尿毒症皮肤瘙痒症的中西医临床研究进展

A Review on the Application of Traditional Chinese Medicine and Western Medicine in Treating Uremic Pruritus

摘要: 本文概述尿毒症皮肤瘙痒症的发病机制、中医概念以及中西医的治疗进展。尿毒症相关性皮肤瘙痒是终末期肾病患者中最常见和最痛苦的并发症之一，其患病率因国家、透析方式、透析单位和研究人群而异。西医发病机制可能与毒素沉积、周围神经病变、免疫系统失调、阿片样物质失衡、透析不充分或过度失水等因素有关；通常采用的治疗方法包括局部润肤治疗、抗组胺药物治疗、阿片类药物治疗、抗癫痫药物、充分透析、甲状旁腺切除术、光疗。中医主要病机为肾气亏虚，湿浊壅滞气机，主要以“标本兼顾”为总原则，通过中药汤剂内服、针灸、中药药浴、中药熏蒸、中药贴敷、中药灌肠等方法治疗。因其发病机制不明确，在西医治疗上效果不能让人十分满意。中医内治和外治并驱，可以明显改善患者的症状和生活质量。在往后的UP治疗过程中，应考虑采用中西医结合的治疗方案，做到更有效、更经济、更规范。

Abstract: This article summarizes the pathogenesis, concept of traditional Chinese medicine, and treatment progress of both traditional Chinese and Western medicine in relation to uremic pruritus. Uremic pruritus is one of the most common and painful complications in patients with end-stage renal disease, and its prevalence varies depending on countries, dialysis methods, dialysis units, and the population studied. The pathogenesis of Western medicine may be related to toxin deposition, peripheral neuropathy, immune system disorders, opioid imbalance, inadequate dialysis, or excessive dehydration. Commonly used treatments include topical emollient therapy, antihistamines, opioids, antiepileptic drugs, sufficient dialysis, parathyroidectomy, and phototherapy. The main pathogenesis of traditional Chinese medicine is kidney qi deficiency and dampness and turbidity stagnation. It mainly adopts the general principle of “treating both the root and the branch” through methods such as internal administration of decoction, acupuncture, medicinal bath, fumigation, patching, and enema. Due to its unclear pathogenesis, the effect of Western medicine treatment is not entirely satisfactory. The combined use of internal and external treatment in traditional Chinese medicine can significantly improve patients’ symptoms and quality of life. In future UP treatment, it is recommended to consider adopting a combined treatment plan of traditional Chinese and Western medicine to achieve more effective, economic and standardized results.