中西医结合治疗阿昔洛韦致急性肾损伤1例
增强出版Treatment of Acute Renal Injury Caused by Acyclovir with Integrated Traditional Chinese and Western Medicine
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1.重庆市中医院肾病科,重庆400021
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刘承玄, 熊维建. 中西医结合治疗阿昔洛韦致急性肾损伤1例[DB/OL].(2023-04-28)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36537053&Fpath=home&index=0
LIU Chengxuan, XIONG Weijian. Treatment of Acute Renal Injury Caused by Acyclovir with Integrated Traditional Chinese and Western Medicine[DB/OL].(2023-04-28)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36537053&Fpath=home&index=0
刘承玄, 熊维建. 中西医结合治疗阿昔洛韦致急性肾损伤1例[DB/OL].(2023-04-28)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36537053&Fpath=home&index=0 DOI:
LIU Chengxuan, XIONG Weijian. Treatment of Acute Renal Injury Caused by Acyclovir with Integrated Traditional Chinese and Western Medicine[DB/OL].(2023-04-28)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=36537053&Fpath=home&index=0 DOI:
病史摘要,2,老年男性患者,既往有高血压病病史。本次因“右胁部皮肤疱疹伴疼痛8天,无尿2天”入院。患者入院前8天无明显诱因出现右胁部带状分布皮肤疱疹,伴持续性灼痛,外院诊断为带状疱疹,输注阿昔洛韦治疗,入院前2天出现无尿,随访血肌酐进行性升高。入院时患者诉右胁部皮肤疼痛,乏力,活动后胸闷、气短,脐周阵发性疼痛,进食后明显,伴恶心、呕吐,时有咳嗽、咯少量白色粘痰,无恶寒发热,纳差,睡眠可,大便正常,无小便。查体:体温36.3℃,脉搏101次/分,呼吸18次/分,血压207/87 mmHg。背部、右侧腋下、右侧腹股沟区可见散红色皮损,双肺可闻及少量湿啰音,腹软,全腹散在压痛,无反跳痛,肝、肾区无叩击痛,无移动性浊音,无浮肿。舌暗红,苔白腻,脉滑数。中医诊断 肾衰(脾肾气虚兼湿浊证)西医诊断 急性肾小管坏死;带状疱疹;高血压病3级(极高危);肺部感染干预措施 入院后积极完善相关检查,予抗感染、控制血压、补液支持,并行连续性血液净化治疗(CBP)2次,中医治以健脾补肾、化湿降浊,予四君子汤合六味地黄汤加减,辅以中药十味肾毒清液结肠透析排毒降浊。完善肾脏病理提示“肾小管坏死”,结合病史考虑阿昔洛韦导致急性肾损伤,停止CBP治疗,继续抗感染、补液支持及中医治疗。疗效转归 尿量逐渐恢复正常,随访血肌酐进行性下降至基本正常后出院。
Summary of case history ,The elderly male patient has a history of "hypertension". Who was admitted to hospital because of "right flank skin herpes with pain for 8 days and no urine for 2 days". The patient had no obvious inducement to develop herpes zoster in the right flank 8 days before admission, accompanied by persistent burning pain. The patient was diagnosed as "herpes zoster" in the external hospital, and was treated with "acyclovir". There was no urine 2 days before admission, and the blood creatinine increased progressively. On admission, the patient complained of skin pain and fatigue in the right flank, chest tightness and shortness of breath after activities, paroxysmal pain around the umbilicus, obvious after eating, accompanied by nausea and vomiting, cough with little white sticky sputum, no chills and fever, poor appetite, normal sleep and stool, but no urine. Physical examination: body temperature: 36.3 ℃, pulse: 101/min, respiration: 18/min, blood pressure: 207/87 mmHg. Scattered red skin lesions can be seen in the back, right armpit and right inguinal area, a small amount of wet rales can be heard in both lungs, the abdomen is soft, the whole abdomen is scattered with tenderness, no rebound pain, no percussion pain, no mobile dullness and no edema in the liver and kidney areas. The tongue is dark red, the moss is white and greasy, and the pulse is slippery.,TCM diagnosis ,kidney failure (spleen and kidney qi deficiency and dampness turbidity syndrome),Western medicine diagnosis ,acute tubular necrosis; herpes zoster; hypertension grade 3 (extremely high risk); pulmonary infection,Therapeutic methods ,After admission, actively finish relevant examinations, give anti infection、control blood pressure、fluid infusion and continuous blood purification treatment (CRRT) twice. The traditional Chinese medicine treatment is to strengthen the spleen and kidney, remove dampness and reduce turbidity, we selected Sijunzi Decoction and Liuwei Dihuang Decoction, supplemented by colon dialysis with Shiwei kidney toxin clear liquid to remove toxins and reduce turbidity. The renal pathology is "Renal tubular necrosis" Witch is considered acute renal injury caused by acyclovir in combination with the medical history, stop CRRT treatment and continue anti infection、fluid infusion and traditional Chinese medicine treatment.,Clinical outcomes ,The urine volume gradually returned to normal, and the blood creatinine gradually decreased to basically normal before discharge.
阿昔洛韦急性肾损伤肾小管坏死
acyclovirAcute renal injuryTubular necrosis
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