温阳健脾汤治疗肝硬化顽固性腹水临床研究

Clinical Study on Wenyang Jianpi Tang for Refractory Ascites Induced by Liver Cirrhosis

目的:观察温阳健脾汤治疗肝硬化顽固性腹水的临床疗效及对患者门静脉血流动力学指标的影响。方法:将顽固性腹水患者80例随机分为2组,对照组40例行西医常规治疗,观察组40例在对照组的基础上加服温阳健脾汤,疗程均为2周;于治疗前后测定患者24h尿量、腹围及体质量改变状况,ELISA法检测血清白蛋白(Alb)、丙氨酸氨基转移酶(ALT)、总胆红素(TBil)、门冬氨酸氨基转移酶(AST)、尿钠及血钠含量,彩色多普勒超声诊断仪检测门静脉及脾静脉血流量、流速和腹水暗区深度情况。结果:总有效率观察组为95.00%,对照组为70.00%,2组比较,差异有统计学意义(P <0.05)。治疗后2组患者脾静脉、门静脉血流量及腹水暗区深度均较治疗前明显降低(P <0.05),且观察组上述指标均低于对照组(P <0.05)。治疗后2组患者腹围较治疗前明显降低(P <0.05),24 h尿量明显升高(P <0.05);且观察组上述指标改善较对照组更显著(P <0.05)。治疗后观察组患者血清Alb含量较治疗前明显升高(P <0.05),ALT、TBil、AST含量明显降低(P <0.05);且观察组上述指标改善较对照组更显著(P <0.05)。2组治疗前后脾静脉血流速度、门静脉血流速度及体质量均变化不明显(P> 0.05)。结论:温阳健脾汤结合常规西药治疗可显著改善肝硬化顽固性腹水患者肝功能、门静脉血流动力学指标,临床疗效显著。

Objective:To observe the clinical effect of Wenyang Jianpi tang for refractory ascites induced by cirrhosis and its influence on portal hemodynamic parameters.Methods:Divided 80 cases of patients with refractory ascites randomly into two groups.40 cases in the control group were treated with western medicine,while other 40 cases in the observation group were additionally given Wenyang Jianpi tang.The course of treatment was both 2 weeks.Measured the changes of urine volume in 24 hours of patients before and after treatment,abdominal circumference and body mass,detected serum albumin(Alb),alanine aminotransferase(ALT),total bilirubin(TBil),aspartate aminotransferase(AST),urine sodium and blood sodium content by ELISA,and detected blood flow of portal vein and splenic vein,velocity and depth of ascites dark area by color Doppler ultrasound diagnostic instrument.Results:The total effective rate was 95.00%in the observation group and 70.00%in the control group,compared the two groups,difference being significant(P<0.05).After treatment,the blood flow of the splenic vein and portal vein and the depth of the ascites dark area of patients in the two groups were significantly lower than those before treatment(P<0.05);these indexes in the observation group were lower than those in the control group(P<0.05).After treatment,the abdominal circumference of patients in the two groups was significantly lower than that before treatment(P<0.05);the urine volume in 24 h was significantly increased(P<0.05);the improvement of these indexes in the observation group was more significant than that of the control group(P<0.05).After treatment,the serum Alb levels of patients in the observation group were evidently higher than those before treatment(P<0.05);the contents of ALT,TBil and AST were obviously decreased(P<0.05);the improvement of the these indexes in the observation group was more significant than that in the control group(P<0.05).There were no significant changes being found in the comparison of splenic venous flow velocity,portal venous flow velocity and body mass in the two groups before and after treatment(P>0.05).Conclusion:The application of Wenyang Jianpi tang combined with routine western medicine treatment can significantly improve liver function,portal hemodynamic parameters in patients with refractory ascites induced by cirrhosis.It has obvious clinical effect.