| Background.End stage renal disease(ESRD)refers to the terminal stage of various chronic renal diseases,with obvious renal atrophy,decreased glomerular filtration rate,inability to maintain basic functions,clinical retention of metabolic products,imbalance of water,electrolyte and acid-base,and systemic involvement.Hemodialysis is the main renal replacement therapy for ESRD patients.With the development of China's economy and the reform of the medical system,the number of ESRD patients receiving hemodialysis has increased year by year.Digestive tract diseases(including organic and functional lesions)are the early occurrence and common chronic complications of extrarenal diseases in patients with endstage renal disease,among which constipation is one of the common complications,which has a certain impact on the quality of life(QOL)of patients with hemodialysis.How to solve chronic constipation(CC)of patients with maintenance hemodialysis(MHD)is one of the problems concerned by clinical and patients.The premise of TCM intervention is to fully understand the patients' TCM syndromes,and only by syndrome differentiation and treatment can the best therapeutic effect be achieved,so the research on syndrome is one of the key problems in the modernization of TCM research.At present,the overall quality of life of hemodialysis patients is low,and chronic constipation has a more serious impact on the quality of life of patients.How to improve the quality of life of patients with maintenance hemodialysis,improve the degree of social regression,and reduce the social and family burden has become an important research direction.Objective.By studying the distribution characteristics of TCM syndromes of chronic constipation in patients with maintenance hemodialysis and the relationship between different syndromes and the quality of life,this study provides a basis for clinical treatment based on syndrome differentiation,and provides a reference for better guiding TCM intervention of this disease and improving the quality of life of patients in the futureMethods.This research adopts the cross-sectional survey research,collecting 170 cases of general situation of maintenance hemodialysis patients with chronic constipation,TCM four diagnostic information,the quality of life situation,comparing the syndromes of traditional Chinese medicine distribution and its correlation with quality of life among various dimensions,discusses maintenance hemodialysis patients with chronic constipation of syndromes distribution characteristics,and the relationship between different syndrome and quality of life.Results.1.Analysis of general clinical data:a total of 170 patients with chronic constipation due to maintenance hemodialysis were included in this study,including 99 males and 71 females,with a male to female ratio of 1.79:1.The average age was 60.94±11.66 years old,which was divided into 18-44 years old group(youth group),45-59 years old group(middle age group),60-80 years old group(elderly group).The average age of dialysis was 69.07±47.94 months,which was divided into less than 12 months,12-60 months,61-120 months,121-180 months,and more than 180 months The age distribution of dialysis patients was the highest from 12 to 60 months,with 81 cases,accounting for 47.65%of the total cases.The first 3 cases were 55 cases(32.35%)of chronic glomerulonephritis,46 cases(27.06%)of diabetic nephropathy,and 16 cases(9.41%)of hypertensive renal damage.2.Distribution characteristics of TCM syndromes:in this study,the main syndromes of 170 patients with chronic constipation with maintenance hemodiaemia were deficiency constipation,which accounted for 82.94%in 141 cases,including 52 cases of Yang deficiency constipation(30.59%),33 cases of qi deficiency constipation(19.41%),29 cases of blood deficiency constipation(17.06%),and 27 cases of Yin deficiency constipation(15.88%).There were 29 cases of positive constipation,accounting for only 17.06%,including 14 cases of qi stagnation constipation(8.24%),8 cases of cold accumulation constipation(4.71%),and 7 cases of heat accumulation constipation(4.12%).Maintenance hemodialysis patients with chronic constipation of syndromes in the distribution of different gender,age,dialysis age difference has no statistical significance(P>0.05),the results showed that gender aspects of male TCM syndrome mainly Yang deficiency constipation,accounted for 28.28%,followed by qi deficiency constipation,accounted for 24.24%,women also is given priority to with Yang deficiency constipation,accounted for 33.80%,but followed by blood deficiency constipation,accounted for 16.90%;In terms of