊乱，值得推广。

关键词 腹膜透析液;尿毒清颗粒;保留灌肠;非透析;电解质;肾功能

Abstract Objective：To investigate effects of peritoneal dialysis fluid combined with urotoxan granules retention enema on renal function and electrolytes for non-dialysis patients.Methods：A total of 68 non-dialysis patients admitted to Kidney Department of Anqing First People′s Hospital from January 2018 to December 2019 were selected as the research objects.According to random number method，they were divided into a control group and an observation group（n=34） and the observation group（n=34）.Both groups were given basic Western medicine treatment according to KDOQI and KDIGO guidelines.Both groups were treated with Western medicine in accordance with the guidelines of KDOQI and KDIGO.The control group received 1 000 mL of 1.5% peritoneal dialysate per day for cleaning enema，and the observation group received 1 000 mL of 1.5% peritoneal dialysate to flush the intestines，and then 2 packs of Niaoduqing granules were added.200 mL of normal saline was retained enema for 40 minutes，and the treatment effect，TCM syndrome score，renal function and serum electrolyte phosphorus（P） and potassium（K） were compared between the 2 groups.Results：The effective rate of treatment in the observation group was higher than that in the control group（P<0.05）.Before treatment，there was no significant difference between the 2 groups of patients with poor appetite，fatigue，weakness of waist and knees，heavy limbs，and abdominal distension（P>0.05）.After treatment，the scores of 5 TCM syndromes of the 2 groups decreased，and the decline in the observation group was greater than that in the control group（P<0.05）.After treatment，the blood creatinine（Scr），blood urea nitrogen（BUN），and uric acid（UA） of the 2 groups of patients decreased，and the estimated glomerular filtration rate（eGFR） increased significantly，and the decrease of Scr，BUN，and UA in the observation group was greater than those in the control group，the increase in eGFR was greater than that in the control group（P<0.05）.After treatment，the expression levels of P and serum potassium in the observation group were lower than those in the control group（P<0.05）.Conclusion：Peritoneal dialysate combined with urodoqing granule retention enema has a positive effect on the condition control of patients with CKD5 non-dialysis patients.The operation is simple and the electrolyte disturbance can be improved，which is worthy of promotion.

Keywords Peritoneal dialysis fluid; Niaoduqing Granules; Retention enema; Non-dialysis patients; Electrolyte; Renal function

中图分类号：R289.5;R692文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.11.014

慢性肾脏病（Chronic Kidney Disease，CKD）病情迁延不愈可发展至慢性肾衰竭，具有较高的发病率及致死率，消耗大量社会医疗资源，已经成为全球性社会卫生问题[1]。CKD病情多表现为进行性进展，5期患者多采用肾脏替代治疗，其治疗期间患者承受疾病折磨，不良反应多，肾源稀缺，增加家庭较重的经济负担[2]。因此探究延缓肾衰竭、提高患者生命质量的经济、有效治疗方式是肾脏学亟需探究的重要课题。中药治疗是CKD疾病治疗的重要方法，在延缓肾衰竭、延长生存时间方面具有无可比拟的优点[3]。尿毒清颗粒含有大黄、甘草、黄芪、车前草、丹参、党参、川芍等药材，具有活血化瘀、健脾益肾等作用[4]，通过保留灌肠避免胃肠道消化液对药物的破坏作用，经肠腔吸收达到全身，让药物产生的代谢废物经肠道排出体外，具有排毒功效[5]。……