| Background.With the prolongation of the life span of patients with maintenance hemodialysis(MHD),the incidence of fatigue increased gradually.Fatigue is the most common clinical symptom reported by hemodialysis patients.It not only reduces the quality of life of patients,but also increases the risk of all-cause mortality,cause-specific mortality and cardiovascular disease hospitalization rate,which seriously affects the daily life and prognosis of patients.Although in recent years,more and more attention has been paid to the fatigue of hemodialysis patients,so far there is no clinical intervention guide for fatigue.Therefore,how to prevent,early identify and effectively intervene the fatigue of MHD patients has become the focus of clinical workers.Objective.Through the multi center cross-sectional study,this paper analyzes the distribution of TCM syndromes in patients with maintenance hemodialysis fatigue,discusses the relationship between different fatigue conditions and TCM syndromes,and the influencing factors of fatigue,in order to pay close attention to the disease in clinical practice and identify it early,at the same time,give full play to the characteristic advantages of syndrome differentiation and treatment for Chinese medicine in the future,individualize treatment and improve maintenance hemodialysis patients Fatigue can provide some clinical reference for improving the quality of life and long-term survival rate of dialysis patients.Methods.In this study,a multi center cross-sectional study was conducted to evaluate the fatigue of MHD patients according to the Piper Fatigue revised scale,and to systematically collect the general situation of MHD patients with fatigue,the four diagnostic information of traditional Chinese medicine and laboratory index data,analyze the distribution of TCM Syndromes of MHD patients with fatigue,explore the correlation between different fatigue conditions and TCM syndromes,and analyze the patients with clinical data and laboratory index The influence factors of fatigue.Results.1.Analysis of general clinical dataIn this study,172 patients with MHD fatigue were included,including 99 males and 73 females.The ratio of males to females is about 1.36:1.Males are more than females.The age distribution of the patients in the 60-89-year-old group(the elderly group)accounts for the highest proportion.The average age of the patients included is(62.14±13.09)years.The proportion of the patients in the 60-120-month-old group is the highest.The average dialysis age of the patients included is(66.88d±57.78)months,the dialysis frequency of most patients was 3/w.The top three primary diseases were diabetic nephropathy,chronic glomerulonephritis and hypertensive renal damage.MHD patients included in this study are mainly those who are married,retired and educated in middle school or above.The general fatigue status of 172 patients with MHD fatigue was mostly moderate and severe level,including 10 cases of mild fatigue,103 cases of moderate fatigue,59 cases of severe fatigue,the average fatigue score was(5.48±1.48),and the fatigue scores of all dimensions were behavior,perception,emotion and cognition from high to low.2.Distribution characteristics of TCM SyndromesIn the distribution of TCM Syndromes of 172 patients with MHD fatigue,most of them were spleen and kidney yang deficiency syndrome(51 cases),spleen and Kidney Qi Yin deficiency syndrome(46 cases),liver and kidney yin deficiency syndrome(31 cases),spleen and kidney qi deficiency syndrome(27 cases),yin and yang deficiency syndrome(17 cases).The number of mixed syndrome and marked positive syndrome can be 1-2.37 patients showed simple deficiency syndrome,but no single marked positive syndrome.There was no significant difference in the distribution of MHD fatigue patients in gender,age,dialysis age and primary disease(P>0.05).In the gender distribution,the deficiency of spleen and Kidney Yang was the most common in male patients,followed by the deficiency of spleen and kidney qi and Yin,while the deficiency of spleen and kidney yang and spleen and kidney qi and Yin coexisted in female patients,followed by the deficiency of liver and kidney yin.According to the age of the patients,the patients with MHD fatigue were divided into young middle-aged group(<60 years old)and old-age group(? 60 years old).Among the three main primary diseases of MHD patients,the deficiency of spleen and kidney qi and Yin accounted for the highest proportion in diabetic nephropathy and chronic glomerulonephritis,and the deficiency of spleen and kidney yang accounted for the highest proportion in hypertensive kidney damage.3.Correlation analysis of fatigue and TCM SyndromesThere was no significant difference in the distribution of fatigue degree among patients with different syndrome of deficiency(P<0.05).In patients with mild and moderate fatigue,the proportion of Spleen Kidney Qi Yin deficiency was the highest(50.00%,31.07%),in patients with severe fatigue,the proportion of spleen kidney yang deficiency was the highest(35.59%),followed by liver kidney yin deficiency(18.64%).There were significant statistical differences in the fatigue scores of the patients with different deficiency syndrome.The average fatigue score of the patients with spleen kidney yang deficiency syndrome was(5.76±1.46),the average fatigue score of the patients with Yin Yang deficiency syndrome was(5.89±1.23),which were higher than the average fatigue score of the patients with Spleen Kidney Qi Yin deficiency syndrome(P<0.05).There was no statistical significance in the distribution of the degree of fatigue in different standard cases(P>0.05).The scores of MHD patients with damp heat syndrome and wind movement syndrome were higher than those of patients without such standard cases(P=0.036,P=0.017).There was significant difference in the distribution of fatigue between the patients with pure deficiency syndrome and the patients with mixed deficiency and excess syndrome(P<0.01).The proportion of the patients with simple deficiency syndrome in the patients with mild fatigue(70.00%)was significantly higher than that in the patients with moderate and severe fatigue.The proportion of the patients with mixed deficiency and excess syndrome in the patients with severe fatigue was the