| Recent studies have found that the incidence of frailty in patients with end-stage kidney disease is high,reaching 67.7%in elderly or near-elderly patients with end-stage kidney disease.After entering the dialysis stage,many complications,such as anemia.malnutrition,chronic microinflammation,renal osteopathy,uremic cardiomyopathy,neuropathy,cardiac insufficiency,anxiety and depression,lead to the prevalence of frailty in hemodialysis patients.It would increase the mortality rate,risk of hospitalization and falling,and reduce the quality of life of hemodialysis patients with frailty syndrome.Therefore,it is of great significance to treat frailty in hemodialysis patients so as to improve the quality of life of patients,reduce mortality and promote the return of patients to society.Objective:1.Through multicenter cross-sectional survey of frailty in maintenance hemodialysis patients,to summarize the characteristics of TCM syndrome elements,and to provide a breakthrough point for clinical intervention of TCM.2 Through clinical prospective randomized controlled study,to observe and evaluate the improvement effect of moxibustion by syndrome differentiation on frailty in maintenance hemodialysis patients,and to provide clinical reference for the application of Moxibustion in this field.Method1 Study on TCM Syndrome Element Characteristics of frailty in maintenance hemodialysis patients.With the method of multi-center and cross-sectional investigation and design.204 frailty patients undergoing regular hemodialysis in Wangjing Hospital of Chinese Academy of Traditional Chinese Medicine,General Aeronautical Hospital and Blood Purification Center of Changping Hospital of Integrated Traditional Chinese and Western Medicine from December 2017 to December 2018 were selected as the research objects.The general data,clinical symptoms and signs of patients were collected regularly,referring to those written by Zhu Wenfeng.The simplified measurement method in Syndrome Differentiation and Differentiation of Syndromes and Elements is used to determine syndromes and analyze the distribution characteristics of TCM syndromes in patients with frailty hemodialysis syndrome through the pathogenicity and location Syndromes.2 Clinical Study on Moxibustion for Improving frailty in Patients with Maintenance HemodialysisA prospective,randomized and controlled clinical trial was conducted to select 112 patients with maintenance hemodialysis who met the diagnostic criteria of frailty and TCM syndromes in two blood purification centers of Wangjing Hospital and Aviation General Hospital from December 2017 to July 2018.The third-party Institute of clinical basic medicine of Chinese Academy of Chinese Medical Sciences was entrusted to use SPSS 19.0 software package for randomization,which was divided into treatment group(56 cases)and control group(56 cases).Both groups were treated with routine western medicine hemodialysis.The experimental group was treated with syndrome differentiation moxibustion,while the control group was treated with Levocarnitine injection.The two groups were treated with 4 weeks as a course of treatment,three courses of treatment were observed,a total of 12 weeks.Observation indicators include:general information of patients,various indicators of weakness syndrome,quantitative score of TCM symptom classification,quality of life score of nephropathy,body composition.SPSS 22.0 software was used for statistical analysis to evaluate the changes of various indicators before and after moxibustion and the curative effect.Result1 Study on the characteristics of TCM syndromes in frailty patients with maintenance hemodialysis1.1 Distribution of symptoms and signs in frailty patients with maintenance hemodialysisIn this study,204 frailty patients with MHD were enrolled.Finally.401 items of symptoms and signs(except tongue and vein)were collected.After eliminating the items with less than 5%frequency,238 items remained.The first 15%of the symptoms and signs were chronic illness,low urine,fatigue,thirst,insomnia,weak waist and knee,fatigue,dry skin,forgetfulness,itching.cold limbs,vomiting,chronic anorexia,poor skin elasticity,skin pigmentation,blurred vision,irritability,loose teeth,shallow complexion,physical distress,nausea,tinnitus,constipation,acid.Severe pain,lons-term lack of food,frequent fear of cold,vigilance of muscles and muscles,difficulty in defecation,dry stool,lack of sleep,numbness of limbs,spitting,thirst for drinking,fever,discomfort in defecation,low back pain,blindness,the frequency of occurrence is more than 49%.From the distribution of tongue texture,the frequencies of light tongue,varicose sublingual veins and cracked tongue were 67.16%,54.41%and 48.04%.respectively.From the distribution of tongue coating,the frequencies of greasy tongue coating,white tongue coating,yellowish tongue