- 期刊
針灸與中藥併用改善住院病人右腎全切除後雙下肢水腫之病例報告
Combined Therapy of Traditional Chinese Medicine and Western Medicine in Bilateral Leg Edema-A Case Report
摘要
急性腎損傷是手術後可能出現的併發症，而大型手術、年長者、原先腎功能不佳，都是發生急性腎損傷的高危險群，腎臟功能受損會增加住院病人的死亡率，增加醫療負擔，現今尚無準確的生物指標可提供早期確診。急性腎損傷後經常發生水腫症狀，雙下肢水腫最為常見，本文個案於腫瘤切除、右腎全切除手術後出現嚴重全身水腫，體重增加8公斤，本身肝腎功能不佳，已使用抗生素與利尿劑，雙下肢仍明顯腫脹合併蜂窩性組織炎，難以下床行走，嚴重影響生活自理能力。西藥持續治療，並會診中醫，搭配腎著湯、針灸，雙管齊下，水腫得以明顯改善，並且沒有復發。藉此病例提出以培土制水，溫腎散寒法作為治療下肢水腫的治療思路，提供給各位醫師同道參考。
並列摘要
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.