highest(88.14%),and the proportion in the patients with moderate fatigue was 77.67%,mixed deficiency and excess syndrome The fatigue score of patients was higher than that of simple deficiency syndrome(P<0.05).The TCM symptom scores of the patients with different deficiency syndrome were significantly different(P<0.05).The lowest TCM symptom score was(2830±9.23),which was lower than that of the patients with spleen kidney yang deficiency syndrome,liver kidney yin deficiency syndrome and Yin Yang deficiency syndrome(P<0.05).The average TCM symptom score of the patients with spleen kidney qi deficiency syndrome was(32.22±13.11),which was lower than that of the patients with liver kidney yin deficiency syndrome The average TCM symptom score of patients with mild fatigue was the lowest(16.80±5.43),which was lower than that of patients with moderate and severe fatigue(P<0.01).4.Analysis of the influencing factors of fatigueThere was no significant difference in the distribution of gender,age of dialysis,frequency of dialysis,marital status and main primary diseases in different fatigue levels(P<0.05).There was significant difference in the distribution of age,occupational status and education level in different fatigue levels(P=0.008,P=0.003,P=0.002).In terms of age,the average age of patients with mild fatigue was(49.10±13.30),moderate fatigue was(60.61 ± 13.41),and severe fatigue was(63.10±12.50).The difference was statistically significant(P<0.05).In terms of occupational status,the number of retired patients is the largest,and the proportion of patients with moderate and severe fatigue is significantly higher than that of patients with mild fatigue.The proportion of active patients with mild fatigue is the largest(50%),which is significantly higher than that of patients with moderate and severe fatigue.In terms of education level,the proportion of mild fatigue patients with college education level is the highest(80%),significantly higher than the proportion of moderate and severe fatigue.The mean fatigue score of patients with diabetes mellitus was higher than that of patients without diabetes mellitus,the difference was statistically significant(P<0.05).In this study,some clinical routine monitoring laboratory indexes of MHD patients were selected.The results showed that Bun,Hb,Ca,P,Ca×P,SF,IPTH,TG,CHO,Glu,K,Na,Cl,HCO3-,Kt/v had no significant statistical difference in the distribution of patients with different fatigue degrees(P>0.05).Scr,UA,ALB had significant statistical difference in the distribution of patients with different fatigue degrees(P<0.01).The highest UA level of patients with mild fatigue was(507.30±87.88)umol/L,which was higher than that of patients with moderate and severe fatigue(P<0.01).The lowest Scr level of patients with severe fatigue was(798.81±235.37)umol/L,which was lower than that of patients with mild and moderate fatigue(P<0.05).The highest ALB level of patients with mild fatigue was(40.76±1.47)g/L,and that of patients with moderate fatigue was(39.27±2.68)g/L.The ALB level of the patients with severe fatigue was lower than that of the patients with mild and moderate fatigue(P<0.05),which was(38.01±2.30)g/L.In this study,multiple linear stepwise regression was used to analyze the influencing factors of MHD patients' fatigue score.The results showed that the final independent variables into the equation were ALB,on-the-job,deficiency and excess syndrome,spleen and Kidney Qi Yin deficiency syndrome,combined with diabetes mellitus(P<0.01),suggesting that patients' ALB level,on-the-job,spleen and Kidney Qi Yin deficiency syndrome were negatively correlated with patients' fatigue score,combined with diabetes,deficiency and excess syndrome and deficiency and excess syndrome There was a positive correlation between patients' fatigue scores.Conclusions.1.The traditional Chinese medicine syndromes of the patients with maintenance hemodialysis fatigue are characterized by the deficiency of the original and the excess,and the deficiency and the excess are mixed.A few patients are characterized by the single deficiency of the original.Among them,the deficiency of the original syndrome is mainly characterized by the deficiency of spleen and kidney yang and the deficiency of spleen and kidney qi and Yin,and the standard demonstration is mainly characterized by the syndrome of blood stasis and damp heat.2.The degree of fatigue of maintenance hemodialysis patients is mostly moderate or severe,and the scores of behavior dimension and perception dimension are relatively high.The age,education level,occupational status,SCR,UA,ALB of patients are related to the degree of fatigue.Through multiple linear regression analysis,the score of fatigue is negatively related to the level of ALB,on-the-job,spleen and Kidney Qi Yin deficiency syndrome,and positively related to the combination of diabetes and deficiency and excess syndrome.We should pay more attention to the fatigue of patients with diabetes mellitus and the elderly,monitor the level of Alb closely,and improve the nutritional status of patients in time to reduce the level of fatigue3.In the fatigue degree of patients with maintenance hemodialysis,spleen-kidney qi-Yin deficiency was the main syndrome in patients with mild and moderate fatigue,while spleen-kidney Yang deficiency was the main syndrome in patients with severe fatigue.The fatigue score of patients with deficiency of spleen and kidney qi and Yin was lower than that of patients with deficiency of kidney Yang and deficiency of Yin and Yang,the fatigue score of patients with syndrome of dampness and heat and syndrome of wind movement was higher in the standard evidence,and the fatigue score of patients with single syndrome was lower than that of patients with deficiency and solid combined syndrome.The average TCM symptom score of patients with mild fatigue was lower than that of patients with moderate and severe fatigue,and that of patients with spleen-kidney qi-Yin deficiency was lower than that of spleen-kidney Yang deficiency,liver-kidney Yin-yin deficiency and Yin-Yang deficiency.Timely recognition and intervention of fatigue in hemodialysis patients is of great significance in clinical practice,which can help to reduce clinical symptoms. |
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