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水肿就一定是肾脏惹的祸吗?

发布时间:2020-09-23    来源:温州市中医院  

h2span style="font-size: 16px;"水肿就一定是肾脏惹的祸吗?/spanbr//h2divsectionsectionsectionpspan style="font-size: 16px;"在医院肾内科门诊,常常会遇到因为身上出现眼睑、足背或全身水肿来就诊,而且一开口就问:“医生,我身上肿了,是不是就是肾不好了?”/span/p/section/sectionsectionsectionpspan style="font-size: 16px;"在大众观念中一提及水肿,常常将“水肿”扣上“肾不好”的帽子。究其原因,肾脏病常见的症状之一水肿,但是并非所有的水肿都是肾脏病引起的。br//span/p/section/sectionsectionsectionpbr//p/sectionsectionsectionsectionsectionsectionsectionsectionsectionsection/section/section/sectionsectionsection/section/section/sectionsectionsectionsectionsection/section/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"什么叫水肿br//span/p/section/sectionsectionsection/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsection/section/section/sectionsectionsection/section/section/sectionsectionsectionsectionsection/section/section/section/section/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"水是人体重要的组成部分,主要储存在细胞内、血管内和组织间隙这三个地方。正常情况下,人体各个部位的水会相互交换,维持内环境动态平衡状态。其中,组织间隙的水大约占15%。/span/p/section/sectionsectionsectionpspan style="font-size: 16px;"一旦组织间隙的水变多了,轻者积聚在组织疏松部位,如眼睑和面部,重者分布在全身各个部位,就出现我们所说的“水肿”。/span/p/section/sectionsectionsectionpspan style="font-size: 16px;"据手指按压水肿部位的表现不同可分为两类水肿:手指按压后立即出现凹陷,就像出现一个小坑,称为凹陷性水肿;如果不会,则称为非凹陷性水肿。br//span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"肾不好的人,为什么容易出现水肿/span/p/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"由肾脏疾病引起的水肿称为肾性水肿。肾性水肿可分为肾炎性水肿和肾病性水肿两类。/span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"1. 肾炎性水肿/span/p/section/sectionsectionsection/section/sectionsectionsection/section/section/sectionsectionsectionsectionsection/section/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"肾小球滤过能力下降,而肾小管对钠和水的重吸收尚好,导致钠在体内蓄积并随后引起钠水潴留,此时常伴全身毛细血管通透性增加,多余的水份渗透到了血管外。此种情况多见于肾小球肾炎,故而得名。/span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"水肿特点:肾炎性水肿早出现在组织疏松的部位比如眼睑、面部,晨起时更明显,常常同时伴有高血压。/span/p/section/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"2. 肾病性水肿/span/p/section/sectionsectionsection/section/sectionsectionsection/section/section/sectionsectionsectionsectionsection/section/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"大量蛋白尿导致蛋白从肾脏丢失而引起血浆蛋白过低,血液的胶体渗透压下降,水分从血管内渗透到血管外。血白蛋白的一个重要作用是拉住血管内的水分,一旦血白蛋白减少,水就会从血管内跑到组织间隙中,开始出现水肿。常见于肾病综合征" 肾病综合征,故而得名。/span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"水肿特点:由于重力的作用,水肿早出现在位置低的部位比如下肢,常从踝部开始。下午、晚上重,晨起轻。卧床的患者背部、臀部也会出现明显的水肿。br//span/p/section/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"引起水肿的其他原因/span/p/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"许多种疾病都能够引起全身或局部水肿,不同原因都有自己的特点。/span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"1. 心源性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"由心脏功能障碍引发的水肿。清晨双下肢水肿不明显,白天活动后加重,经夜间休息后缓解,同时有心脏病的其他表现,如心悸、气短、呼吸困难,甚至有胸水、腹水等。/span/p/section/sectionsectionpbr//p/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"2.  