中药联合腹水超滤浓缩回输法治疗肝硬化顽固性腹水的临床研究

Clinical observation of TCM combinating with ascites concentration re-transfusion in the treatment of refractory cirrhosis ascites

目的:观察中药联合腹水超滤浓缩回输法治疗肝硬化顽固性腹水的疗效。方法:选择肝硬化顽固性腹水住院患者62例,随机分为两组,治疗组32例,采用中药+腹水超滤浓缩回输+基础治疗;对照组30例,采用腹水超滤浓缩回输+基础治疗。疗程均为1个月,腹水超滤浓缩回输的频率为2周1次,1次超滤的腹水为3 000ml^8 000ml,观察治疗前后患者的体重、腹围、24小时尿量、血浆白蛋白、腹水白蛋白、门脉主干的血流动力学变化及患者血浆和腹水中内毒素水平的变化。结果:两组患者的临床症状均得到较好改善,患者体重及腹围显著下降,24小时尿量增加,血浆及腹水中蛋白量增加,治疗组患者门静脉、脾静脉内径及血流量、血浆中内毒素水平较治疗前显著下降,对照组患者则无明显改善,两组比较差异有显著性意义(P<0.05);治疗组患者腹水Ⅰ级消退者18例,占56.3%,对照组只有4例,占13.3%,两组比较差异有显著性意义(P<0.05)。结论:中药联合腹水超滤浓缩回输治疗肝硬化顽固性腹水有较好疗效,其作用机制可能与改善患者血浆内毒素水平有关。

Objective： To observated the effection of TCM combinating with ascites concentration re-transfusion in the treatment of refractory cirrhosis ascites, Methods： Sixty-two inpatients with refeactory cirrhosis ascites were randomly divided into two groups： 32 cases of the treatment group were treated with TCM ＋ ascites concentration re-transfusion ＋ basic therapy; 30 cases of the control group were treated with ascites concentration re-transfusion ＋ basic therapy. The course of treatment was 1 month. The frequency of ascites concentration re-transfusion was once per two weeks. Observated wht changes of body weight, abdomen circumference, 24 hours urinary output, plasma-albumin, ascites-albumin, haemodynamics in main portal vein and the endotoxin level in plasma and ascites before and after the treatment. Results： The clinical symptom of the two groups were better improved. The body weight and abdomen circumference were obviously descended, 24 hours urinary output were increased, plasma-albumin and ascites-albumin were also increased. The inner diameter and blood flow in portal vein and splenic vein were obviously descended in treatment group （ P 〈 0. 05 ）, while those of control group were not obviously improved （ P 〉0. 05 ） ; The endotoxin level in plasma was obviously descended in treatment group （ P 〈 0.05 ） ; while that of control group was not obviously improved （ P 〉 0. 05 ） , both of the endotoxin levels in plasma were descended after teratment, but there were not statistical significance （P 〉 0. 05 ） ; The ascites decreasing quantity above I level was account of 56. 3% in treatment group, while that of control group was account of 13.3%. The was obviously difference （P 〈 0. 05 ） . Conclusion： TCM combinating with ascites concentration re-transfusion which to treat refractory cirrhosis ascites can obviously better improve the clinical symptom. It can make inner diameter and blood flow in portal vein and splenic vein descended, make the endotoxin level in plasma descended. And it also make the recurrence rate of ascites degress. Maybe the degressing is relative with the obviously descending of endotoxin level in plasma.