腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水疗效评价

Efficacy of ascites ultrafiltration and peritoneal reinfusion in the treatment of refractory cirrhotic ascites

目的评估腹水超滤浓缩回输腹腔术治疗肝炎肝硬化顽固性腹水患者临床疗效。方法 75例肝硬化顽固性腹水患者分为治疗组(50例)和对照组(25例),两组患者均采用保肝、利尿、对症、支持等常规治疗,疗程4周。对照组在常规治疗基础上,采用多次治疗性腹穿放液治疗;治疗组在常规治疗基础上,采用腹水超滤浓缩回输腹腔治疗,观察并比较两组治疗后体重、腹围、24 h尿量和尿钠排出量、肝功能、肾功能、血电解质及不良反应。结果治疗4周后治疗组腹围、体重、24h尿量优于对照组(P<0.01);血清白蛋白、肾小球滤过率及24 h尿钠量高于对照组(P<0.01),肌酐、胱抑素C水平低于对照组(P<0.05。P<0.01);治疗组显效率(48.0%)和总有效率(80.0%)明显好于对照组(24.0%和52.0%)(P<0.05):两组均未出现严重不良反应。结论腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水患者临床疗效优于多次治疗性腹穿放液。

Objective To evaluate the clinical efficacy of ascites ultrafltration and peritoneal reinfusion in the treatment of r＆ractoy ,cirrhotic ascites. Methods 75 cirrhotic patients with refractory, ascites were randomly divided into treatment group（ n =50） and control group（ n = 25 ）. The two groups rceeiyed conventional therapy for 4 weeks. The control group received abdominal paracentesis apocenosis ,while the treatment group received ascites uhrafltration and peritoneal reinfusion. The body weight, abdomen circumference, urine volume and urinary, natrium output in 24 hours,liver and kidney function, blood electrolytes of the two groups were observed and compared after treatment. Results After 4 weeks of treatment, the weight, abdomen circumference, urine volume for 24h were significantly better（ P 〈 0. 01 ） , serum albumin, glomerular titration rate and 24 hour urinary sodium were significantly higher （ P 〈 0. 01 ） and creafinine, cystatin C levels were significantly lower （ P 〈 0. 01 ） in the treatment group than those in the control group. The significant efficiency and total effective rate in treatment group were 80. 0% and 48.0% respectively,which were significant higher than those in control group （24% and 52% ） （P 〈 0. 05 ）. There were no serious adverse reactions in the two groups. Conclusion The clinical efficacy of ascites ultrafiltration and peritoneal reinfusion treatment for refractoD＇cirrhotic ascites is better than repeatedly abdominal paracentesis apocenosis.