林越　李雨

摘要：目的 觀察大柴胡汤加味治疗维持性血液透析便秘患者的临床疗效。方法 采用随机数字表法将60例患者随机分为治疗组和对照组各30例。2组均予西医基础治疗。治疗组在西医治疗基础上予大柴胡汤加味，每日1剂，浓煎100 mL，早晚餐后分2次口服。对照组在西医治疗基础上予麻仁润肠丸，每次1丸，每日2次，口服。2组均连续治疗1个月。比较2组临床疗效，观察2组治疗前后便秘症状、透析中低血压发生率、肌肉痉挛发生率及Kt/V值。结果 治疗组总有效率为93.33%（28/30），对照组为66.67%（20/30），治疗组明显优于对照组（P<0.05）。与本组治疗前比较，2组治疗后每周排便次数增多、蹲厕时间减少（P<0.05）；2组治疗后比较，治疗组每周排便次数、蹲厕时间改善明显优于对照组（P<0.05）。与本组治疗前比较，治疗组血液透析中低血压发生率明显降低（P<0.05）；2组治疗后比较，治疗组低血压发生率明显低于对照组（P<0.05）。与本组治疗前比较，2组Kt/V明显提高（P<0.05）；2组治疗后比较，治疗组Kt/V改善明显优于对照组（P<0.05）。结论 大柴胡汤加味可有效改善血液透析患者便秘症状，改善透析充分性。

关键词：维持性血液透析；便秘；大柴胡汤

DOI：10.3969/j.issn.1005-5304.2018.06.008

中图分类号：R259.744；R272.969 文献标识码：A 文章编号：1005-5304（2018）06-0030-04

Clinical Study on Effects of Modified Dachaihu Decoction on Treatment of Constipation in Hemodialysis Patients

LIN Yue1， LI Yu2

1. Beijing Royal Integrated Medicine Hospital， Beijing 102209， China；

2. Chaoyang District Traditional Chinese Medicine Hospital of Beijing， Beijing 100020， China

Abstract： Objective To observe the clinical efficacy of modified Dachaihu Decoction on the treatment of constipation in hemodialysis patients. Methods Totally 60 hemodialysis patients were divided into treatment group and control group through random number table method， with 30 cases in each group. Both groups received Western basic treatment. The treatment group was given modified Dachaihu Decoction on the basis of Western medicine treatment， one dosage 100 mL per day， morning and evening after dinner， orally. The control group received Maren Runchang Pills， one pill each time， twice a day， orally. The treatment cycle for both groups was one month. The clinical efficacy， constipation symptoms， incidence of hypotension during dialysis， incidence of muscle spasm and Kt/V were compared between the two groups. Results The total effective rate was 93.33% （28/30） in the treatment group and 66.67% （20/30） in the control group. The treatment group was significantly better than the control group （P<0.05）. Compared with before treatment， the number of defecation per week increased after treatment in both groups， and the squatting time decreased； Comparing the two groups after treatment， the number of defecation per week and squatting time in the treatment group were significantly better than those in the control group （P<0.05）. Compared with before treatment， the incidence of hypotension rate in the treatment groups of dialysis were significantly reduced （P<0.05）； After treatment， the incidence of hypotension in the treatment group was significantly lower than those in the control group （P<0.05）. Compared with before treatment， Kt/V in both groups increased significantly （P<0.05）； After treatment， the improvement of Kt/V in the treatment group was significantly better than that in the control group （P<0.05）. Conclusion Modified Dachaihu Decoction can effectively improve the symptoms of hemodialysis patients with constipation and improve the dialysis adequacy.

Keywords： maintenance hemodialysis； constipation； Dachaihu Decoction

便秘是维持性血液透析（maintenance hemodialysis，MHD）患者常见并发症，亚洲人群发生率较高[1]。便秘直接影响MHD患者每次透析超滤量的设定，常致超滤量设置过高，诱发透析中低血压、肌肉痉挛等并发症的发生，甚至导致透析中断，影响患者生活质量[2]。目前，西医治疗主要采用灌肠、增加肠动力剂、泻剂等，可短期缓解症状，一旦停药症状易反复[3]。大柴胡汤和解与泻下并用[4]，笔者采用大柴胡汤加味治疗MHD便秘患者，观察其治疗前后便秘症状改善情况，现报道如下。

1 资料与方法

1.1 一般资料

选择2014年10月-2017年10月北京王府中西醫结合医院血液净化中心患者60例，采用随机数字表法分为治疗组和对照组各30例。治疗组男21例，女9例；平均年龄（60.57±11.47）岁；透析病程8～42个月，平均（21.76±4.72）个月；便秘病程3～30个月，平均（11.50±9.01）个月；原发病为糖尿病10例，慢性肾炎5例，高血压性肾损害4例，间质性肾病5例，多囊肾2例，其他4例。……