腹腔置管持续腹水引流对肝肾综合征的疗效分析

Efficacy of intraperitoneal catheter persistent ascites drainage in patients with hepatorenal syndrome

目的:分析腹腔置管持续腹水引流对肝肾综合征的临床疗效。方法:选取中南大学湘雅三医院2007年1月至2010年1月间52例肝肾综合征合并腹水的患者,根据是否行腹腔置管分为两组。其中腹腔置管进行持续腹水引流者28例;未行腹水引流,仅使用药物治疗组24例。两组患者均限制钠水摄入,给以护肝、输注蛋白、纠正电解质紊乱、改善微循环等基础治疗。治疗两周后,观察两组患者腹胀、食欲减退、尿量等症状的改善情况及治疗前后肝功能、肾功能、电解质结果,比较两组患者的住院天数、静脉白蛋白用量、治疗费用等指标。结果:腹腔置管持续腹水引流组患者治疗后尿量较治疗前增加了688mL/24h(P(0.01),血液中尿素氮、肌酐水平、血钠水平较治疗前得到了改善(P(0.05);药物治疗组患者尿量增加较治疗前无明显变化(P(0.05),尿素氮、肌酐水平较治疗前稍有下降,低血钠水平较治疗前升高,但差异无明显统计学意义(P(0.05)。腹腔置管持续腹水引流组患者尿量的改善情况明显优于药物治疗组(P(0.01),白蛋白用量和住院费用亦低于药物治疗组(P(0.05)。两组患者的谷丙转氨酶、尿素氮、肌酐、白蛋白及电解质变化差异无统计学意义(P(0.05);腹腔置管持续腹水引流组的临床有效率明显高于药物治疗组。结论:腹腔置管持续腹水引流辅以基础治疗能有效增加肝肾综合征患者的尿量,减少腹水,改善患者症状及生化指标;且能缩短住院时间,减少治疗费用,是一种治疗肝肾综合症的有效手段,值得推广。

Objective To analyze the curative effect on the intraperitoneal catheter persistent drainage of ascites in patients with hepatorenal syndrome.Methods A total of 52 patients with hepatorenal syndrome were divided into 2 groups randomly. The Group A （n=28） was treated with the intraperitoneal catheter to drain the ascites persistently. The Group B （n=24） was treated with general medical therapy. Both groups received the basic treatment such as liver protection, infusion of albumin, restriction of sodium and water, the vasoactive substances, and so on. The clinical curative effect and the biochemical indicators for hepatic function, renal function, and electrolyte between the two groups after treatment were compared. The urine output, hospitalization days, and the costs were also compared.Results The urine volume, urea nitrogen, creatinine, and serum sodium in Group A were significantly improved after the treatment, whereas there was no significant changes in Group B. Group A had much better effect on increasing the urine volume than the control group （P0.01）.The difference in albumin and ALT between the two groups was not statistically significant （P0.05）. But the costs for hospitalization and amounts for albumin usage were higher in Group B （P0.05）. Group A had better clinical curative effect than that of Group B.Conclusion Continuous ascites drainage has the advantages in treating patients with hepatorenal syndrome. It includes increasing the urine volume of the patients, reducing ascites and incidence of complications, and decreasing the hospitalization costs.