冷冻浓缩腹水回输治疗顽固性肝硬化腹水的临床研究

CLINICAL STUDY ON THE REINFUSION TREATMENT OF OBSTINATE ASCITIC FLUID CAUSED BY POST HEPATITIS CIRRHOSIS WITH FROZEN AND ULTRAFILTRATED AUTOLOGOUS ASCITIC LIQUID

目的 :探讨冷冻浓缩腹水回输治疗顽固性肝硬化腹水的疗效。方法 :采用血液透析机对 32例顽固性肝硬化腹水患者的腹水进行超滤浓缩 ,置 - 18℃环境中冷冻 2～ 3d,37℃温浴溶解后静脉回输。结果 :冷冻浓缩腹水回输前后 ,血清总蛋白分别为 (5 9.1± 5 .6 ) g/ L 和 (6 6 .3± 4 .7) g/ L,白 /球比值为 0 .8± 0 .3和 1.1± 0 .5 ,腹水总蛋白分别为 (15 .2±6 .8) g/ L 和 (5 5 .6± 8.4 ) g/ L,内生肌酐清除率分别为 (47.6± 6 .4 ) ml/ m in和 (71.2± 7.3) ml/ min,肾素分别为 (6 .3±1.5 ) ng.m l/ h和 (3.4± 1.4 ) ng.ml/ h,血管紧张素分别为 (30 2 .4± 4 6 .5 ) ng/ ml和 (137.7± 4 3.2 ) ng/ ml,醛固酮分别为 (6 2 7.8± 94 .3) μg/ m l和 (32 4 .5± 89.7) μg/ m l,治疗前后相比 ,差异均有高度显著性 (P<0 .0 1)。冷冻浓缩腹水回输后 ,未发生低血压、肝昏迷、消化道出血现象 ,未出现蛋白凝集 ,堵塞管腔。结论 :冷冻浓缩腹水回输可降低肾素 -血管紧张素 -醛固酮活性 ,克服了以往浓缩腹水静脉回输出现蛋白凝集、堵塞管腔的缺陷 ,是治疗顽固性肝硬化腹水的首选方法之一 。

Objective:To explore the value of the reinfusion treatment of obstinated ascitic liquid caused by post hepatits cirrhosis with frozen and ultrafiltrated autologous ascitic liquid.Methods:The ascitic fluid after being frozen (-18℃) for 2~3 days and ultrafiltrated by dialyzator and incubated (37℃) were reinfused for the patients with post hepatits cirrhosis.Results:Before and after being reinfused with frozen and ultrafiltrated autologous ascitic fluid,the level of total protein in serum was (59 1±5 6)g/L and (66 3±4 7)g/L,the rates of albumin/globulin were 0 8±0 3 and 1 5±0 5,the level of total protein in ascites was (15 2±6 8)g/L and (55 6±8 4)g/L,the rates of endogenous creatinine clearance were (47 6±6 4)ml/min and (71 2±7 3)ml/min,the level of renin was (6 3±1 5)ng.ml/h and (3 4±1 4)ng.ml/h,the level of angiotensin was (302 4±46 5)ng/ml and (137 7±43 2)ng/ml,the level of aldosteron was (627 8±94 3)μg/ml and (324 5±89 7)μg/ml,respectively.There was significant difference between before and after treatment with frozen and ultrafiltrated autologous ascitic liquid ( P <0 01).After being reinfused with frozen and ultrafiltrated autologous ascitic liquid,the level of plasma albumin,urine volume increased and the level of urea nitrogen decreased respectively.Conclusion:The reinfusion treatment with frozen and ultrafiltrated can not only decrease the level of renin,angiotensin,aldosteron but also increase the rate of endogenous creatinine clearance.It can overcome the defect of albumen agglutination and lumen blocking during the reinfusion with frozen and ultrafiltrated autologous ascitic fluid and is one of important and effective methods and can be applied widely.