| BackgroundPeritoneal Dialysis (Peritoneal Dialysis, PD) was popular used in end-stage renal disease patients, but there were still some problems, such as malnutrition and overhydration in PD patients. Currently the treatment of these problem was still limited. Chinese medicine doctors also finished a lot of researches, but the general way to prevent the complications mainly included decoction, infusion, and drug injection into dialysate. In fact, all the general way may took more clinical problems such as overhydration and inflammation.TCM syndrome differentiation is the prerequisite for treatment, but currently the study about PD patients'syndrome was very lack. And PD treatment was a long process, the nutritional and capacity of patients throughout the whole years may be different, Four Seasons Theory, as an important part of TCM theory, may be suitable to be use in the management of nutrition and the capacity complication, And which may provide a new way to improve the dialysis treatment with TCM.ObjectivesTo analysis the relationship between changes of syndromes and four seasons'yin-yang and the indicators of nutrition and capacity. Then made a clinical research of adlay diet to prove the possible interventions. Try to provide a new thinking with TCM for the treatment of malnutrition and overhydration even all the complication of PD. MethodsStudy One:According to the criterion made by the Nephropathy Branch of China association of Chinese Medicine in 2006, the syndrome type of 164 patients were differentiated, and the parameters about nutrition and capacity were measured.Study Two:To collect 150 CAPD patients'data about nutrition and volumes overload for 2 years. It included dialysis dose, dialysate osmotic, KT/V(ALL), KT/V(RRF), subjective general nutrition Appraisal(SGA), daily energy intake (DEI), daily protein intake (DPI), grip strength, blood urea nitrogen (BUN), albumin (ALB), the extracellular water (ECW), the intracellular water (ICW), the total body water (TBW), E/I, blood pressure, body weight, total drinking water, the urinary volume and the ultra filtration water (UF) for 24 hours. And then analyze the data with SPSS 13.0.Study Three:PD patients referred to'damp-heat'or'turbid-damp'TCM syndromes were brought into our study. They were randomly divided into two groups including 16 patients in adlay group and 13 patients in control group. We let adlay group patients add 30g adlay in their daily diet, which should be kept every day for 3 months. Then we evaluated all the patients'parameters about nutrition and capacity pre and post the treatment.ResultStudy One:Syndrome type presented in patients was different. Along with the progress of dialysis, it changed in the origin syndromes from Spleen-Kidney-Qi-deficiency to Spleen-Kidney-Yang-deficiency and further to both Yin-Yang deficiency, while in the excess syndromes it turned from none-excess-syndrome and turbid-damp to blood-stasis. The intake of nutrition may be lowest in Spleen-Kidney-Yang-deficiency and Yin-Yang deficiency patients and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). And for the excess syndromes, the turbid-damp and damp-heat patients may intake least and their malnutrition and overhydration maybe most serious (P＜0.01, P＜0.05). furthermore, the dialysate osmotic may highest in the patients with the two syndromes (P＜0.01, P＜0.05)Study Two:There were significantly differences between four seasons of the DEI and DPI (P＜0.05), with the order was autumn＞summer＞spring＞winter. And SGA were significantly difference (P＜0.05), with the order was spring ＞autumn＞summer＞winter. BUN, E/I were significantly difference (P<0.05), with the order was winter＞spring＞summer＞autumn. But there were no significantly differences between four seasons of the urinary volume and the UF. And the ICW and TBW were significantly differences between four seasons time (P＜0.01), with the order was spring＞winter＞summer＞autumn. And the total drinking water were significantly difference (P＜0.01), with the order was summer＞autumn＞spring＞winter.Study Three:After 3 months, the patients'parameters about nutrition and capacity in adlay group were significantly lower than those at the beginning (P＜0.01, P＜0.05), and their clinical syndromes and symptoms were changed, too (P＜0.01, P＜0.05). while there were no significant differences in those of the control group (P＞0.05)ConelusionStudy One:Some rules of syndrome type distribution could be seen in patients undergoing peritoneal dialysis, which is related with some laboratory parameters about nutrition and capacity, so may provide a few references for clinical treatment based on syndrome type.Study Two:PD patients nutrition and overload capacity does change with the seasons corresponding of Chinese yin and yang, but there is some special changes for PD patients. And this regular pattern may help us to prevent the complication of nutrition and overload capacity of PD patients.Study Three:adlay diet in daily life may be a simple and efficient treatment to prevent the malnutrition and overhydration for PD patients. |
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