桃核承气汤联合西药治疗肝硬化顽固性腹水疗效观察

Observation of Therapeutic Effect of Taohe Chengqi Decoction on Intractable Ascitesdue to Cirrhosis

目的观察桃核承气汤联合西药对肝硬化顽固性腹水患者的临床疗效及安全性分析。方法57例辨证为气滞血瘀型的肝硬化顽固性腹水患者,按照随机数字表法分为两组,对照组28例给予呋塞米、螺内酯、白蛋白等常规内科治疗;治疗组29例在对照组治疗基础上加用桃核承气汤,疗程28 d。于治疗前后观察两组的肝肾功能[总胆红素(TBIL)、天冬氨酸氨基转移酶(ALT)、丙氨酸氨基转移酶(AST)、白蛋白(ALB)、血肌酐(Cr)]、腹围、体质量、腹水深度、肝门静脉内径的变化,评估两组临床疗效。结果治疗后,治疗组的TBIL、ALB、ALT、AST、腹围、腹水深度均有改善,治疗前后有统计学意义(P<0.05),而对照组仅ALB在治疗前后有统计学意义(P<0.05)。治疗后两组在TBIL及腹水深度上比较有统计学意义(P<0.05),其他指标未发现统计学意义(P>0.05)。进一步对上述指标治疗前后的差值进行组间比较,发现腹围、腹水深度、体质量、肝门静脉内径有统计学意义(P<0.05)。临床疗效:治疗组显效16例,有效9例,无效4例,总有效率86.2%(25/29);对照组显效7例,有效11例,无效10例,总有效率64.3%(18/28),治疗组的显效率及疗效构成比优于对照组(P<0.05)。两组治疗过程中均未出现严重肾损害及其他不良反应。结论桃核承气汤对气滞血瘀型肝硬化顽固性腹水疗效确切,能改善肝功能,无严重不良反应,值得临床推广。

Objective To observe the clinical efficacy and safety analysis of Taohe Chengqi decoction in patients with cirrhotic refractory ascites.Methods Fifty-seven patients with intractable ascites due to cirrhosis of the stagnation type of Qi stagnation and blood stasis were collected and divided into a treatment group of 29 cases and a control group of 28 casesaccording to the random number table method.The control group was treated with furosemide,spironolactone,albumin and other conventional medical treatments.On the basis of the control group,the treatment group was given"Taohe Chengqi"Decoction.The treatment period was 28 days.The changes of liver function,kidney function,abdominal circumference,body weight,depth of ascites and inner diameter of hepatic portal vein were observed before and after treatment.The clinical efficacy of the two groups was evaluated.Results After treatment,TBIL,ALB,ALT,AST,abdominal circumference,and ascites depth of the treatment group all improved,with statistical difference before and after treatment(P<0.05),while only ALB was significant differencesin the control group(P<0.05).After treatment,the two groups were statistically different in TBIL and depth of ascites(P<0.05),and no significant difference was found in other indicators(P>0.05).Further differences between the groups before and after the treatment of the above indicators were compared,and found that the abdominal circumference,ascites depth,body weight,and hepatic portal vein diameter were statistically different(P<0.05).In terms of clinical efficacy:16 cases were markedly effective,9 cases were effective,4 cases were ineffective,and the total effective rate was 86.2%in the treatment group;7 cases were markedly effective,11 cases were effective,10 cases were ineffective,and the total effective rate was 64.3%in the control group.The marked efficiency and the effective composition ratio were better in the treatment group(P<0.05).No serious kidney damage and other adverse reactions occurred during the treatment of both groups.Conclusion Taohe Chengqi Decoction has satisfactory curative effect and no serious adverse reactions,can improve liver function,which is worthy of clinical promotion.