Clinical Study Of Bian-stone Therapy Along The Mericlians On Improving Motor Function In Hemodialysis Patients

BackgroundThe incidence of chronic kidney disease(CKD)in China has reached 10.8%,and there are about 130 million CKD patients,among which the number of end-stage renal disease(ESRD)is about 3 million.Maintenance hemodialysis(MHD)is the most commonly used alternative treatment for end-stage renal disease patients,accounting for more than 90%,and the number of hemodialysis patients is increasing year by year.According to the annual data of China National Renal Data System(CNRDS),as of December 31,2019,the number of dialysis patients in China has reached 720,000,including 630,000 hemodialysis patients,and more than 100,000 new hemodialysis patients each year.Due to the continuous improvement of blood purification technology and the gradual improvement of the national medical security system,the survival time of hemodialysis patients has been greatly prolonged,and the 5-year survival rate has exceeded 75%.However,due to the non-physiological replacement of hemodialysis,only partial renal function can be replaced,and there are still many complications,such as protein-energy wasting(PEW),continuous micro-inflammatory state,metabolic acidosis,and multiple endocrine disorders,which lead to the gradual decline of physiological function and the decline of motor function in hemodialysis patients.With the extension of dialysis time,Muscle atrophy is common in hemodialysis patients.Physical dysfunction can occur in severe cases,resulting in decreased motor function in hemodialysis patients.For the elderly hemodialysis patients,the decline of motor function is more obvious.More than 50%of elderly MHD patients need assistance from others in basic daily living activities such as eating,dressing,bathing and walking.More than 95%of the elderly hemodialysis patients can not complete their functional daily life activities,such as shopping on the street,preparing meals,etc.These poor functional states seriously affect the quality of life of patients and increase the rehospitalization rate and mortality of MHD patients.The motor function rehabilitation of hemodialysis patients has been paid more and more attention.However,limited to China’s national conditions,there is a relatively lack of rehabilitation physiotherapists,insufficient hardware facilities,and lagging development of community medical treatment.It is still difficult for MHD patients to carry out organized and personalized rehabilitation training.At present,the management of hemodialysis patients in China presents the status quo of "giving priority to treatment" and "insufficient rehabilitation".How to promote the rehabilitation of motor function of hemodialysis patients,improve the quality of life,and promote the return of patients to society is a current concern.ObjectiveProspective,randomized and controlled clinical research methods were used to evaluate the rehabilitation effect of Bian-stone therapy along meridians on motor function of hemodialysis patients.Methods76 hemodialysis patients were selected from the blood purification center of Wangjing hospital,Chinese Academy of traditional Chinese medicine.The Institute of clinical basic research of traditional Chinese medicine,Chinese Academy of traditional Chinese medicine,was entrusted to apply the central random system for random grouping.They were randomly divided into observation group and control group,with 38 cases in each group.The control group was treated with conventional western medicine,The observation group was treated with Bian-stone therapy along the Mericlians on the basis of routine western medicine treatment.The Bian-stone therapy along the meridians was performed by using a hammer-type vibrating needle along the stomach meridian of Foot Yangming and spleen meridian of foot Taiyin of both lower limbs,and each meridian was operated for 5～10min.The temperature,point,vibration and pressure of Zusanli and Sanyinjiao were highlighted,and the feeling of "sourness,numbness,distension" was the best.The Bian-stone therapy along meridians was performed in hemodialysis patients with MHD,with 4 weeks as a course of treatment,and 3 courses of treatment were observed for a total of 12 weeks.Before and after treatment,the exercise function of the patients were evaluated,and the evaluation indexes were cardiopulmonary endurance and muscle strength.Cardiopulmonary endurance was tested by 6 min walking test,and muscle strength was measured by isokinetic and isokinetic muscle strength.Equal length muscle strength measurement grip strength,lower limbs pedal force.Grip force measurement Select Guangdong Xiangshan Group Co.,Ltd.production of electronic grip gauge(implementation standard number:Q/XHCB07-2014),measurement of non-fistula arm,test 3 times,take the maximum.The pedal force of the lower limbs is tested by the dynamometer(model:LG3000)produced by BODYGREEN Company,and the maximum value is taken three times.Isokinetic muscle strength measurement of knee extension,flexion peak torque(N·M),the application of the United States BIODEX company produced isokinetic muscle strength assessment training system(model:System4)for measurement.To evaluate the rehabilitation effect of Bian-stone therapy along the meridians on motor function in MHD patients.Results1.General data analysis:A total of 76 maintenance hemodialysis patients were included in this study,including 45 males and 31 females,with a male to female ratio of 1.45:1.The average age was 58.42±13.405 years,the oldest age was 71 years,the youngest age was 45 years,the top three primary diseases were chronic nephritis,diabetic nephropathy,respectively and Hypertensive Renal damage.There was no difference between the two groups in age,gender,marital status,nationality,primary disease,dialysis age,case source,and diabetes mellitus(P>0.05).2.The two groups were paired before and after treatment.The difference of 6-min walking distance before and after treatment was compared between the two groups by one-way analysis of variance.The two groups increased after treatment compared with that before treatment.The degree of increase in the observation group was greater than that in the control group.The difference between the two groups was statistically significant(P<0.05).3.After treatment,the grip strength and pedal force of both lower limbs in the observation group were significantly higher than those in the control group by one-way analysis of variance(P<0.05).4.The two groups were paired before and after treatment.Single factor analysis of variance was used to compare the difference of grip strength,pedaling force of lower limbs and peak torque between the two groups before and after treatment.The absolute value of the difference of grip strength,pedaling force of lower limbs and peak torque of knee extension in the observation group was significantly higher than that in the control group,and the difference between the two groups was statistically significant(P<0.05).5.During the study,6 cases fell off in the control group and 3 cases in the observation group.There were no adverse reactions related to Bian-stone therapy along the mericlians.ConclusionsBian-stone therapy along the mericlians can improve cardiopulmonary endurance and muscle strength and improve motor function of hemodialysis patients.It is safe,effective and easy to operate.It can be used as an external treatment method of traditional Chinese medicine to improve motor function of MHD patients.