真武汤合五苓散加减联合西医常规方法治疗1例梗阻性肾病合并心力衰竭患者报告

A case report on one patient with obstructive nephropathy complicated with heart failure treated by modified Zhenwu decoction combined with Wuling powder and routine Western medicine

在面对重度心力衰竭(心衰)所产生的难治性水肿,兼见水肿导致的一系列临床症状,西医应用利尿剂等常规治疗无效时,可以中医温阳利水之治则从利尿的角度入手给予治疗。黑龙江中医药大学附属第一医院重症医学科于2020年11月12日收治1例52岁女性患者,既往有冠心病、糖尿病、高血压等多种慢性病,因梗阻性肾病合并重度心衰诱发顽固性水肿、喘促等症状;辅助检查显示心电图异常,胸部CT可见双肺间质性改变和部分炎性病变,头颅CT显示老年性脑改变;实验室检查显示凝血功能和多项生化指标异常。西医诊断为梗阻性肾病合并重度心衰,给予抗感染、扩张血管、利尿、平喘、营养支持等对症治疗;中医诊断为喘证(水凌心肺),治则为:温阳化气、利水渗湿,辨证施以真武汤合五苓散加减。服用中医汤剂后,患者尿量明显增多,水肿迅速消退,喘促伴呼吸困难缓解;治疗7 d后,患者喘促伴呼吸困难症状基本消失,饮食、睡眠正常,诸症好转,准予出院。本病例以真武汤合五苓散加减联合西医常规治疗来对症治疗重度心衰诱发的难治性水肿患者,能极快地缓解病情,为中医药治疗急危重患者提供了有效可行的方法和新的临床依据。

When facing refractory edema with a series of clinical symptoms caused by severe heart failure and edema and using Western medicine(WM)diuretics and other conventional treatment ineffective,the principle of warming yang and diuresis in traditional Chinese medicine(TCM)can be applied.On November 12,2020,one female patient,52 years old,was admitted in the Department of Critical Care Medicine of the First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine,and she had past histories of various chronic diseases,such as coronary heart disease,diabetes,hypertension,etc.Because of the development of obstructive nephropathy complicated with severe heart failure inducing refractory edema,dyspnea,etc.symptoms,auxiliary examinations were made,showing that there were abnormal electrocardiogram(ECG),interstitial changes in both lungs with partial inflammatory lesions in chest CT,senile brain changes in cranium CT examination,coagulation function and several biochemical indexes abnormal.The WM diagnosis was obstructive nephropathy complicated with severe heart failure,and symptomatic treatment such as anti-infection,vasodilation,diuresis,asthma relief and nutritional support were given;the TCM diagnosis was asthma syndrome(water touches the heart and lung).The therapeutic principles were as follows:warming yang and transforming qi,promoting diuresis and clearing dampness,and according to syndrome differentiation in the TCM,using adding and/or subtracting ingredients in the prescriptions of Zhenwu decoction and Wuling powder for the patient.After taking TCM decoction,the patient's urine volume was increased significantly,the edema was subsided rapidly and the dyspnea was relieved.After 7 days of treatment,the patient's symptom of dyspnea basically disappeared,her diet and sleep were normal,and all the other symptoms were improved,so she was allowed to be discharged.In this patient,the modified TCM Zhenwu decoction combined with Wuling powder was used to treat her refractory edema induced by severe heart failure,the therapeutic result was quite satisfactory,showing her condition very quickly alleviated and providing an effective and feasible TCM method and a new clinical basis for treatment of acute critically ill patient.