利尿剂联合应用治疗难治性肝硬化腹水临床疗效及对电解质的影响

The clinical curative effect of combiningdiuretics in the treatment of refractory cirrhotic ascitesand its influence on electrolyte

目的探讨多种利尿剂联合应用治疗难治性肝硬化腹水的临床疗效,并分析该疗法对电解质的影响。方法纳入2013年6月至2014年6月我院收治的100例难治性肝硬化腹水患者为研究对象,随机均分为观察组及对照组。前者首7 d予安体舒通联合巯甲丙脯酸治疗,次7 d视实际情况,酌情加用速尿联合多巴胺治疗,最后对未达预期疗效者予甘露醇治疗;后者应用白蛋白及速尿。均持续治疗28 d。对比两组疗效及治疗前后血及尿钠钾水平变化。结果观察组总有效率96.0%,明显高于对照组84.0%(P<0.05);两组治疗前电解质水平接近,治疗后两组血钠、血钾无明显差异,且均接近于治疗前,上述差异均无统计学意义(P>0.05),但两组24 h尿钠及24 h尿钾水平均明显上升,且观察组两项指标明显高于对照组,此差异有统计学意义(P<0.05)。结论多种利尿剂联合应用,有助于提升难治性肝硬化腹水疗效,值得推广。

Objective This paper was to investigate the clinical effect of combining multiple diuretics in the treatment of refractory cirrhotic ascites and to analyze the effect on electrolyte.Methods 100 patients with refractory cirrhotic ascites in our hospital during June 2013 and June 2014 were selected as the research object. They were randomly divided into observation group and control group.The former were treated with spironolactone and captopril at the first 7 days.Then depending on the actual situation, some of them got furosemide combined with dopamine as a combination.Finally, patients whose curative effects were not reached expect got mannitol therapy as a combination.While the control group got only albumin and furosemide.The treatment lasted for 28 days.Then we compared their treatment effect and the change of Na ＋and K ＋levels in blood and urine. Results The total efficiency rate of the observation group was 96.0%, which was significantly higher than 84. 0%of the control group （P〈0.05）.Before treatment, serum Na＋and K＋, 24h urine Na＋and K＋of the two groups were similar, without significant difference.The serum Na＋and K＋of two groups after treatment were also similar, and were similar to the date before treatment.Differences above all showed no statistically significance （P〉0.05）.But the 24h urine Na＋and K＋of both groups were significantly increased, and the two indexes of the observation group were obviously higher than that of control group, the difference has statistically significant （P〈0.05）.Conclusions The combination of multiple diuretics helps to increase the curative effect of refractory ascites due to cirrhosis, it is worth promoting.