活血疏风止痒中药外洗联合血液灌流对维持性血液透析患者皮肤瘙痒改善及血液透析充分性指标的影响

Effect of external washing with the TCM Huoxue Shufeng Zhiyang Recipe combined with hemoperfusion on the improvement of skin pruritus and hemodialysis adequacy indexes in patients with maintenance hemodialysis

目的探讨活血疏风止痒中药外洗联合血液灌流对维持性血液透析患者皮肤瘙痒改善及血液透析充分性指标的影响。方法将2019年8月-2021年8月收治的60例尿毒症期皮肤瘙痒症患者随机分成对照组和观察组,对照组采用血液灌流联合血液透析治疗,观察组在此基础上,联合活血疏风止痒方外洗治疗,2组均连续治疗12周。观察比较2组治疗前后DirkR.Kuypers评分、视觉模拟评分(VAS)、钙磷代谢指标[钙(Ca)、磷(P)、甲状旁腺激素(PTH)]、血液透析充分性指标[尿素氮(Bun)、β2-微球蛋白(β2-MG)、血肌酐(Scr)、Kt/v]变化,并对比2组总有效率和不良反应事件情况。结果治疗后,2组DirkR.Kuypers评分、VAS评分,P、PTH水平,Bun、β2-MG、Scr水平均明显降低(P<0.05),且观察组上述评分和指标水平均明显低于对照组(P<0.05);治疗后,2组Ca水平,Kt/v均明显升高(P<0.05),且观察组该两项指标水平均明显高于对照组(P<0.05);治疗期间及治疗前后2组患者肝功能指标(AST、ALT)、血常规(PLT、HG、WBC)均未发生异常,也均未发生不良反应事件。结论活血疏风止痒中药外洗联合血液灌流能够显著缓解尿毒症皮肤瘙痒症患者临床症状,提高血液透析充分性,促进Bun、Scr、β2-MG等中小分子毒素得到更好的净化,有助于改善本病患者生存质量。

Objective To investigate the effect of the external washing therapy with the TCM Huoxue Shufeng Zhiyang Recipe combined with hemoperfusion on the improvement of skin pruritus and hemodialysis adequacy indexes in patients with maintenance hemodialysis.Methods A total of 60 uremia patients with pruritus admitted from August 2019 to August 2021 were randomly divided into a control group and an observation group.The control group was treated with hemoperfusion combined with hemodialysis,while the observation group was additionally treated with the external washing of Huoxue Shufeng Zhiyang Recipe,both for 12 consecutive weeks.The DirkR.Kuypers scores,visual analogue scale(VAS)scores,calcium phosphorus metabolism indexes[calcium(Ca),phosphorus(P),parathyroid hormone(PTH)],hemodialysis adequacy indexes[blood urea nitrogen(Bun),β2-microglobulin(β2-MG),serum creatinine(Scr),Kt/v],and the total effective rates and adverse reactions before and after treatment were compared between the two groups.Results After treatment,the DirkR.Kuypers scores,VAS scores,levels of P,PTH,Bun,β2-MG,Scr were significantly decreased in the two groups(P<0.05),and the observation group was significantly lower than the control group(P<0.05).After treatment,the levels of Ca and Kt/v were significantly increased in both groups(P<0.05),and the observation group was significantly higher than the control group(P<0.05).During,before and after treatment,there were no abnormal liver function indexes(AST,ALT),blood routine test(PLT,HG,WBC)scores,and no adverse reactions in the two groups.Conclusion External washing with the TCM Huoxue Shufeng Zhiyang Recipe combined with hemoperfusion can significantly relieve the clinical symptoms of uremia patients with pruritus,improve the adequacy of hemodialysis,and promote the better purification of small and medium-molecule toxins such as Bun,Scr andβ2-MG,and contribute to improve their quality of life.