健脾活血利水方联合西药治疗脾虚血瘀肝硬化腹水随机平行对照研究

Randomized Controlled Study on the Combination of Jianpi Huoxue Lishui Fang combined with Western Medicine in the Treatment of Ascites of Liver Cirrhosis with Spleen Deficiency and Blood Stasis

[目的]观察健脾活血利水方联合西药治疗脾虚血瘀肝硬化腹水疗效。[方法]使用随机平行对照方法,将100例住院患者按随机数字表方法随机分为两组,卧床休息,饮食限水、限钠。对照组50例螺内酯,起始2片/次,2次/d,根据病情及腹水程度调整,最大剂量≤400mg/d;呋塞米,起始量1片/次,1次/d,根据病情及腹水程度调整剂量,最大剂量≤400mg/d。治疗组50例健脾活血利水方(黄芪30g,太子参20g,党参、茯苓各15g,白术30g,泽泻、鳖甲各15g,土鳖虫10g,甘草6g,茜草15g)水煎300m L,2次/d;西药治疗同对照组。连续治疗4周为1疗程。观测临床症状、腹围、24h尿量、体质量、谷丙转氨酶(ALT)、谷草转氨酶(AST)、不良反应。治疗1疗程(4周),判定疗效。[结果]腹围、24h尿量两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01),体质量两组均无明显变化(P>0.05)。ALT、AST两组均有改善(P<0.01),治疗组改善优于对照组(P<0.01)。[结论]健脾活血利水方联合西药治疗脾虚血瘀肝硬化腹水,可提高利尿作用,改善肝功能,缩小腹围,值得推广。

[Objective] To observe the effect of Jianpi Huoxue Lishui Fang combined with western medicine in the treatment of aseites with liver cirrhosis with spleen deficiency and blood stasis. [Methods] 100 hospitalized patients were randomly divided into two groups according to the random digital table method by random parallel control method. The rest of the bed, the water limit of the diet and the limit of sodium. The control group of 50 cases of spironolactone, starting 2 tablets each time, 2 times/d, adjusted according to the condition and the degree of ascites, the maximum dose is less than or equal to 400 mg/d; furosemide, the initial dose of 1 tablets each time, 1 times/d, according to the condition and the degree of ascites to adjust the dose, the maximum dose is less than 400 mg/d. The treatment group of 50 cases of Jianpi Huoxue Lishui Fang （Huangqi 30g, Taizishen 20g, Dangshen, Fuling each 15g, Baizhu 30g, Zexie, Biejia each 15g, Tubiechong 10g, Gancao 6g, Qiancao 15g） decoction 300mL, 2 times/d; westernmedieinewiththecontrolgroup. Continuous treatment for 4 weeks was the 1 course of treatment. Observation of clinical symptoms, abdominal circumference, 24h urine volume, body mass, alanine aminotransferase （ALT） and aspartate aminotransferase （AST）, adverse reaction. The 1 course of treatment （4 weeks） was treated and the curative effect was determined. [Results] Abdominal circumference, 24h urine volume in two groups were improved （P^0.01）, the treatment group was better than the control group （P〈0.01）, body weight of two groups had no significant changes （P〉0.05）. The two groups of ALT and AST were improved （P〈0.01）, and the improvement of the treatment group was better than that of the control group （P〈0.01）. [Conclusion] Jianpi Huoxue decoction combined with western medicine in the treatment of spleen deficiency and blood stasis cirrhosis ascites, can improve the diuretic effect, improve liver function, reduce abdominal circumference, worthy of promotion.