Investigation And Analysis Of TCM Syndromes Of Hemodialysisin Patients With End Stage Renal Disease

BackgroundFor a long time,dialysis as one of the main treatment of patients with end-stage renal disease,and the timing of dialysis is related to the prognosis.Therefore,the choice of appropriate dialysis opportunity is significant to the patients.How to determine the timing of dialysis?How does the decline in renal function begin to dialysis?Various studies have shown that early access to Renal Replacement Therapy(RRT)has not been beneficial.Three large observational studies in the United States,Canada,and Taiwan have found that patients with low eGFR survival at RRT treatment had a higher survival benefit.Meta-analysis studies have shown that the sooner the dialysis begins,the higher the risk of death.A study using the Cleveland Clinic Foundation database found that there was no significant difference in survival between patients with early or late entry into RRT therapy.However,the current consensus is that it is not advisable to use creatinine-based eGFR alone to initiate dialysis at a time that must be combined with the patient's clinical symptoms.Chinese medicine in terms of Western medicine,attention to the patient's subjective feelings and analysis of the clinical characteristics related to the characteristics of a certain characteristics and advantages.According to the clinical situation,it can be seen that ESRD patients with different dialysis opportunities have their own clinical characteristics.However,there is no report on TCM syndromes of ESRD patients with different dialysis opportunities.Therefore,in this paper,ESRD patients with symptoms and TCM syndromes were discussed in order to guide the ESRD patients to grasp the timing of dialysis in a better way.ObjectiveTo describe the symptoms of end stage renal disease for the first time into hemodialysis,and to explore the correlation between different dialysis opportunities and TCM syndromes,and to provide reference for the identification of TCM syndromes for different dialysis opportunities.MethodsIn this study,retrospective survey method was used to study the hospitalized medical records of the patients with end-stage renal disease for the first time in the past five years,and then read the medical records from the hospital information department.Then,Requiring the extraction of the required data,and ultimately included 301 cases of effective cases.Investigate the TCM syndromes,symptom characteristics,laboratory indicators and other relevant information,thus establishing a database of hemodialysis combined with traditional Chinese and Western medicine.According to the guidelines related to dialysis,301 patients were divided into two groups(emergency dialysis group and non-emergency dialysis group)to explore the relationship between different dialysis opportunities and TCM syndromes in patients with end stage renal disease.SPSS20.0 statistical software for data analysis,counting data using chi-square test,if more than 20%of the cell expected frequency less than 5,then Fisher exact probability analysis,the results of the frequency table or percentage to describe.The data were normalized by Kolmogorov-Smirnov test.If the data were normal distribution and the variance homogeneity was satisfied,the single factor analysis of variance was used.The results were expressed as mean ± standard deviation.If the data were not normal distribution,Nonparametric rank sum test,the results are described as the median(lower quartile,upper quartile).P for the bilateral test,P<0.05 for the difference was statistically significant.Results1.In this study,358 cases were selected and 301 cases were included.Among the 301 cases,the proportion of ESRD patients who entered hemodialysis was mainly in the elderly patients,and there was no significant difference between the emergency dialysis group and the non-emergency dialysis group.The primary disease of the subjects was mainly diabetes(102 cases,34.0%),hypertension(85 cases,28.2%),chronic glomerulonephritis(75 cases,24.9%),followed by obstruction Kidney disease(13 cases,accounting for 4.3%),Others(26 cases,8.6%).2.Of the ESRD patients included in this study,the most common cause of dialysis in patients with hemodialysis was acute heart failure(164 cases,54.5%),followed by gastrointestinal symptoms(44 cases,14.6%).3.Tired and weak(96%)as the main symptoms,poor appetite(73.4%),edema(62.5%),sleep difference(50.2%),asthma(42.2%),dry mouth(40.2%)were the most common symptoms in ESRD patients.Among the 301 cases of ESRD,the tongue was the most common in tongue light,accounting for 70.4%,followed by dark red(15.0%)and pale tongue(12.3%).Tongue to greasy fur for the most common,accounting for 49.2%,followed by yellow tired(26.9%),white fur(15.3%).Fine veins for the most common,accounting for 64.5%,followed by Chord(37.5%),Sinking pulse(30.9%),Sliding veins(26.2%),and Number of pulses(16.3%).4.TCM syndromes in this deficiency to spleen and kidney qi deficiency(244 cases,accounting for 82.7%)as the most common,followed by spleen and kidney yang(27 