摘要
目的研究围手术期应用托伐普坦治疗肝硬化腹水患者的临床疗效及安全性。方法入组2018年10月至2020年5月住院的需手术治疗的110例肝硬化患者,随机分为观察组56例(托伐普坦+螺内酯治疗)和对照组54例(螺内酯治疗),根据主要诊断施行外科手术,在相同常规综合治疗基础上,比较两组患者围手术期的腹水程度、腹围、体质量、住院时间、血电解质的变化情况及安全性。结果观察组术后大量腹水患者占比显著低于对照组(术后5 d:24.53%vs.57.69%;术后1个月:7.14%vs.22.22%);观察组患者术前与术后1个月肝脏超声弹性值之差高于对照组[(0.75±0.20)vs.(0.28±0.19),P<0.05];观察组患者入院日腹围与出院日腹围差[(2.59±0.16)cm vs.(1.66±0.18)cm,P<0.05]、入院日体质量与出院日体质量差[(1.20±0.08)kg vs.(0.92±0.07)kg,P<0.05]、术后3、5 d尿量、血清钠浓度均显著高于对照组(P<0.05),而住院时长较对照组明显缩短[(6.40±0.12)d vs.(7.33±0.12)d,P<0.05];围手术期观察组与对照组患者血钾浓度差异无统计学意义(P>0.05)。结论围手术期肝硬化患者应用托伐普坦治疗可有效控制腹水,促进尿量增多,有利于快速康复,同时可改善低钠血症,且不影响血钾浓度,安全性高。
Objective To investigate the clinical efficacy and safety of tolvaptan in the treatment of the patients with cirrhosis ascites during the perioperative period.Methods 110 cirrhosis patients who were hospitalized and required surgical treatment from October 2018 to May 2020 were enrolled and randomly divided into observa⁃tion groupand control group.56 cases in observation group were treated with Tolvaptan and spironolactone,while 54 cases were treated with spironolactone.Surgical operation was performed according to the main diagnosis.During the perioperative period,the changes in ascites degree,abdominal circumference,weight,length of hospital stay,blood electrolytes,and safety were compared between the two groups using the same conventional comprehensive treatment.Results The proportion of patients with massive ascites after operation in the observation group was significantly lower than that in the control group(day 5 after operation:24.53%vs.57.69%;day 30 after operation:7.14%vs.22.22%);The difference in ultrasound fibro touch to measure liver stiffness between preoperative and 1 month after surgery of the observation group was higher than that of the control group[(0.75±0.20)vs.(0.28±0.19),P<0.05];The abdomen circumference difference value and the weight difference value on patient admission day and hospital discharge day of the observation group were higher than those of the control group.[(2.59±0.16)cm vs.(1.66±0.18)cm,P<0.05];[(1.20±0.08)kg vs.(0.92±0.07)kg,P<0.05];respectively.The urine output and the serum sodium concentration on the day 3 and day 5 after operation of the observation groupwere higherthan those of the control group(P<0.05).But the hospital stays in the observation group was less than that in the control group[(6.40±0.12)d vs.(7.33±0.12)d,P<0.05];There was no significant difference in the serum potassium concentration between the two groups during the perioperative period(P>0.05).Conclusions In perioperative patients with cirrhosis,tolvaptan therapy can effectively control ascites,promote increased urine volume,facilitate rapid recovery,and improve hyponatremia without affecting blood potassium concentration,which is highly safe.
作者
张猛
刘娇
陈晹
李叶晟
黄杨卿
ZHANG Meng;LIU Jiao;CHEN Yi;LI Yesheng;HUANG Yangqing(Department of Hepatobiliary surgery,Shanghai Public Health Clinical Center,Shanghai 201508,China)
出处
《实用医学杂志》
CAS
北大核心
2021年第16期2137-2141,共5页
The Journal of Practical Medicine
基金
上海市卫生和计划生育委员会科研项目(编号:201840128)。
关键词
肝硬化
托伐普坦
腹水
随机对照研究
liver cirrhosis
tolvaptan
ascites
randomized controlled trial(RCT)