肝源性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"主要见于肝硬化失代偿期或肝癌。四肢消瘦却有突出的大肚子腹水造成是特征性表现。/span/p/section/sectionsectionpbr//p/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"3. 营养不良性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"又称为低蛋白性水肿,常见于营养吸收减少或慢性疾病导致营养消耗过多,如**肿瘤、结核的患者会出现如肌肉消瘦、全身乏力、精神不振等。水肿可以波及全身,主要为凹陷性水肿。/span/p/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"4.  黏液性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"常见于甲状腺功能减退症。非凹陷性水肿是主要特点,常见于小腿胫骨前水肿,皮肤常出现类似于象皮一样的改变干燥粗糙、脱屑、增厚,同时伴有怕冷、少汗、反应迟钝等其他症状。/span/p/section/sectionsectionpbr//p/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"5. 特发性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"多见于20-50岁的女性,从轻度的肿胀感到严重的凹陷性水肿都可以发生。体格检查及尿检均为正常,具体原因尚不清楚,可能由内分泌功能失调或直立体位的反应异常所致,多发生在体位下垂部分。特发性水肿没什么危害,一般无须治疗。/span/p/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/sectionsectionsectionsectionsection/section/section/section/sectionsectionsection/section/sectionsectionsection/section/section/section/section/section/sectionsectionsectionsection/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"6.  药物性水肿/span/p/section/sectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"一般在使用某种药物后发生,停药后消失,与人体反应特性有关。能引起水肿的药物较常见的有:吲哚美辛、糖皮质激素、口服避孕药、胰岛素、胰岛素增敏剂、硝苯地平、哌唑嗪、米诺地尔、中药甘草、人参等。br//span/p/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"喝冬瓜汤、红豆薏米汤、玉米须能消肿吗/span/p/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"《金匮要略中称水肿为“水气”,按病因、病证分为风水、皮水、正水、石水、黄汗五类。元代中医名家朱丹溪将水肿分为阴水、阳水两大类。他提出水肿的治疗原则应分阴阳而治,阳水主要治以发汗、利小便、宜肺健脾,水势壅盛则可酌情暂行攻逐,总以祛邪为主;阴水则主要治以温阳益气、健脾、益肾、补心,兼利小便,酌情化瘀,总以扶正助气化为治。虚实并见者,则攻补兼施。/span/p/section/sectionsectionsectionpspan style="font-size: 16px;"虽然喝冬瓜汤、红豆薏米汤、玉米须等对于极少部分患者可能稍改善水肿的程度,但不能解决本问题,且不能盲目大量食用,需要在中医师辨证下进行辨证论治,避免加重病情。br//span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionpspan style="font-size: 16px;"可以直接去药店购买利尿药消肿吗/span/p/section/section/section/section/sectionsectionpbr//p/sectionsectionsectionpspan style="font-size: 16px;"一旦出现水肿,首要措施就是积极控制原发病,减少肾脏蛋白的漏出,尿蛋白减少了,血白蛋白就会上来,急性肾衰竭患者肾功能恢复后,水肿自然会减轻。但是对于慢性晚期肾衰竭患者,肾功能不能恢复,需透析去除多余的水。/span/p/section/sectionsectionsectionpspan style="font-size: 16px;"在治疗肾脏原发病和水肿急性期的患者中,医生可能会使用利尿药来帮助机体消除水肿,绝不会一看见“水肿”就不分青红皂白就用利尿药。如果盲目使用利尿药,出现利尿速度太快,有可能加重血容量不足的现象,出现疲乏无力、体位性头晕、嗜睡,甚至引起急性肾功能衰竭。br//span/p/section/sectionsectionpbr//p/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/section/section/section/section/sectionsectionsectionsectionsectionsectionsectionsectionsection/section/section/section/section/sectionsectionsectionpspan style="font-size: 16px;"出现水肿并非都是肾脏病,肾科医生会依据病情判断,或是指导患者合理调整生活方式,或是进一步检查,或是转诊至其他科室。所以,一旦出现水肿,请前往医院就诊,不要自行服用药物,以免延误病情。/span/p/section/sectionsectionsectionsectionsectionsection/section/section/section/section/section/section/section/sectionsectionsectionsectionsection/section/section/section/section/section/section/section/section/divpbr//p

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