| Objective:To investigate the current situation of hypertension in patients with maintenance hemodialysis(MHD)in our center,and on this basis,patients with maintenance hemodialysis complicated with hypertension were selected and treated with traditional Chinese medicine foot bath.We will observe the changes of patients’ blood pressure,TCM symptom score and quality of life score before and after treatment,and discuss the effectiveness and safety of TCM foot bath,so as to provide reference for the application of TCM in MHD patients.Method:Research One:A total of 198 MHD patients in the Blood Purification Center of Jiangsu Hospital of Traditional Chinese Medicine were investigated.Basic information,blood pressure data and specific medication were collected to preliminaries understand the prevalence of hypertension in hemodialysis of the center,the rate of blood pressure control reaching the standard and the medication status of patients.Research Two:According to the inclusion criteria,52 patients who met the requirements were selected as the research objects and randomly divided into treatment group and control group,with 26 patients in each group.The treatment group was additionally treated with traditional Chinese medicine foot bath,while the control group was only treated with conventional basic treatment for 4 weeks.The changes of blood pressure,TCM symptom scores and life quality scores were observed before and after treatment.Result:Research One:① A total of 198 hemodialysis patients were investigated in this study,including 128 males and 70 females.The average age was 60.92±13.54 years old,the average dialysis age was 6.58±6.02 years,the average systolic blood pressure was(149.97±19.87)mmHg,and the average diastolic blood pressure was(77.43 ± 14.86)mmHg.Among them,190 hemodialysis patients had hypertension,and the prevalence rate of hypertension on hemodialysis was as high as 96.0%,and the overall blood pressure value of the patients was high.② Among the 190 hypertensive patients on hemodialysis,160 patients received antihypertensive drug therapy,and the drug treatment rate was 84.2%.After the unified relaxation of the predialysis blood pressure control target to<160mmHg,it was found that there was still an average rate of 34.2%of predialysis blood pressure substandard,and the blood pressure control rate of dialysis hypertensive patients was worrying.③Further analysis of the drugs taken by the patients showed that 63.7%of the patients were taking 2 or more antihypertensive drugs,30.0%of the patients were taking 3 or more antihypertensive drugs,and a large number of patients were taking multiple antihypertensive drugs at the same time.The most frequent use of antihypertensive drugs was calcium channel blockers,followed by beta receptor blockers.④Compare the results of this survey with those of Anhui province in 2014.The prevalence rate in this survey was higher than that in Anhui Province in 2014.The rate of drug treatment and the proportion of people taking more than two drugs were slightly lower than the survey of Anhui Province in 2014,and the common drugs and the average blood pressure of patients maintained a high consistency.In terms of blood pressure control standards,due to the different control targets selected(<160mmHg before penetration in this survey,and<140/90mmHg in Anhui Province in 2014),the comparison is not made for the time being.However,the two reflect that most patients’ blood pressure is not well controlled from different directions.Research Two:① Efficacy evaluation:the total effective rate of the treatment group was 69.23%;The total effective rate of the control group was 30.77%,and the effect of the treatment group was significantly better than that of the control group(P<0.01).②In the treatment group,the scores of TCM symptoms decreased obviously,and the symptoms of dizziness and headache,dry mouth and bitter mouth,tiredness and fatigue,pruritus and lack of food and absorption were the most obvious improvement(P<0.01).Compared with the control group,the symptoms of the treatment group improved more,especially the dizziness,headache,dry mouth and bitter mouth(P<0.05),with statistical significance.③The KDTA and SF-36 scores of the KDQOL-SFTM 1.3 scale were both higher in the treatment group after treatment than before treatment(P<0.01).Improvements in physiological function,physical pain,general health,mental health,energy,health changes,symptoms/problems,sleep,and the impact of kidney disease were the most common(P<0.05).Compared to the control group,the treatment group scored significantly better on energy(P<0.01),symptoms/problems,physical pain,mental health,cognitive function,and physiological function were also better than those in the control group(P<0.05).④The mean blood pressure before dialysis in the treatment group was 1.54mmHg lower than before.In the control group,the blood pressure before dialysis increased by 0.03mmHg.The treatment group was superior to the control group,but the change of overall blood pressure was too small to be statistically significant(P>0.05).In the treatment group,the mean reduction of substandard blood pressure(1.27 times)was higher than that of the control group(0.69 times),but(P>0.05),and there was no statistical significance.Conclusion:①With medical progress,the status quo of the dialysis center maintenance hemodialysis patients with hypertension has not been improved,still has a high prevalence,low control and patients’ whole blood pressure values on the high side,more number of antihypertensive drugs,drug species is given priority to with calcium channel blockers and beta blockers such as the characteristics of the current problem of maintenance hemodialysis patients with high blood pressure is still a big problem in the clinical,the lack of a clear management objectives and the new and effective treatment,clinical doctors should pay high attention.②Adding TCM foot bath therapy to the stable basic treatment can effectively improve the TCM symptom scores of patients with dizziness,headache,dry mouth,bitter mouth and other aspects,improve the overall quality of life of patients,and may be helpful to the hypertension control of patients to reach the standard. |
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