麝黄膏未时脐敷联合腹水超滤浓缩回输治疗顽固性肝硬化腹水随机平行对照研究

The Randomized Parallel Group Study of Shehuangpaste Paved on the Umbilicus Between Weishi Combined Ascites Ultrafiltration Reinfusion on liver Refractory Cirrhosis Ascites

[目的]观察麝黄膏未时脐敷联合腹水超滤浓缩回输治疗顽固性肝硬化腹水疗效。[方法]使用随机平行对照方法,将120例住院患者按病志号抽签方法简单随机分为两组。对照组60例WLFHY2500型电脑腹水超滤浓缩回输系统,一次性滤出液体3000~8000m L,1次/周。治疗组60例麝黄膏（田螺30g,麝香1g,人工牛黄1g,葱白、甘遂各10g）,取本方葱白榨汁,甘遂加水煎煮2次,2h/次,合并,与葱白汁混合过滤,浓缩成相对密度为1120的稠膏,放冷,备用;麝香、人工牛黄用95%乙醇回流提取3次,回收乙醇至适量;田螺肉粉碎,去渣,蒸制消毒;将麝香、牛黄提液和田螺制品加入稠膏混匀,密封,制成3cm×3cm巴布帖,1贴/次,1次/d,未时（13~15时）外敷脐部;腹水超滤浓缩回输治疗同对照组。连续治疗1个月为1疗程。观测临床症状、体重、腹围、24h尿量、不良反应。连续治疗6疗程,判定疗效。[结果]治疗3个月,治疗组Ⅰ级14例,Ⅱ级15例,Ⅲ级11例,无效20例,总有效率66.60%。对照组Ⅰ级1例,Ⅱ级2例,Ⅲ级9例,无效48例,总有效率20.00%。治疗6个月,治疗组Ⅰ级15例,Ⅱ级15例,Ⅲ级12例,无效18例,总有效率70.00%。对照组Ⅰ级0例,Ⅱ级0例,Ⅲ级9例,无效51例,总有效率15.00%。治疗组疗效优于对照组（P〈0.01）。[结论]麝黄膏未时脐敷联合腹水超滤浓缩回输治疗顽固性肝硬化腹水,疗效满意,无副作用,值得推广。

[Objective]To observe the effect of shehuangpaste paved on the umbilicus between Weishi combined ascites ultrafiltration reinfusion on liver Refractory Cirrhosis Ascites.[Methods]A randomized, parallel group trial was conducted,120 patients were randomly divided into two groups,60 cases in control group were given reinfusion of concentrated ascites fluid to the abdominal cavity by ascites reinfusion instrument WLFHY2500,once reinfused 3000-8000 m L ascites,once a week.60 cases in treatment group were given shehuangpaste（snail flesh 30 g, artificial Moschus 1g, artificial Calculus Bov 1g, Bulbus Allii fistulosi 10 g and Rad ix Euphorbiae Kansui 10 g）. Extract Bulbus Allii fistulosi,mixed Rad ix Euphorbiae Kansui with water and boiled twice,2 hour a time,mixed both and filtrated, concentrate relative density as 1：20 thick paste,cooled,reserved;used redlux exteaction with 95% ethanol to extract artificial Moschus and artificial Calculus Bov three times,recycled appropriate ethanol. snail flesh was smashed,got rid of dregs,steamed to sterilize.Mixed all of them, sealed and made into a medicated patch 3 cm×3 cm in size,one paste at a time, once a day. paved on the umbilicus between Weishi（thirteen –fifteen o’clock）The ascites ultrafiltration reinfusion treatment was the same as control group.Each course of treatment lasted a month. The clinical symptoms and signs, weight, abdominal circumference,24 hours urine volume and adverse effects were observed.Judge the efficacy after six coutinuous courses.[ Result] After treatments of three months,in treatment group levelⅠ14 cases, levelⅡ15 cases, levelⅢ 11 cases,invalid 18 cases,,total effective rate was 66.60%, In control group levelⅠ1 case, levelⅡ 2 cases, level Ⅲ9 cases,invalid 48 cases,total effective rate was 20.00%. After treatments of six months,in treatment group levelⅠ15 cases, levelⅡ 15 cases, level Ⅲ 12 cases,invalid 18 cases,total effective rate was 70.00%,In control group levelⅠ0 case, levelⅡ 0cases, level Ⅲ9 cases,invalid 51 cases,total effective rate was 15.00%.The efficacy of treatment group was better than control group（ P〈0.01）.[Conclusions] Shehuangpaste paved on the umbilicus between Weishi combined ascites ultrafiltration reinfusion on liver cirrhosis with refractory ascites were satisfied,with no side effect and worth to be promoted.