cases,accounting for 9.0%),Qi and Yin Deficiency(19 cases,accounting for 6.3%),yin and yang two Virtual(4 cases,0.3%),liver and kidney(1 case,1.7%).Blood stasis syndrome(287cases,accounting for 28.9%)as the most common,water vapor syndrome(81 cases,accounting for 26.9%),wet syndrome(115 cases,38.2%),followed by damp-heat syndrome(87 cases,accounting for 28.9%),Wind card(5 cases,1.7%).5.Relevance1)the correlation between different dialysis opportunities and deficiencyThe data shows that there was no significant difference between emergency dialysis and non-emergency dialysis patients with ESRD(P>0.05).From the overall distribution,the proportion of spleen and kidney qi deficiency syndrome in the emergency dialysis group was larger(82.6%),followed by spleen and kidney yang deficiency syndrome(9.2%),Qi and Yin Deficiency(5.5%),liver and kidney yin deficiency(2.3%),yin and yang deficiency(0.5%).Non-emergency dialysis group still spleen and kidney qi deficiency syndrome(84.3%),followed by spleen and kidney yang deficiency(9.6%),Qi and Yin Deficiency(6.0%),liver and kidney yin deficiency(0%),Yin and yang deficiency(0%).Thus,compared with the emergency dialysis group,non-emergency dialysis group in the proportion of traditional Chinese medicine in this deficiency are less.2)the relationship between different dialysis opportunities and empiricalThe data shows that there is a statistically significant difference between the two groups(P<0.05).From the overall distribution,blood stasis(49.9%%)and wet turbid syndrome(20.0%)were the most common,followed by wet and heat syndrome(15.1%%),water vapor syndrome(14.1%%),Wind pressure(0.9%%).Among them,the emergency dialysis group was mainly composed of blood stasis syndrome(49.8%),followed by wet turbidity syndrome(19.4%),water vapor syndrome(16.6%),damp heat syndrome(13.2%)and wind pressure syndrome(1.0%).The non-emergency dialysis group was mainly blood stasis syndrome(50.4%),followed by wet turbidity syndrome(21.4%),damp-heat syndrome(20.1%),water vapor syndrome(7.5%)and wind pressure syndrome(0.6%).Compared with the non-emergency dialysis group,the five empirical cases in the emergency dialysis group of patients accounted for a larger proportion,indicating that the emergency dialysis group of patients more obvious evidence.And the proportion of water vapor in the emergency dialysis group was higher than that in the non-emergency dialysis group(85.2%).3)the correlation between different dialysis opportunities and primary diseaseIn this study,statistical analysis of different dialysis opportunities and primary disease in ESRD patients have showen that a statistically significant difference between the two groups(P<0.05),indicating that different primary diseases were associated with the need for emergency dialysis treatment Sex.In the overall distribution,301 patients had the most common cause of diabetes(32.9%),followed by hypertension(30.2%),chronic glomerulonephritis(24.6%),other(8.0%),obstructive nephropathy(4.3%).Among them,the incidence of emergency dialysis mostly diabetes(38.1%),followed by hypertension(31.2%),chronic glomerulonephritis(17.9%),other(7.8%),obstructive nephropathy(5.0%);The primary incidence of emergency dialysis was chronic glomerulonephritis(42.2%),followed by hypertension(27.7%),diabetes(19.3%),other(8.4%),obstructive nephropathy(2.4%).Compared with non-emergency dialysis group,the distribution of primary disease in emergency dialysis group was larger.4)the correlation between different dialysis opportunities and laboratory indicators(P=0.00000),creatinine(P=0.000),TC02(P=0.000),and the level of serum potassium(P=0.000)was statistically different(P<0.05)when the ESRD patients entered hemodialysis and hemoglobin(P<0.00).Conclusion1.The study showed that 301 cases of ESRD patients with hemodialysis in the first clinical symptoms is fatigue,followed by poor appetite,edema,sleep disorders,asthma,dry mouth as a common symptom.Tongue to pale tongue dark,followed by the tongue dark red,pale tongue.tongue coating to greasy fur for the most common,followed by the yellow greasy fur,white fur.Fine veins is the most common,followed by Chord,Sinking pulse,Sliding veins,Number of pulses.The distribution of TCM syndromes are mainly:the deficiency to spleen and kidney qi deficiency syndrome,followed by spleen and kidney yang deficiency,Qi and Yin Deficiency syndrome,yin and yang deficiency syndrome,liver and kidney yin deficiency.Standard evidence to blood stasis and wet turbidity mainly,followed by damp heat syndrome,water vapor syndrome,wind pressure syndrome.2.There was no significant difference between the ESRD patients in the emergency dialysis group and the non-emergency dialysis group(P>0.05)between the deficiency,but there was no significant difference between the two groups(P>0.05)between the certification.Compared with non-emergency dialysis group,the proportion of five kinds of evidence(blood stasis syndrome,water vapor syndrome,dampness syndrome,damp-heat syndrome,wind pressure syndrome)in the emergency dialysis group were larger,especially water vapor syndrome is more prominent.