age,the results showed that Yang deficiency constipation(22.22%),blood deficiency constipation(22.22%)and Yin deficiency constipation(22.22%)were dominant in the 18-44 year old(youth)group,while Yang deficiency constipation was dominant in the 45-49 year old(middle age)group and 60-80 year old(old age)group.Yang deficiency constipation accounted for 36%and 29.41%of this age group,respectively.The results of dialysis age showed that the patients with dialysis age less than 12 months were mainly Yang deficiency constipation and Yin deficiency constipation,the patients with dialysis age of 12-60 months were mainly Yang deficiency constipation and blood deficiency constipation,and the patients with dialysis age more than 60 months were mainly Yang deficiency constipation and qi deficiency constipation.3.The influence of chronic constipation on the quality of life:the results of this study showed that the scores of most dimensions of the quality of life of patients with chronic constipation of maintenance hemodialysis were not high.The lowest dimension of the scores of the quality of life was the dimension of WS(work status)(score 31.47±36.82),and the highest dimension was the dimension of DSF(dialysis staff encouragement)(score 88.60 ± 16.76).The seven dimensions with scores lower than 60 were WS(31.47±36.82),RP(role-physical)(32.35±42.45),BKD(burden of kidney disease)(33.71 ± 24.72),GH(general health)(44.17±20.26),over all health(54.41 ± 20.18),RE(role-emotional)(56.27±46.89),and sleep(59.46 ± 21.92).Factors influencing the QOL score of patients with chronic constipation with maintenance hemodialysis include:gender,age,and dialysis age,among which age has statistical significance on the dimensions of PF(physical functioning),BP(bodily pain),SPL(symptoms/problem list)dimensions(P<0.05),and the results are negatively correlated.Dialysis age had a statistically significant effect on the regression of BKD(P<0.05),and the results were positively correlated4.The doctor of traditional Chinese medicine syndrome and survival quality correlation analysis:deficiency syndrome constipation patients' quality of life in PF,RP,BP,GH,EB(emotional well-being),RE,SF(social function),VT(vitality),SPL,EKD(effects of kidney disease),BKD,CF(cognitive function),QSI(quality of social interaction),sleep,SOS(social support),and DSF 16 dimensions,and overall health assessment score is lower than the empirical constipation patients.According to the statistical analysis,the differences between deficiency syndrome constipation and positive syndrome constipation in each dimension of quality of life were statistically insignificant for the most part,and the differences were statistically significant only in the dimensions of CF and overall health assessment(p<0.05).The TCM syndromes that affect the QOL score of patients with chronic constipation due to maintenance of hemodialysis include Yang deficiency constipation,qi deficiency constipation,cold accumulation constipation,and heat accumulation constipation.Among them,Yang deficiency constipation had statistical significance(P<0.05)in BP,GH and CF,and the results were negatively correlated.Conclusions.1.The TCM syndrome distribution of patients with chronic constipation with maintenance of hemodialysis is dominated by deficiency syndrome constipation,among which Yang deficiency constipation and qi deficiency constipation are the most common,while empirical constipation is less,among which heat accumulation constipation is the least common.Chronic constipation in patients with maintenance of hemodialysis has a longer course of disease,and Yang deficiency and qi deficiency are more common.Clinical syndrome differentiation treatment should focus on helping Yang and qi,pay attention to protecting vital qi,and do not blindly adopt the method of purging the bow-organs to relieve heat,such as rhubarb preparation,mirabilite,and senna leaf.2.Among the patients with chronic constipation due to maintenance of hemodialysis,the quality of life of patients with asthenia syndrome constipation is lower than that of patients with empirical constipation in all dimensions except WS,PS(patient satisfaction),and overall health assessment score.Therefore,clinical medical staff should pay more attention to the quality of life of patients with asthenia syndrome constipation.In TCM syndromes,Yang deficiency constipation is negatively correlated with BP,GH,and CF scores.Patients with Yang deficiency constipation have prominent physical pain,poor subjective evaluation of their health conditions,and some cognitive dysfunction. |
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