中药外洗联合盐酸西替利嗪对行血透治疗尿毒症患者皮肤瘙痒症状及睡眠质量的影响

Effects of external washing with traditional Chinese medicine combined with cetirizine hydrochloride on skin pruritus and sleep quality in patients with uremia undergoing hemodialysis

目的观察中药外洗联合盐酸西替利嗪对行血透治疗尿毒症患者皮肤瘙痒症状及睡眠质量的影响。方法选取2018年1月至2021年1月间在西安市中医医院血液净化中心行血透治疗的尿毒症120例患者为研究对象,采用随机数表法分为观察组和对照组,每组60例。对照组患者采用盐酸西替利嗪治疗,观察组患者在对照组治疗的基础上联合中药外洗治疗,均治疗8周。评价两组患者治疗后的疗效,以及治疗前后的瘙痒程度[视觉模拟评分(VAS)及四项目瘙痒量表(FIIQ)],睡眠质量[匹兹堡睡眠质量指数(PSQI)],钙(Ca)、磷(P)水平和血清因子变化情况,并比较两组患者治疗期间的不良反应发生情况。结果治疗8周后,观察组患者的治疗有效率为96.67%,明显高于对照组的76.67%,差异有统计学意义(P<0.05);治疗后,观察组患者的VAS、FIIQ及PSQI评分分别为(1.39±0.55)分、(5.37±0.81)分、(5.85±2.63)分,明显低于对照组的(4.51±2.69)分、(8.75±1.53)分、(9.22±2.59)分,差异均有统计学意义(P<0.05);治疗后,观察组患者的P、5-羟色胺(5-HT)水平分别为(1.96±0.31)mmol/L、(299.66±78.07)pg/mL,明显低于对照组的(2.14±0.35)mmol/L、(416.03±101.84)pg/mL,差异均有统计学意义(P<0.05);治疗后,观察组患者的甲状旁腺激素(PTH)、β2微球蛋白(β2-MG)、C-反应蛋白(CRP)水平分别为(489.76±17.65)pg/mL、(17.15±5.21)mg/L、(5.54±1.47)mg/L,明显低于对照组的(497.63±19.44)pg/mL、(21.04±5.67)mg/L、(6.69±1.87)mg/L,差异均有统计学意义(P<0.05);治疗期间,两组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论中药外洗联合盐酸西替利嗪可明显改善行血透治疗尿毒症患者皮肤瘙痒症状,改善患者睡眠质量,疗效显著,且安全性高。

Objective To observe the effect of external washing with traditional Chinese medicine combined with cetirizine hydrochloride on skin pruritus and sleep quality in patients with uremia undergoing hemodialysis.Methods A total of 120 patients with uremia undergoing hemodialysis in Blood Purification Center of Xi'an Hospital of Traditional Chinese Medicine were enrolled as the research objects between January 2018 and January 2021.According to random number table method,they were divided into an observation group and a control group,with 60 patients in each group.The control group was treated with cetirizine hydrochloride,while the observation group was treated with external washing with TCM on basis of control group,all for 8 weeks.The curative effect after treatment,changes in pruritus degree[Visual Analogue Scale(VAS),Four-item Itch Questionnaire(FIIQ)],sleep quality[Pittsburgh Sleep Quality Index(PSQI)],levels of calcium(Ca),phosphorus(P),and serum factors before and after treatment in both groups were evaluated.The occurrence of adverse reactions during treatment was recorded and compared between the two groups.Results After 8 weeks of treatment,the effective rate of treatment in the observation group was 96.67%,which was significantly higher than 76.67%in the control group(P<0.05).After treatment,the scores of VAS,FIIQ,and PSQI in the observation group were(1.39±0.55)points,(5.37±0.81)points,and(5.85±2.63)points,which were significantly lower than(4.51±2.69)points,(8.75±1.53)points,(9.22±2.59)points in the control group(P<0.05).After treatment,the levels of serum P and 5-hydroxytryptamine(5-HT)in the observation group were(1.96±0.31)mmol/L and(299.66±78.07)pg/mL,which were significantly lower than(2.14±0.35)mmol/L,(416.03±101.84)pg/mL in the control group(P<0.05).After treatment,the levels of parathyroid hormone(PTH),β2 microglobulin(β2-MG),and C-reactive protein(CRP)in the observation group were(489.76±17.65)pg/mL,(17.15±5.21)mg/L,and(5.54±1.47)mg/L,which were significantly lower than(497.63±19.44)pg/mL,(21.04±5.67)mg/L,(6.69±1.87)mg/L in the control group(P<0.05).During treatment,there was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).Conclusion External washing with traditional Chinese medicine combined with cetirizine hydrochloride can significantly improve the symptoms of skin pruritus and sleep quality of uremic patients undergoing hemodialysis,which has significant curative effect and high safety.