coating and less tongue coating were 84.80%.41.67%,41.67%and 39.71%,respectively.The frequency of pulse appearance was 60.29%,48.53%,45.10%and 44.61%,respectively.1.2 Distribution of Syndrome Elements1.2.1 General Distribution of Syndrome ElementsIn this study,48 syndrome elements were involved.After eliminating the evidence elements whose frequency was less than 5%of the total number,35 syndrome elements remained.Among the pathogenic factors,the higher frequency of deficiency syndrome elements was Qi deficiency(100.00%),blood deficiency(100.00%),Yin deficiency(100.00%),Yang deficiency(100.00%),essence deficiency(87.75%)and Jin deficiency(64.22%).The higher frequency of deficiency syndrome elements was dampness(98.04%),qi stagnation(88.73%),phlegm(84.80%),blood stasis(79.90%)and cold(65.20%).The higher frequency of location syndrome elements were spleen(100.00%),kidney(100.00%),liver(95.59%),stomach(73.04%),lung(68.14%)and heart(66.67%).The syndromes with higher weight are Yang deficiency,Qi deficiency,kidney,Yin deficiency,blood deficiency,spleen,liver,dampness and Qi stagnation.1.2.2 Distribution of Syndrome Elements in Patients of Different Genders The frequency of syndrome elements like deficiency of essence,nonconsolidation,blood stasis,lung and large intestine in male patients was higher,and the difference was statistically significant(P<0.05).1.2.3 Distribution of Syndrome Elements in Patients of Different Ages The weight values of Yang deficiency and kidney syndrome element had statistical significance among different ages(P<0.05).Syndrome essence deficiency,Qi depression,extinction,yang depletion,dampness,Qi stagnation,phlegm,blood stasis.heat,water stopping,dryness,stomach,lung,skin,bones and muscles,meridians and large intestine distribution in different ages were compared,and the difference was statistically significant(P<0.05).1.2.4 Distribution of Syndrome Elements in Patients of Different Dialysis AgesThe distribution of syndrome elements like nonconsolidation,collapse,yang depletion,Qi stagnation,cold,Yang hyperactivity,heat.lung,heart,skin,surface and large intestine in different dialysis ages was different.The difference was statistically significant(P<0.05).1.2.5 Distribution of syndrome elements in patients with different hospitalization timesThere were significant differences in the weight of Yang deficiency syndrome elements among different hospitalization times(P<0.05).The distribution of syndrome elements,phlegm and mind in different hospitalization times were compared,and the difference was statistically significant(P<0.05).1.2.6 Distribution of Syndrome Elements in Patients with Different Falling Frequency LevelsThere was no significant difference in the distribution of syndrome elements among different levels of falls(P>0.05).1.2.7 Distribution of Syndrome Elements in Patients with Different CCI LevelsAt different CCI levels,the distribution of essence deficiency,exfoliation,death of yang,dampness,Qi stagnation,phlegm,blood stasis,cold,yang-heat,water retention.liver,heart,mind and surface were compared,with statistical significance(P<0.05).1.2.8 Distribution of Syndrome Elements in Patients with Different Numbers of DrugsThe distribution of syndrome elements in blood stasis,water retention,dryness,lung,heart,skin and meridians at different levels of medication was compared,and the difference was statistically significant(P<0.05).1.3 Relation between frailty Indicators and Main TCM Syndromes in Hemodialysis PatientsThe weight loss of the frailty patients with hemodialysis is correlated with blood deficiency syndrome elements,and the failure of grip strength is correlated with Yang deficiency syndrome elements.2 Clinical Study on Moxibustion for Improving Weakness Syndrome in Patients with Maintenance Hemodialvsis2.1 General data comparisonThere were no significant differences in gender,age.dialysis age.dialysis frequency,marital status,living alone,education level,monthly income,hospitalization times in one year,falls times in one year.Charlson's complication index and the number of medications taken between the two groups(P>0.05).2.2 Comparison of various indicators of weakness syndromeIntra-group comparison:In the experimental group,the walking speed before treatment was 0.85±0.19 m/s.the MET value was 342.97±398.13 MET-min/w.the fatigue score 1 was 0.83±0.83,the fatigue score 2 was 1.85±0.62.the walking speed after treatment was 0.92±0.19 m/s the MET value 456.191498.64 MET-min/w.the fatigue score 1 was 0.63±0.71,the fatigue score 2 was 1.00±0.65,all improved after treatment,and the difference was statistically significant(p<0.05).In the control group,before treatment,the score of fatigue 1 was 1.19±0.94,the score of fatigue 2 was 2.00±0.52,after treatment,the score of fatigue 1 was 0.92±0.81.and the score of fatigue 2 was 1.55±0.67.After treatment,the score