不同浓度中药保留灌肠对预防甘露醇肾损害的临床疗效观察

Observation of the clinical efficacy on the prevention of the mannitol renal damage in patients treated with different concentrations of herbal retention enema

关键词:  通腑泻浊法  中药灌肠  脑卒中  甘露醇  急性肾损害

Key words:  eliminating the turbid by purgation method  herbal enema  stroke  mannitol  acute kidney injury

摘要:

[目的] 探讨采用不同浓度中药保留灌肠，预防脑卒中患者静脉滴注甘露醇引起急性肾损害的临床疗效。[方法] 将符合纳入标准的30例患者随机分为试验组15例和对照组15例，两组颅压升高患者应用甘露醇为主要脱水剂，并采用相同剂量中药保留灌肠30 min，每日1次。试验组采用50 mL高浓度液保留灌肠，对照组采用200 mL常用浓度液保留灌肠。通过检测两组患者治疗前、治疗第5天及治疗10 d血肌酐、尿素氮、血清胱抑素C进行疗效评估，并对患者接受中药保留灌肠的舒适程度进行比较。[结果] 试验组发生甘露醇肾损害1例，发生率6.67%，对照组1例因脑水肿加重死亡，发生甘露醇肾损害2例，发生率为13.33%，差异无统计学意义（P>0.05）.两组患者治疗过程中各项肾功能指标情况相似（P>0.05）.两组患者接受灌肠后舒适程度比较，试验组优于对照组（P<0.05）.[结论] 通腑泄浊法保留灌肠能有效预防静脉滴注甘露醇后急性肾损害，且使用高浓度、液体量较少的中药保留灌肠药疗效肯定，患者接受程度、依从性、感觉舒适度更高，值得深入探讨。

Abstract:

[Objective] To investigate the clinical efficacy on the stroke patients with acute renal damage caused by the mannitol treated by different concentrations of herbal retention enema. [Methods] The 30 patients were recruited and randomly divided into the test group and the control group, 15 cases in each group. Two groups of patients with increased intracranial pressure caused by the mannitol as the main dehydrating agent. The same dose of retention enema herb was used for 30 min, 1 time every day. Patients in test group were treated with 50 mL concentrated liquid retention enema, while the control group with 200 mL common concentration liquid retention enema. The efficacy of serum creatinine, blood urea nitrogen, serum cystatin C and comfort acceptance of patients were detected to assess the efficacy of patients between two groups before treatment, 5 days and 10 days after treatment. [Results] One case of damage occurs in treatment group with mannitol renal damage. The incidence was 6.67%. Mannitol renal damage occurred twice including one died due to cerebral edema in control group. The incidence was 13.33%. Both group were no statistically significant difference (P>0.05). The renal function indexes of patients between two groups in the process were similar (P>0.05). Comparison of comfort level of receiving enema of patients between two groups, the test group was better (P<0.05). [Conclusion] Eliminating the turbid by purgation method retention enema can effectively prevent the acute kidney damage caused by intravenous mannitol. The use of high concentration, less amount of fluid herbal retention enema is effective. In addition, patients' acceptability, compliance and comfort are on a higher degree. All above are worthy of further exploration.