托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水患者疗效初步研究

Transient improvement of patients with liver cirrhosis-induced refractory ascites by oral tolvaptan administration at base of concentrated ascites reinfusion

目的 探讨采用托伐普坦联合腹水超滤浓缩回输术治疗肝硬化并发顽固性腹水(RA)患者的临床效果。方法 2019年9月~2022年9月我院收治的肝硬化并发RA患者93例,采用随机数字表法将患者分为对照组(n=46)和观察组(n=47),分别接受腹水超滤浓缩回输术治疗或在此基础上联合应用托伐普坦片治疗7 d。使用全自动生化分析仪检测血清尿素氮(BUN)、血肌酐(sCr)和电解质,使用超声诊断仪测量门静脉内径(DPV)、脾静脉内径(DSV)、门静脉血流量(PVF)、脾静脉血流量(SVF)和腹水深度。结果 在治疗7 d末,观察组24 h尿量为(1957.5±50.3)mL,显著多于对照组【(1316.2±49.1)mL,P<0.05】,而体质量为(58.1±7.2)kg、腹围为(80.6±4.7)cm和腹水深度为(16.5±4.2)mm,均显著低于对照组【分别为(65.4±7.8)kg、(88.1±4.5)cm和(42.7±5.3)mm,P<0.05】;观察组血清BUN和sCr水平分别为(6.2±1.4)mmol/L和(114.2±9.7)μmol/L,显著低于对照组【分别为(6.9±1.6)mmol/L和(129.4±10.3)μmol/L,P<0.05】,而两组肝功能指标比较,差异无统计学意义(P>0.05);观察组血钠为(144.3±1.1)mmol/L,显著高于对照组【(138.1±1.0)mmol/L,P<0.05】;观察组PVF为(994.3±195.7)mL/min,显著低于对照组【(1175.2±210.6)mL/min,P<0.05】,而两组DPV、DSV和SVF比较,差异无统计学意义(P>0.05)。结论 在进行腹水超滤浓缩回输术治疗肝硬化并发RA患者时,联合应用托伐普坦口服,可帮助消退腹水,提高尿量,升高血钠水平,短期疗效满意。

Objective The aim of this study was to investigate the clinical efficacy of tolvaptan and concentrated ascites reinfusion(CAR)in the treatment of patients with liver cirrhosis-induced refractory ascites(RA).Methods 93 patients with liver cirrhosis-induced RA were encountered in our hospital between September 2019 and September 2022,and were randomly divided into control(n=46)and observation group(n=47),receiving CAR or oral tolvaptan after CAR.The observation lasted for 7 days.Blood urea nitrogen(BUN),serum creatinine(sCr)and serum sodium levels were detected by fully automatic biochemical analyzer.The diameter of portal vein(DPV),diameter of splenic vein(DSV),portal vein flow(PVF)and splenic vein flow(SVF)were measured by ultrasonography.Results At treatment day 7,the 24-hour urine volume in the observation group was(1957.5±50.3)mL,significantly greater than[(1316.2±49.1)mL,P<0.05]in the control group,and the body weight,abdominal circumference and ascites depth were(58.1±7.2)kg,(80.6±4.7)cm and(16.5±4.2)mm,all significantly less than[(65.4±7.8)kg,(88.1±4.5)cm and(42.7±5.3)mm,respectively,P<0.05]in the control;serum BUN and sCr levels in the observation group were(6.2±1.4)mmol/L and(114.2±9.7)μmol/L,much lower than[(6.9±1.6)mmol/L and(129.4±10.3)μmol/L,P<0.05]in the control,while there were no significant differences respect to liver function tests between the two groups(P>0.05);serum sodium level was(144.3±1.1)mmol/L,much higher than[(138.1±1.0)mmol/L,P<0.05]in the control;the PVF was(994.3±195.7)mL/min,much lower than[(1175.2±210.6)mL/min,P<0.05]in the control,while there were no significant differences respect to DPV,DSV and SVF between the two groups(P>0.05).Conclusion The oral administered tolvaptan at base of CAR in dealing with patients with liver cirrhosis-induced RA could help subside ascites,improve the renal function tests and serum sodium levels,and warrants further clinical observation.