of fatigue 1 was improved.The difference was statistically significant(P<0.05).Inter-group comparison:After treatment,the fatigue 2 score of the experimental group was 1.00±0.65,that of the control group was 1.55±0.67,and the difference was statistically significant(P<0.05).It can be concluded that the improvement of the fatigue 2 score of the experimental group was more obvious.2.3 Comparisons of TCM Symptom IntegralIntra-group comparison:The TCM symptom score of spleen-kidney Qi deficiency type in the experimental group was 20.00±6.54 before treatment.14.83±4.53 after treatment,26.56±6.27 before treatment and 19.00±5.06 after treatment,and improved after treatment,with statistical significance(P<0.05).In the control group,the TCM symptom score of spleen-kidney Qi deficiency type was 16.59±6.29 before treatment,14.38±5.86 after treatment.26.83±7.17 before treatment and 21.38±6.68 after treatment,which improved after treatment.The difference was statistically significant(P<0.05).Inter-group comparison:After treatment,the TCM symptom score of spleen and kidney Qi deficiency type in the experimental group was 14.83±4.53.while that of the control group was 14.38±5.86.with no significant difference(P>0.05).After treatment.the scores of TCM symptoms of spleen and kidney yang deficiency type in the experimental group were 19.00±5.06 and 21.38±6.68 in the control group,with no significant difference(P>0.05).2.4 comparison of Dimension in KDQOL-SFTM1.3Intra-group comparison:before treatment,the overall health of the experimental group was 40.47±17.17,vitality 55.24±24.72,health change 25.00±20.91,symptoms and discomforts 72.92(62.50,82.29),effects of kidney disease on daily life 52.89±18.47,social quality 80.00(66.67,86.67),sleep 54.44±17.88,overall health assessment 52.38±16.70,overall health 46.67±14.43,vitality 61.67±22.98,health change 5.The effects of kidney disease on daily life,social quality,sleep and general health assessment were 57.82±17.73,80.00(73.33,86.67),60.00±19.13 and 61.43±15.25,respectively.The differences were statistically significant(P<0.05).The social function of the control group was 52.61±25.55 before treatment,the health change was 26.14±16.32,the social function was 60.00±16.61 after treatment,and the health change was 45.45±16.61,all of which were improved.The difference was statistically significant(P<0,05).Inter-group comparison:After treatment,the overall health score of the experimental group was 46.67±14.43 higher than that of the control group 35.22±20.67,P<0.05,with statistical significance.2.5 Comparison of human body componentsIntracellular comparison:After treatment,the muscle content of the experimental group was 25.31±8.36,the intracellular water content was 17.81±9.27,which was 26.18±9.11.the intracellular water content was 19.05±10.30,and the difference was statistically significant(P<0.05).After treatment,the visceral fat content was 5.72±3.54.the extracellular water content was 13.88±4.29,which was 5.15±3.33,and the extracellular water content was 12.98±4.90 higher than that before treatment,the difference has statistical significance(P<0.05).There was no significant change in body composition levels before and after treatment in the control group,and there was no significant difference between the two groups by paired t test(P>0.05).The levels of body composition after treatment were compared between the two groups.T test showed that there was no significant difference between the two groups(P>0.05).Conclusion1 The syndrome elements of frailty in hemodialysis patients are mainly Qi deficiency,blood deficiency,Yin deficiency.Yang deficiency,spleen and kidney deficiency.The syndrome characteristics of Qi and blood deficiency,Yin and Yang deficiency,spleen and kidney deficiency can be classified into the category of "weakness" disease in traditional Chinese medicine.Blood deficiency syndrome element is a risk factor for weight loss(?5%)of frailty in hemodialysis patients,and Yang deficiency syndrome element is a risk factor for poor grip strength of frailty in hemodialysis patients2 Through prospective randomized controlled clinical trial,moxibustion has the effect of Warming Yang and invigorating qi.It can improve the walking speed,physical activity level,fatigue score,TCM syndrome score and the survival in the field of general health,vitality,health change,symptoms and discomforts,the influence of kidney disease on daily life,social quality,sleep and general health assessment of frailty patients with hemodialysis.3 This study provides a new intervention method with Chinese medicine characteristics for the prevention and treatment of weakness syndrome in maintenance hemodialysis patients by traditional Chinese medicine.What's more,the relevant moxibustion treatment scheme deserves further study. |
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