中医药研究论丛

254.8 针灸与中药并用改善住院病人右肾全切除後双下肢水肿之病例报告

 TJ TCM.25(4) : 85-96, 2022

DOI : 10.6516/TJTCM.202212_25(4).0008
 
针灸与中药并用改善住院病人右肾全切除後双下肢水肿之病例报告
Chinese Medicine Inpatient Consultation for Relieving Postoperative Ileus-A Case Report
郭佩珍1 王人澍1,2 伍崇弘1,2*
1 台中慈济医院,台中,台湾
2 慈济大学,花莲,台湾
【摘要】
急性肾损伤是手术後可能出现的并发症,而大型手术、年长者、原先肾功能不佳,都是发生急性肾损伤的高危险群,肾脏功能受损会增加住院病人的死亡率,增加医疗负担,现今尚无准确的生物指标可提供早期确诊。急性肾损伤後经常发生水肿症状,双下肢水肿最为常见,本文个案於肿瘤切除、右肾全切除手术後出现严重全身水肿,体重增加8 公斤,本身肝肾功能不佳,已使用抗生素与利尿剂,双下肢仍明显肿胀合并蜂窝性组织炎,难以下床行走,严重影响生活自理能力。西药持续治疗,并会诊中医,搭配肾着汤、针灸,双管齐下,水肿得以明显改善,并且没有复发。藉此病例提出以培土制水,温肾散寒法作为治疗下肢水肿的治疗思路,提供给各位医师同道叁考。
【关键词】中西医结合、右肾切除、下肢水肿、肾着汤、针灸
 
Pei-Chen Kuo1Jen-Shu Wang1,2Chung-Hung Wu1,2*
1Department of Chinese Medicine, Taichung Tzu Chi Hospital, Buddhist Tzu Chi Medical
Foundation, Taichung, Taiwan
2Tzu Chi University, Hualien, Taiwan
【Summary】
Acute kidney injury (AKI) is one of the most prevalent postoperative organ
injuries, and it is associated with increased risk of death and length of hospital stay.
Risks factors for postoperative AKI include advanced age, major surgery and a lower
baseline of estimated GFR (eGFR). However, the early diagnosis of postoperative
AKI remains quite a challenge due to the lack of instantaneously and early change in
the amount of urine output and serum creatinine data. AKI patients are more likely to
develop fluid overload, resulting in fluid accumulation and edema. Lower extremity
edema is a common problem in patients with AKI, causing decreased physical
function and reduced movement. In our case, this 68-year-old female had undergone
surgical intervention of the tumor resection and nephrectomy. After surgery, the
patient developed symptoms of decreased renal function and generalized edema. The
patient still has symptoms of lower extremity edema after taking diuretics. Therefore,
the patient requested to be transferred to other hospital for further treatment and
consultation with Chinese medicine as integrated treatment. After receiving traditional
Chinese medicine treatment, the patient’s edema subsided significantly, and lost 8 kg
of body weight as well. When discharged, the patient could get out of bed freely and
have a better quality of life. The therapeutic efficacy of this case was excellent to take
as a reference for clinicians: another choice for poor diuretic response in patients with
edema. The detailed history of this case is as follows.
 
【Keywords】radical nephrectomy; lower extremity edema; integrative traditional
Chinese and western medicine; acupuncture; Shen Zhuo Tang