血浆置换联合腹水超滤浓缩回输治疗顽固性肝腹水伴发Ⅱ型肝肾综合征的临床效果

Clinical effect of plasma exchange combined with ultrafiltration reinfusion of concentrated ascites in the treatment of refractory ascites in liver cirrhosis with type Ⅱ hepatorenal syndrome

目的研究腹水超滤浓缩回输治疗顽固性肝腹水伴发Ⅱ型肝肾综合征的临床效果。方法将本院2012年3月至2015年3月确诊并收治的140例肝硬化失代偿期合并顽固性肝腹水伴发Ⅱ型肝肾综合征的患者按照随机数表法分为研究组与对照组,每组各70例。研究组患者实施人工肝血浆置换术治疗,同时给予腹水超滤浓缩腹腔回输;对照组患者单纯实施腹水释放治疗。对比两组患者腹水、肝肾综合征相关疗效指标及不良反应发生情况。结果两组患者治疗后腰围、24小时尿量、血钾及血尿素氮水平较治疗前均显著改善(P<0.05),研究组患者各指标改善情况均显著优于对照组(P<0.05)。两组患者各不良反应发生率比较差异均无显著性(P>0.05)。结论血浆置换联合腹水超滤浓缩回输治疗顽固性肝腹水伴发Ⅱ型肝肾综合征,能够显著释放肝腹水的液体量,明显增加24小时尿量,改善患者肾功能、血钾及血尿素氮水平,且未增加不良反应。

Objective To study the clinical effect of plasma exchange combined with ultrafiltration reinfusion of concentrated ascites in the treatment of refractory ascites in liver cirrhosis with type II hepatorenal syndrome. Method 140 cases of liver cirrhosis with type II hepatorenal syndrome treated in our hospital from March 2012 to March 2015 were randomly divided into study group and control group, 70 cases in each group. Study group patients were treated with artificial liver plasma exchanging, and reinfusion of ascites concentration by ultrafiltration back to abdominal cavity. Control group patients were treated with peritoneal effusion. Compared two groups of patients with ascites, hepatorenal syndrome related efficacy indicators and adverse reactions. Result Waist circumference, 24 hours urine volume, serum potassium and blood urea nitrogen levels were significantly improved in the two groups after treatment （P 〈 0.05）, the improvement of each index in study group were significantly better than control group （P 〈 0.05）. There was no significant difference in the incidence of adverse reactions between the two groups （P 〉 0.05）. Conclusion Plasma exchange combined with ultrafiltration reinfusion of concentrated ascites in the treatment of refractory ascites in liver cirrhosis with type II hepatorenal syndrome, can significantly release the liquid volume of liver ascites and increased the amount of urine 24 hours, improve renal function, serum potassium and blood urea nitrogen levels, and will not increase the adverse reaction.