两种利尿用药方案对肝癌患者肝切除术后腹水的影响

Effects of two diuretic drugs on ascites after hepatectomy in patients with liver cancer

目的 评价两种利尿用药方案对肝癌患者肝切除术后腹水的影响.方法 选取计划行肝切除术的肝癌患者110例.根据随机数字表法分为实验组（n=55）与对照组（n=55）.术后患者均给予常规治疗,实验组患者服用100 mg螺内酯片＋40 mg呋塞米片,1次/d.对照组服用100 mg螺内酯片,2次/d;40 mg呋塞米片,1次/d.观察并比较两组患者的利尿指标及血钠、血肌酐、血白蛋白、血钾、血尿素氮、肝功能指标、不良反应及利尿治疗的有效性.结果 治疗后,实验组夜间排尿次数为（2.3±0.7）次,显著低于对照组的（3.0±0.8）次,差异有统计学意义（t=2.530,P=0.013）.治疗后两组患者血尿素氮、血钾、血钠及血白蛋白与治疗前比较均显著改善（均P〈0.05）.治疗后两组患者肝功能指标与治疗前比较显著改善,差异有统计学意义（P〈0.05）.实验组与对照组不良反应发生率比较差异未见统计学意义（76.4％比70.9％,χ2=0.421,P=0.516）.结论 两种利尿用药方案可以显著降低肝切除术后肝癌患者腹水的发病率,同时也可以降低并发症发生率,呋塞米40 mg联合螺内酯100 mg,1次/d的用药方案可以显著减少患者夜间排尿频次,值得临床推广应用.

Objective To evaluate the effects of two diuretic drugs patients after hepatectomy. Methods One hundred and ten patients with on the ascites of liver cancer liver cancer who planned to undergo hepatectomy were selected and were divided into experimental group and control group according to the random number table method, with 55 patients in each group. All patients were given routine treat-ment that patients in experimental group received 100 mg spironolactone tablets, 40 mg furosemide tab-lets, once a day; patients in control group were given 100 mg spironolactone tablets, 2 times a day, while administrated 40 mg furosemide tablets, once a day. The diuretic index and serum sodium, serum creatinine, albumin, adverse reactions, blood potassium, blood urea nitrogen, liver function index and the effectiveness of diuretic treatment in the two groups were observed and compared. Results After treatment, the number of micturition in experimental group was significantly lower than that in control group at night [ (2.3 ± 0. 7) times vs. (3.0 ± 0. 8) times ] , the difference was statistically significant (t = 2. 530, P = 0. 013）. After treatment, the levels of blood urea nitrogen, blood potassium, blood so-dium and serum albumin were significantly improved in the two groups, and the differences were statisti-cally significant (all P 〈 0. 05). After treatment, the liver function indexes of the two groups were signif-icantly improved (P 〈 0. 05). There was no significant difference in the incidence of adverse reactions between experimental group and control group (76. 4% vs. 70. 9%, X2 = 0. 421, P = 0. 516). Conclusions The two protocols of diuretic drugs both can significantly reduce the incidence of ascites in patients with liver cancer after hepatectomy. The incidence of complications was also reduced. But the regimen, taking 40 mg furosemide and 100 frequency of urination at night, it is worthy mg spironolactone once a day, can significantly reduce the of clinical application.