消风散加减、西替利嗪内服联合血液灌流对血液透析皮肤瘙痒患者的疗效观察

目的探讨消风散加减、西替利嗪内服联合血液灌流对血液透析皮肤瘙痒患者的临床疗效。方法选择南京中医药大学沭阳附属医院2017年1月至2019年12月期间收治的血液透析皮肤瘙痒患者162例。采用随机数字法分为A组、B组和C组,各54例。所有患者给予血液透析,A组给予血液灌流治疗,B组给予消风散加减、西替利嗪内服治疗,C组给予消风散加减、西替利嗪内服联合血液灌流治疗,疗程3个月。采用视觉模拟评分(visual analogue score,VAS)及改良Duo氏瘙痒评分(Duo's pruritus score,Duo's VAG)评估患者瘙痒程度,采用匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)评估患者睡眠质量。比较三组治疗前后瘙痒程度、睡眠质量、血肌酐(serum creatinine,Scr)、血尿素氮(blood urea nitrogen,BUN)、β2微球蛋白(β2-microglobulin,β2-MG)、C-反应蛋白(C-reactive protein,CRP)、甲状旁腺激素(parathyroid hormone,PTH)、血钙(Ca)、血磷(P)等指标变化。结果三组治疗前VAS评分、Duo's VAG评分、PSQI评分、Scr、BUN、β2-MG、CRP、PTH、Ca及P等水平比较,差异无统计学意义(P>0.05);治疗后,三组VAS评分、Duo's VAG评分、PSQI评分、β2-MG、CRP、PTH、P水平均降低(P<0.05),Scr、BUN、Ca水平均无明显变化(P>0.05);C组治疗后VAS评分、Duo's VAG评分、PSQI评分、β2-MG、CRP、PTH、P均低于A组和B组(P<0.05);C组总有效率90.74%高于A组(74.07%)和B组(72.22%),差异有统计学意义(P<0.05)。结论消风散加减、西替利嗪联合血液灌流可有效改善血液透析皮肤瘙痒患者瘙痒症状,提高睡眠质量,降低血清PTH、β2-MG、CRP、P等指标水平,临床疗效满意。

Efficacies of Xiaofengsan Powder,cetirizine and hemoperfusion on hemodialytic patients with pruritus

Objective To explore the clinical efficacies of Xiaofeng Powder,cetirizine and hemoperfusion for hemodialytic patients with pruritus.Methods From January 2017 to December 2019,a total of 162 pruritics on hemodialysis were recruited and divided randomly into groups A,B and C(n=54 each).All of them received hemodialysis.Group A underwent hemoperfusion,group B had oral intakes of Xiaofengsan Powder and cetirizine while group C received a 3-month therapy of Xiaofengsan Powder,cetirizine and hemoperfusion.The improvements of pruritus and sleep quality,the changes of serum creatinine(Scr),urea nitrogen(BUN),β2-microglobulin(β2-MG),C-reactive protein(CRP),parathyroid hormone(PTH),calcium(Ca)and phosphorus(P)were compared before and after treatment.Results No significant differences existed in the levels of VAS score,Duo's Vag score,Pittsburgh Sleep Quality Index(PSQI)score,Scr,BUN,β2-MG,CRP,PTH,Ca and P among three groups(P>0.05).After treatment,VAS score,Duo's Vag score,PSQI score,β2-MG,CRP,PTH and P declined markedly(P<0.05)and the levels of Scr,BUN and Ca showed no obvious changes(P>0.05);after treatment,VAS score,Duo's Vag score,PSQI score,β2-mg,CRP,PTH and P were lower in group C than those in groups A and B(P<0.05).The total effective rate of group C was 90.74%and it was higher than those of groups A(74.07%)and B(72.22%)(P<0.05).Conclusions Xiaofengsan Powder and cetirizine plus hemoperfusion can effectively improve the pruritic symptoms of hemodialytic patients,improve their quality of sleep and reduce the serum levels of PTH,β2-MG,CRP and P.And the clinical efficacy is satisfactory.