从病例谈经方干预血液透析相关并发症的策略

Strategies of interventing complications in hemodialysis with classical prescriptions from clinical cases

目前我国有40万长期维持血液透析的病人。血液透析延长了终末期肾衰竭患者的寿命,是目前最常见的一种肾脏替代治疗方法。但是血液透析治疗仍存在很多并发症,这些并发症的发生降低了病人的生活质量,甚至可能危及患者生命,而且有时候处理起来还比较棘手。在现代经方常常指经典有效的方剂,主要是来源于《伤寒杂病论》的方剂,经方多与宋元时代后出现的时方相对。方证相应是指证候与方剂一一对应,是随证用方,方证相应有很多优势,是临床有效的关键。血液透析患者很多并发症临床表现典型,常常可以与经典的方剂对应的证候相合,临床使用起来可很快缓解病人症状。该文主要从方证相应的角度分析了透析相关的肌痉挛、失衡综合征、不安腿综合征、尿毒症脑病、透析后心律失常、继发性甲旁亢6个临床病例,进一步探讨经方干预血液透析相关并发症的策略。

There are 400 thousand patients with long-term hemodialysis in China nowadays. Hemodialysis,as the most common alternative to renal replacement therapy,prolongs the life span of patients with end stage renal failure. However,there are still many complications of hemodialysis treatment. These complications reduce the quality of life of patients and may even endanger their life,and sometimes they are difficult to deal with. Classical prescriptions,commonly referred to as classical effective prescriptions in modern medicine,mainly indicating the formulas recorded in Treatise on Febrile Diseases and Synopsis of Golden Chamber,were relative to contemporary prescriptions emerging after Song and Yuan dynasties. Prescriptions corresponding to syndromes means one-to-one correspondence between syndromes and prescriptions,with many advantages and that is the key of clinical efficacy. Many complications of hemodialysis patients have typical clinical manifestations,which can match the syndromes corresponding to classical prescriptions,thus quickly relieving the symptoms of patients in clinical application. Six clinical cases of dialysis muscle spasm,disequilibrium syndrome,restless legs syndrome,uremic encephalopathy,post dialysis arrhythmia,and secondary hyperparathyroidism were used in this paper,to explore the intervention strategies for hemodialysis related complications.