居家照護之末期慢性腎臟病皮膚疾患中醫治療病例報告

Home healthcare A Traditional Chinese Medicine Intervention Case Report of End Stage Renal Disease with Skin Disease

10.29810/SJTTCM.202112_12(2).0004

李姿宜(Tzu-Yi Lee)；許名鈞(Ming-Chun Hsu)；高宗桂(Tsung-Kuei Kao)

慢性腎炎 ； 尿毒搔癢症 ； 中醫 ； 針灸 ； 貼灸 ； chronic kidney disease ； uremic pruritus ； Chinese medicine ； acupuncture ； application therapy

臺灣中醫科學雜誌

12卷2期（2021 / 12 / 26）

40 - 50

繁體中文

此為97歲男性。公元2021年2月14日時因嚴重下半身水腫伴隨左膝蜂窩性組織炎於屏東醫院腎臟內科住院治療，住院期間使用利尿劑仍無法有效改善水腫，並出現肺炎、雙側肺部浸潤、心臟衰竭及尿毒性腦病變導致的意識昏迷，因此於2月17日進行導管置放並開始規律血液透析後，意識逐漸恢復，但開始出現嚴重皮膚搔癢症狀，嚴重時會冒出大小水疱、整片紅疹、口腔黏膜牙齦出血，西醫診斷患有類天疱瘡及尿毒搔癢症，給予類固醇藥膏及抗組織胺皆無法有效改善，故於2021年11月開始合併中醫治療，經中醫治療2週後，搔癢情形大幅降低，排尿量增，意識進一步改善。經中西合療後，這位末期慢性腎病患者獲得很好的療效，以此病例分享經驗。慢性腎病中西醫合療是未來治療可以考慮的一個模式。

The present study focuses on a 97-year-old male who has a history of chronic heart disease with pacemaker insertion in 2018. The patient was admitted to Pingtung Hospital Nephrology ward due to serious lower limb edema with left knee cellulitis on February 14, 2021. However, the patient's lower limb edema didn't improve effectively after using diuretics. Moreover, he was diagnosed with pneumonia, bilateral pleural effusion, heart failure and uremic encephalopathy, leading to coma. The patient started to receive dialysis treatment on February 17, 2021. The patient's conscious gradually recovered after regular dialysis treatment, but the severe skin itch appeared, and sometimes combined with blisters, whole rashes or gum bleedings. Western medicine diagnosed with pemphigoid and uremia pruritus. Both the steroid ointments and antihistamine treatment are incapable of reducing the skin lesion efficiently. Now, after two weeks of the combination of Chinese and Western medicine treatment, the patient lives a better life with lower grade of skin itching, better urination and consciousness improvement. The present study aims to share the experience of the acupuncture treatment and the moxibustion with external application therapy for treating chronic kidney disease.

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