腹腔置管持续腹腔引流对肝硬化顽固性腹水患者的疗效观察

目的观察腹腔置管持续性腹腔积液引流对肝硬化顽固性腹水患者的治疗效果。方法将60例肝硬化顽固性腹水患者随机分为2组,利用中心静脉置管套件行腹腔置管进行持续性腹水引流组28例;利用常规方法行腹腔穿刺+腹水引流术放腹水组32例,且根据患者腹水情况进行多次腹腔穿刺。2组患者均给予护肝、利尿、补充白蛋白等基础治疗。检查肝肾功能、电解质,及观察治疗期间并发症的发生情况和住院天数、静脉白蛋白用量、治疗费用等指标比较2种不同放腹水方法的临床治疗效果。结果利用中心静脉置管套件行腹腔置管腹水持续引流组(A组)治疗后的临床有效率为85.7%,明显高于常规方法放腹水组(B组)的46.9%(P<0.01)。A组患者治疗后尿量较治疗前明显增加(P<0.01),血液中尿素氮含量、低钠血症等也较治疗前得到了改善(P<0.05)。B组患者尿量增加较治疗前无明显变化,尿素氮水平较治疗前下降,血钠水平较治疗前增加,但无明显统计学差异。2组之间比较,A组对尿量的改善情况明显优于B组(P<0.01),A组患者的住院时间、白蛋白用量、住院费用等亦明显低于B组(P<0.01)。但2种放腹水方法对患者转氨酶、肌酐及白蛋白的影响无明显差异,且治疗过程中出现肝性脑病、肝肾综合征、电解质紊乱等并发症情况亦不存在明显差异(P>0.05)。结论利用中心静脉置管套件腹腔置管行持续性腹腔积液引流辅以基础治疗能有效改善肝硬化顽固性腹水患者的生化指征,与常规放腹水方法相比,其能明显提高临床治疗有效率,增加患者的尿量,缩短患者的住院时间,节约治疗费用,值得推广。

Objective To observe the curative effect of continuous drainage of abdominal cavity on refractory ascites Methods A total of 60 patients with refractory ascites were divided into two groups randomly.The first group（28patients）used the intraperitoneal catheter in order to drain the ascites continuously,while the second group used conventional methods.Both of the two groups received the basic treatment such as protection of liver function, infusion of albumin,restriction of sodium and water, and therapeutic diuresis.And then we compared the biochemical indicators of hepatic function, renal function and electrolyte between the two groups after treatment,and also compared the urine volume,the occurrence of complications,hospitalization days and the costs between different groups in order to assessment the clinical curative effect.Results There was significantly better clinical curative effect in group used continuous drainage than that in the group used conventional method（P0.01）.According to continuous drainage group, the urine volume,urea nitrogen,serum sodium have significant difference. And the continuous drainage group has much better effect on increasing the urine volume than conventional group（P0.01）.The difference of hepatic function, renal function and the incidence of complications between the two groups was not statistically significant（P0.05）.But the hospitalization days and costs have significant difference between the two groups（P0.01）.Conclusion The continuous ascites drainage use intraperitoneal catheter has better clinical curative effect than the conventional abdominocentesis.And it can significantly increase the urine volume of the patients. It also has the advantages such as less inasin, low incidence of complications, and so on.It also can reduce the hospitalization days and the costs.