滋肾柔肝法治疗肝肾阴虚型肝硬化顽固性腹水临床观察

Clinical Observation of Nourishing Kidney and Softening Liver in Treating Refractory Ascites due to Liver and Kidney Yin Deficiency

目的:观察滋肾柔肝法治疗肝肾阴虚型肝硬化顽固性腹水患者的临床疗效。方法:将72例肝肾阴虚型顽固性腹水患者随机分为治疗组与对照组,每组36例,对照组患者采用常规利尿剂(螺内酯160mg/d、呋塞米80mg/d)、输注白蛋白,治疗性腹腔穿刺放液治疗4周;治疗组患者在对照组综合治疗的基础上将利尿剂减半,同时加用滋肾柔肝法中药汤剂治疗4周。观察两组患者的中医证候评分、体质量、腹围、尿量、肝功能child-pngh评分、MELD评分等变化。结果:治疗组与对照组患者临床有效率分别为91.6%,58.3%,差异有统计学意义(P<0.05);治疗组患者平均24 h尿量、腹围、临床疗效、肝功能指标改善情况均优于对照组(P<0.05)。治疗组患者的口干口渴、皮肤干燥等不良反应明显减轻,与对照组比较,差异有统计学意义(P<0.05)。结论:滋阴柔肝法治疗肝肾阴虚型肝硬化顽固性腹水患者可促进腹水消退,改善肝功能,减少利尿剂用量,减少利尿剂导致的不良反应。

Objective:To observe the clinical effect of nourishing the kidney and softening the liver in the treatment of refractory ascites due to deficiency of liver-yin and kidney-yin.Methods:Total of 72 patients with refractory ascites ofliver and kidney yin deficiency were randomly divided into treatment group and control group, 36 cases in each group. The control group was given diuretics(spironolactone 160 mg/d, furosemide 80 mg/d), albumin infusion, and therapeutic abdominal puncture and drainage for 4 weeks. The treatment group was treated with diuretics halved and kidney-nourishing and Liver-Softening method on the basis of comprehensive treatment of Western medicine, and traditional Chinese medicine decoction withchushizi and zhu ling for 4 weeks. The changes of TCM syndrome evaluation, quality of life score, body mass, ascites grade, edema degree of lower limbs and liver function index were observed between the two groups. Results:(1) For the patients with refractory ascites due to liver and kidney yin deficiency type cirrhosis, the dosage of diuretics can be reduced by nourishing the kidney and softening the liver. The control group was treated with spironolactone 160 mg/d and furosemide 80 mg/d, while the treatment group was treated with spironolactone 80 mg/d and furosemide 40 mg/d,to achieve the purpose of ascites subsidence.(2) The average 24-hour urine volume, ascites grade and edema degree of both lower limbs in the treatment group were better than those in the control group.(3) The method of nourishing kidney and softening liver could improve the symptoms of thirst and dry skin caused by diuretics. Conclusion:Nourishing Yin and softening liver therapy can promote ascites subsidence, improve liver function, reduce the dosage of diuretics and adverse reactions of diuretics in patients with refractoryascites due to liver and kidney yin deficiency.