程新 胡江平 罗方 于国俊

摘要 目的：探究針刺联合苓桂术甘汤对维持性血液透析（Maintenance Hemodialysis，MHD）患者口渴的影响。方法：选取2017年1月至2018年1月郑州市中医院收治的MHD口渴患者106例作为研究对象，按照随机数字表法随机法分为对照组和观察组，每组53例。对照组采用常规西医治疗，观察组在对照组基础上加用针刺联合苓桂术甘汤治疗，均治疗4周。观察2组治疗前后血液学、唾液生化、分泌功能、神经肽、相关评分、刺激唾液量及疗效变化。结果：1）治疗后2组尿素氮、血钙、血磷、甲状旁腺激素、尿素下降率、尿素清除指数、标准化蛋白分解率比较差异无统计学意义（P>0.05）。2）治疗后2组酸碱度（pH）、唾液流率指数、Na+/K+、神经降压素（Neurotensin，NT）、刺激唾液量比值较治疗前均升高，Na+、K+、瘦素（Leptin）、血清神经肽Y（NeuropeptideY，NPY）、口渴强度评分、口腔干燥评分、口渴视觉模拟评分（VAS评分）较治疗前下降，差异有统计学意义（P<0.05），且观察组低于对照组，差异有统计学意义（P<0.05）。3）治疗后观察组临床痊愈率、临床有效率均显著高于对照组，差异有统计学意义（P<0.05）。结论：针刺联合苓桂术甘汤能改善MHD患者唾液分泌功能，提高神经肽，从而改善口渴。

关键词 维持性血液透析;口渴;针刺;苓桂术甘汤;神经肽;唾液分泌功能;唾液生化功能;疗效

Abstract Objective：To explore the effects of acupuncture combined with Linggui Zhugan Decoction on patients with thirst of maintenance hemodialysis（MHD）.Methods：A total of 106 patients admitted to Zhengzhou Traditional Chinese Medicine Hospital with MHD thirst were selected as the research objects and according to random number table method， they were divided into a control group（n=53）and an observation group（n=53）.The control group was treated with Western medicine，and the observation group was treated with acupuncture combined with Linggui Zhugan Decoction on the basis of the control group.Both groups were treated for 4 weeks.The changes of hematology，saliva biochemistry，secretory function，neuropeptide，related score，stimulated saliva volume and curative effect were observed in the 2 groups before and after treatment.Results：1）There was no significant difference in urea nitrogen，serum calcium，serum phosphorus，parathyroid hormone，urea decline rate，urea clearance index and standardized protein decomposition rate between the 2 groups after treatment（P>0.05）.2）After treatment，the pH，salivary flow index，Na+/K+，neurotensin（NT）and the ratio of stimulated saliva volume in the 2 groups were higher than those before treatment，while Na+，K+，leptin，serum neuropeptide Y（NPY），thirst intensity score，oral dryness score and thirst visual analogue score（VAS score）in the observation group were lower than those before treatment（P<0.05）.The observation group was lower than the control group（P<0.05）.3）After treatment，the clinical curative rate and total effective rate in the observation group were significantly higher than those in the control group（P<0.05）.Conclusion：Acupuncture combined with Linggui Zhugan Decoction can improve saliva secretion function，increase neuropeptide and improve thirst in patients with MHD.

Keywords Maintenance hemodialysis; Thirst; Acupuncture; Linggui Zhugan Decoction; Neuropeptide; Salivary secretory function; Salivary biochemical function; Curative effects

中图分类号：R245;R289.4文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.09.023

终末期肾脏病是指各种慢性肾脏疾病终末阶段导致肾脏明显萎缩，肾小球滤过率下降，不能维持基本功能，出现代谢产物潴留，水电解质、酸碱平衡紊乱，全身各系统受累为表现的临床综合征。维持性血液透析（Maintenance Hemodialysis，MHD）是目前较为普遍的肾脏替代疗法，其能在提高终末期患者生存率上改善患者生命质量。但临床上其并发症也较多，常见的有皮肤瘙痒、口渴、失眠、消化不良等[1]。口渴作为MHD最常见并发症之一，不仅是主观感受，也能导致患者说话困难，咀嚼吞咽困难、口腔感染等。口渴……