晚期血吸虫病难治性腹水治疗的对照研究

Therapeutic schemes for refractory ascites of advanced schistosomiasis: a clinical control study

目的探讨晚期血吸虫病难治性腹水优化治疗方案。方法将符合晚期血吸虫病难治性腹水诊断标准的病人按入院时间先后顺序随机分为常规治疗组、白蛋白冲击治疗组、大剂量利尿剂治疗组和综合治疗组,分别按各组所定的治疗方案进行治疗,疗程为4周。每天观察腹围、尿量、体重变化,每周复查一次B超、肝功能、肾功能,观察腹水、A/G、肾功能变化情况。疗程结束后,按显效、有效、无效标准,统计各治疗组间显效、有效、无效的例数和百分率。结果在总有效率、复发率、A/G升高率和肾功能改善方面,白蛋白组、综合组均优于常规组、利尿剂组(P均<0.01),且白蛋白组和综合组之间、利尿剂组与常规组之间差异无统计学意义(P均>0.05);在病例死亡率上,综合组要显著低于其他3组(P<0.01)。结论综合考虑总有效率、复发与死亡、A/G与肾功能变化、治疗成本等因素,综合组疗效最佳,值得推广应用。

Objective To explore the therapeutic schemes for refractory ascites of advanced schistosomiasis. Methods The advanced schistosomiasis patients with refractory ascites were randomly divided into 4 groups ： a conventional group, high-dose al-bumin group, high-dose diuretic group, and comprehensive group, and the course of the treatment was 4 weeks. The abdominal circumference, urine volume, and weight changes were observed daily, and B-ultrasound, liver function, and renal function were performed weekly. Results In the total effective rates, recurrence rates and A/G and renal function changes, the high-dose albu- min group and comprehensive group were superior to the conventional group and high-dose diuretic group （P 〈 0.01 ）. The death rate of the comprehensive group was the lowest among the 4 groups. Conclusion The therapeutic scheme of the comprehensive group is optimum.