长时血液透析联合加巴喷丁治疗尿毒症顽固性皮肤瘙痒的效果  

Efficacy of long-term hemodialysis plus gabapentin in the treatment of intractable uraemic pruritus

作　　者：韦泽丰 郑金花 王自强 WEI Zefeng;ZHENG Jinhua;WANG Ziqiang(Department of Nephrology,the First Affiliated Hospital of Hainan Medical University,Hainan,Haikou 570000,China)

机构地区：[1]海南医学院第一附属医院肾内科,海南海口570000

出　　处：《中国医药科学》2023年第9期5-8,98,共5页China Medicine And Pharmacy

基　　金：海南省卫生健康行业科研项目(20A200532)。

摘　　要：目的观察长时血液透析联合加巴喷丁对血液透析患者顽固性皮肤瘙痒的疗效。方法选取2020年9月至2021年6月在海南医学院第一附属医院血液净化中心规律血液透析大于3个月且合并顽固性皮肤瘙痒患者,随机分为四组,分别给予不同的方案治疗:长时血液透析联合加巴喷丁组(A组)、长时血液透析联合盐酸左西替利嗪组(B组)、常规血液透析联合加巴喷丁组(C组)、常规血液透析联合盐酸左西替利嗪组(D组),所有患者均为规律血液透析3次/周,长时血液透析组在常规透析时长4 h基础上增加1 h,各组每次透析后口服加巴喷丁300 mg或口服左西替利嗪5 mg。检测比较治疗前及治疗后6个月患者血尿素氮(BUN)、血清肌酐(Scr)、全段甲状旁腺素(iPTH)、血钙(Ca)、血磷(P)、β2微球蛋白(β2-MG)临床指标变化,根据视觉模拟评分(VAS)、皮肤瘙痒评分和睡眠质量评分,进行皮肤瘙痒症状改善情况评价,所有患者在治疗期间均未给予其他抗瘙痒药物治疗,同时观察干预药物的不良反应。结果A组患者皮肤瘙痒及睡眠障碍得到明显缓解,未观察到药物严重不良反应。检测治疗前后临床指标(BUN、Scr、iPTH、Ca、P、β2-MG),治疗前各项指标比较,差异均无统计学意义(P>0.05)。四组BUN、Scr、iPTH、P、Ca、β2-MG较治疗前均有不同程度下降,A组较其他试验组皮肤瘙痒症状改善更为显著,差异有统计学意义(P<0.05)。结论长时血液透析联合加巴喷丁治疗透析患者顽固性皮肤瘙痒临床疗效好,同时证实了长时血液透析在清除中大分子毒素具有优势。Objective To observe the efficacy of long-term hemodialysis plus gabapentin on intractable uraemic pruritus in patients.Methods Patients who had intractable uraemic pruritus and received regular hemodialysis for more than 3 months in the Blood Purification Center of the First Affiliated Hospital of Hainan Medical University from September 2020 to June 2021 were selected as study subjects.They were randomly divided into four groups and given different regimens:long-term hemodialysis plus gabapentin group(Group A),long-term hemodialysis plus levocetirizine hydrochloride group(Group B),conventional hemodialysis plus gabapentin group(Group C),and conventional hemodialysis plus levocetirizine hydrochloride group(Group D).All patients received regular hemodialysis 3 times/week,and the two groups with long-term hemodialysis had extra 1 hour on the regular hemodialysis duration of 4 hours.Each group of patients orally took 300 mg of gabapentin or 5 mg of levocetirizine hydrochloride after each hemodialysis.Changes of clinical indicators such as blood urea nitrogen(BUN),serum creatinine(Scr),intact parathyroid hormone(iPTH),blood calcium(Ca),blood phosphorus(P),andβ2-microglobulin(β2-MG)were tested and compared before and after treatment.The improvement of pruritus symptoms was assessed according to the visual analogue scale(VAS),pruritus severity scale and sleep quality scale.No other antipruritic drugs were given to all patients during the treatment period,and the adverse reactions of intervention drugs were observed.Results Patients in Group A had significant relief of pruritus and sleep disturbance,and no serious adverse drug reactions were observed.There were no statistically significant differences among the four groups in clinical indicators including BUN,Scr,iPTH,Ca,P,andβ2-MG before treatment(P>0.05).After treatment,all the above laboratory indicators in all four groups decreased to different degrees compared with those before treatment,and the group A was more significant than the other experimental groups,wi

关 键 词：长时血液透析 加巴喷丁 甲状旁腺激素 皮肤瘙痒 

分 类 号：R692.5[医药卫生—泌尿科学] R758.31[医药卫生—外科学]