基于分段论治理论治疗肝硬化腹水研究进展

Research progress on the treatment of cirrhotic ascites based on the theory of segmented treatment

肝硬化腹水归属中医学“臌胀”范畴,是临床上常见难治性并发症,目前临床医学根据腹水及伴随并发症的严重程度,治疗主张采用三线治疗模式,一线以药物治疗手段为主,二线以药物配合穿刺置管引流,三线以体外器械辅助为主,总体覆盖疾病发展的全过程。中医治疗以整体观念为基础,以辨证论治为原则,认为臌胀发病涉及肝脾肾三脏,准确把握气、血、水在不同阶段的关系,提出治早宜疏肝、中宜利肠胃、晚宜扶正补虚的分段施治原则。肝硬化腹水患者病情易反复,易发生感染、肝肾功能衰竭、电解质紊乱等严重并发症,预后情况较差,且临床长期使用利尿剂、血管活性药物、穿刺引流术配合白蛋白输注等手段疗效有限。因此如何降低腹水的复发率,减少并发症的产生,提高患者生活质量是目前临床研究的热门领域。临床医学三线疗法与中医分段施治有相似之处,现通过整理近5年中西医基于分段论治疗该疾病的研究进展,进一步探讨中西医协同治疗的优势。

Cirrhotic ascites belongs to the category of“tympanites”in traditional Chinese medicine.At present,according to the severity of ascites and accompanying complications,clinical medicine advocates the use of a three-line treatment mode.First,the scheme is mainly based on drug treatment;second,it is combined with puncture and catheter drainage;and the last scheme is mainly assisted by external instruments.The above three scenarios generally cover the whole process of disease development.The treatment of traditional Chinese medicine is based on the holistic concept and the principle of syndrome differentiation and treatment.It is believed that the incidence of tympanites involves the three organs of the liver,spleen,and kidney.It is necessary to accurately grasp the relationship between qi,blood,and water at different stages and put forward the principle of staged treatment by soothing the liver in the early stage,benefiting the intestine and stomach in the middle stage,and strengthening the body’s resistance and tonifying deficiency in the late stage.Patients with cirrhotic ascites are prone to relapse and are prone to serious complications such as infection,liver and kidney failure,and electrolyte disorders,for which the prognosis is poor,and the long-term use of diuretics,vasoactive drugs,puncture,and drainage combined with albumin infusion has limited efficacy.Therefore,how to reduce the recurrence rate of ascites,reduce the occurrence of complications,and improve the quality of life of patients is a hot field of clinical research.There are similarities between the three-line therapy of clinical medicine and the segmented treatment of traditional Chinese medicine.By sorting out the research on the integrative medicine treatment for the disease based on the segmentation theory in the past five years,the advantages of integrated medicine are further discussed.