CJI (Traditional Chinese Medicine)
经方为主治疗透析患者睡眠障碍经验
游培博 1,2,刘文军 1
1.中国中医科学院广安门医院肾病科,北京 100053;2.北京中医药大学临床医学院,北京 100029摘要:睡眠障碍是透析患者常见的并发症之一,严重影响患者生活质量及预后。如何改善透析患者的睡眠质量、提高其生活质量和生存率仍是临床一大难题。目前透析患者睡眠障碍的发病机制尚不清楚,西医治疗以镇静催眠类药物为主,但不良反应大,长期使用会出现药效降低且易产生依赖性。中医药在改善透析患者睡眠障碍及生活质量方面疗效确切。本文介绍了以经方为主辨证用药治疗透析睡眠障碍的经验,临床效果显著。关键词:透析;睡眠障碍;经方;伤寒论
DOI:10.3969/j.issn.1005-5304.2017.08.027
中图分类号:R277.522.5 文献标识码:A 文章编号:1005-5304(2017)08-0113-03
Experience in Treatment of Sleep Disorder of Dialysis Patients with Classic Prescriptions
YOU Pei-bo1,2, LIU Wen-jun1 (1. Department of Nephrology, Guang’anmen Hospital of China Academy of Chinese Medical Sciences, Beijing 100053, China; 2. Clinical College, Beijing University of Chinese Medicine, Beijing 100029, China)
Abstract: Sleep disorder is a common complication of dialysis patients, seriously affecting the life quality and prognosis of the patients. How to improve the quality of sleep of dialysis patients, their quality of life and survival rate, is still a major clinical problem. At present, the pathogenesis of dialysis patients with sleep disorders is not clear. Western medicine treatment is sedative hypnotic drugs, with obvious adverse reactions, and long-term use will reduce the efficacy and easy to produce dependencies. The effects of TCM on improving sleep disorders and life quality of dialysis patients is worth expectation. This article introduced the experience in using classic prescriptions and dialectical treatment for dialysis sleep disorder, with significant clinical efficacy.
Key words: dialysis; sleep disorder; classic prescriptions; Shang Han Lun
睡眠障碍是血液透析和腹膜透析患者常见的并发症之一。资料显示,透析患者普遍存在睡眠障碍,其发病率高达80%,严重影响患者生活质量与疾病预后[1]。由于透析患者出现睡眠障碍的发病机制尚不清楚,西医治疗有一定的风险,且药物依赖及不良反应较大。笔者以经方为主,辨证治疗透析患者睡眠障碍获得满意疗效,兹结合案例介绍如下。
1 不宁腿综合征致睡眠障碍
案例 1:患者,男,34 岁,2016 年 5 月 11 日就诊。患者血液透析4年余。现透析方案:高通量透析,
3次/周;联合血液灌流,1次/周。每次透析后静脉注射左卡尼丁1 g。2016 年 5 月 6日,透析前检查示:
血肌酐(SCr)1156 μmol/L,血尿素氮 34 mmol/L,血钙 2.39 mmol/L,血磷 2.09 mmol/L,血红蛋白 119 g/L, 血清全段甲状旁腺激素480 pq/mL。血压146/87 mm Hg (1 mm Hg=0.133 kPa),心率 76 次/min。患者自觉下肢不适感,小腿部尤明显,影响睡眠,需下床行走累后方可入睡,大便偏干,舌淡红,苔黄厚,脉弦细略数。西医诊断:不宁腿综合征、继发性甲状旁腺功能亢进症。中医辨证:心肝阴血不足证。治以养血柔筋、安神。予加味芍药甘草汤:麸炒白芍40 g,炙甘草 10 g,木瓜15 g,牛膝15 g,伸筋草30 g,全蝎3 g,蜈蚣1条,鸡血藤30 g。每日1剂,水煎服。服药1周后,下肢不适消失,睡眠明显改善。守方继服1周善后。
按:芍药甘草汤出自《伤寒论•辨太阳病脉证并治》“伤寒,脉浮,自汗出,小便数,心烦,微恶寒,脚挛急。反与桂枝欲攻其表,此误也……若厥愈足温者,更作芍药甘草汤与之,其脚即伸”,原方由白芍、甘草两味药组成,系为误汗亡阳的腿脚挛急证而设,药少而力专,二者配伍具有酸甘化阴、养血柔肝、缓急止痛之效,主治营阴不足、肝脾不和所致脘腹诸痛、四肢挛急等症。