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中医外治法治疗尿毒症瘙痒临床应用进展

Progress in clinical application of external treatment of TCM in uremic pruritus

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尿毒症瘙痒(UP)是终末期肾脏病患者常见并发症,严重降低患者生活质量.中医外治法治疗UP相较于中药内治法操作简便、起效迅速,且能避免口服药物所致首关效应及可能带来肝肾损伤,治疗手段主要包括中药外洗、药浴、熏洗、湿敷、灌肠、刮痧、针刺、耳穴贴压、穴位敷贴、穴位离子导入、自体血穴位注射等.目前,多数研究在西医常规治疗基础上加用中医外治法,可提高疗效,在改善瘙痒症状、炎症指标、睡眠质量及焦虑抑郁状态等方面具有一定优势;一些研究选取甲状旁腺激素、血磷、CRP、IL-6、组胺、SCr、BUN、β2-微球蛋白等指标评价疗效,结果提示中医外治法可改善患者微炎症状态,保护肾功能,但其作用机制有待进一步研究.现有研究存在以下问题:临床疗效评价量表不统一,难以横向比较和总结;瘙痒症状的缓解依据量表评判,主观性较强;研究疗程较短,无法评判远期疗效和安全性;部分研究未指明患者证型,难以体现中医辨证论治优势等,今后还需完善.
Uremic pruritus(UP)is a common complication in patients with end-stage renal disease,which seriously reduces the quality of life of patients.Compared with the internal treatment of TCM,the external treatment of TCM for UP is simpler and more effective,and can avoid the first pass effect caused by oral drugs and may cause liver and kidney damage.The treatment methods mainly include external washing of TCM,medicated bath,fumigation,wet compress,enema,scraping,acupuncture,auricular point sticking,acupoint application,acupoint iontophoresis,autologous blood acupoint injection and so on.At present,most studies are based on the conventional treatment of Western medicine,and the addition of external treatment of TCM can improve the efficacy,and has certain advantages in improving itching symptoms,inflammatory indicators,sleep quality,anxiety and depression.Some studies have selected parathyroid hormone,blood phosphorus,CRP,IL-6,histamine,SCr,BUN,β2-microglobulin and other indicators to evaluate the efficacy.The results suggest that external treatment of TCM can improve the micro-inflammatory state of patients and protect renal function,but further mechanism research is needed.The existing research has the following problems:the clinical efficacy evaluation scale is not uniform,and it is difficult to compare and summarize horizontally;the relief of pruritus symptoms is based on the scale evaluation,which is subjective;the course of treatment is short,and the long-term efficacy and safety can not be evaluated;some studies do not specify the patients'syndrome type,which is difficult to reflect the advantages of TCM syndrome differentiation and treatment,and needed to be improved in the future.

UremiaPruritusTCMExternal treatmentEtiological factors and pathogenesisReview

渠雅君、刘洋、李婉雯、唐好知、杨洪涛、郝娜

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天津中医药大学第一附属医院肾病科 国家中医针灸临床医学研究中心,天津 300381

尿毒症 瘙痒症 中医学 外治疗法 中医病因和病机 综述

国家自然科学基金湖北陈孝平科技发展基金会2022年度免疫性疾病研究槐杞黄专项基金人人享有肾脏健康-面向疫情下中老年慢性病患者系列科普宣传项目

81904141CXPJJH122003-0922KPHDRC00040

2024

国际中医中药杂志
中华医学会,中国中医科学院中医药信息研究所

国际中医中药杂志

CSTPCD
影响因子:0.411
ISSN:1673-4246
年,卷(期):2024.46(1)
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