口服中药合腹水超滤浓缩回输治疗肝硬化顽固性腹水的护理研究

The nursing study of oral TCM combining with ascites concentration re -transfusion on the patients with refractory cirrhosis ascites

目的观察口服中药联合腹水超滤浓缩回输护理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，采用口服中药＋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2W1次，1次超滤的腹水为3000—8000ml，观察治疗前后患者的体重、腹围、24h尿量、血浆白蛋白、腹水白蛋白、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有改善，体重及腹围显著下降，24h尿量增加，血浆及腹水中蛋白量增加，血浆中内毒素水平较治疗前显著下降；治疗组患者腹水I级消退者18例，占56．3％，对照组4例，占13．3％，与对照组比较差异有显著性意义（P〈0．05）。结论中药口服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 observe the effect of oral TCM combining with ascites concentration re - transfusion on the patients with refractory cirrhosis ascites. Methods 62 inpatients with refractory cirrhosis ascites were divided into two groups randomly： 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, and the volume of ascites concentration for one time was 3 000 - 8 000 mL The changes of body weight, abdomen circumference, 24 hours urinary output, plasma - albumin, ascites - albumin and the endotoxin level in plasma and ascites before and after the treatment were observed. Results The clinical symptoms of both groups were improved. The body weight and abdomen circumference were obviously decreased; 24 hours urinary output, plasma - albumin and ascites - albumin were increased. The endotoxin level in plasma was obviously decreased after treatment. 18 cases with the ascites decreasing quantity above I level from the treatment group was account of 56. 3%, while 4 cases from the control group was account of 13.3%. There was significant difference between treatment group and control group （ P 〈 0. 05） . Conclusions Oral TCM combining with ascites concentration re - transfusion to treat refractory cirrhosis ascites show better therapeutic effect. The probable mechanism may be related with the descending plasma endotoxin level in patients.