软肝方合麝黄膏敷脐及腹水超滤浓缩回输治疗顽固性肝硬化腹水的临床研究

Combined therapy of Ruangan prescription and Shehuang paste with ascites retrieving through ultrafiltration for treatment of refractory cirrhotic ascites

目的:观察软肝方合麝黄膏敷脐及腹水超滤浓缩回输治疗顽固性肝硬化腹水的临床疗效。方法:120例顽固性肝硬化腹水住院患者,随机分为治疗组和对照组,每组各60例。对照组患者在西药常规治疗的基础上加用腹水超滤浓缩回输,频率为两周1次,疗程为1个月;治疗组患者在对照组治疗的基础上加用麝黄膏外敷脐部,1贴/次,1次/d,疗程为1个月,同时加服软肝中药颗粒,1包/次,2次/d,疗程为3个月。观察患者腹水消退、肝功能、凝血功能、血浆内毒素、NO(一氧化氮)和ET(内皮素)的变化。结果:治疗组患者腹水消退在治疗3个月和6个月的总有效率分别为70%、73.3%,明显优于对照组的20%和15%(P<0.01);两组患者治疗后1、3、6个月ALT(丙氨酸转氨酶)、TB il(总胆红素)均较治疗前明显下降(P<0.01),治疗组在治疗后3个月、6个月时ALT、TB il下降更显著,与对照组同期比较,差异有显著性意义(P<0.05或P<0.01);在PT(凝血酶原时间)的改善上,两组在治疗后3个月、6个月时均较治疗前显著下降,差异有显著性意义(P<0.05),但两组之间差异无显著性意义(P>0.05)。两组在治疗后1个月均可明显降低血浆内毒素和NO、ET含量(P<0.05或P<0.01);在治疗后3个月、6个月时对照组又恢复至治疗前水平;而治疗组患者血浆内毒素、NO、ET含量较治疗前明显下降,与治疗前和对照组同期比较,差异均有显著性意义(P<0.05或P<0.01)。结论:软肝方配合麝黄膏敷脐及腹水超滤浓缩回输治疗肝硬化顽固性腹水能有效地消退腹水,减轻内毒素血症和血管活性物质的产生,防止腹水的短期复发。

Objective：To investigate clinical effect of combined therapy of Ruan gan prescription and Shehuang Paste（SHP） with ascites retrieving through ultrafiltration for treatment of refractory cirrhotic ascites.Methods：One hundred and twenty patients were equally randomized into 2 groups,the control group was treated by ascites retrieving through ultrafiltration once two week on the basic therapy（umbilical application with placebo paste）,the course lasting for 1 month.And the treatment group was by,besides the same therapy as the control group,umbilical application with SHP once a day for 1 month and Ruan gan prescription 1 dose per time,twice a day for 3 month.Change of ascites volume,liver function,blood coagulation function,plasma endotoxin,nitric oxide（NO）,endothelin（ET） were investigated.Results：The total effective rate for ascites of treatment group was 70% at 3th month and 73.3% at 6th month respectively,which significantly surpassed that of control group,just achieving 20% and 15% respectively（P〈0.01）.ALT,TBil decreased significantly in both groups at 1th,3th,6th month after treatment compared with before treatment（P〈0.01） and ALT,TBil decreased more in treatment group at 3th,6th month after treatment than that of control group（P〈0.05或P〈0.01）;PT was shortened in both groups at 3th,6th month after treatment compared with before treatment（P 0.05）.Whereas there was no significant difference between two groups（P〈0.05）.All the level of plasma endotoxin and NO,ET lowered significantly in both groups at 1th month after treatment compared with before treatment（P〈0.05 or P〈0.01）,then recoiled in control group since 3th montn after treatment.Different from homochronous control group and before treatment,plasma endotoxin and NO,ET keep lower level in treatment group at 1th,3th,6th month after treatment.（P〈0.05 or P〈0.01）.Conclusion：Combined therapy of Ruan gan prescription and SHP with ascites retrieving through ultrafiltration for treatment of refractory cirrhotic ascites could effectively eliminate ascites,alleviate endotoxemia,lessen the production of vasoactive substance,prevent prophase relapse of ascites.