腹腔置管治疗顽固性腹水对血浆RAAS的影响  

Effects of percutaneous placement of central venous catheter on RAAS in hepatic cirrhosis patients with refractory ascites

作　　者：汪毅[1] 余贻汉[1] 屈银宗[1] 郭玉飞[1] 计春燕[1] 吴勇进[2] 徐玲[1] 

机构地区：[1]湖北省新华医院消化科,湖北武汉430015 [2]湖北省新华医院检验科,湖北武汉430015

出　　处：《临床肝胆病杂志》2009年第2期131-132,共2页Journal of Clinical Hepatology

摘　　要：目的探讨中心静脉导管腹腔置入术治疗顽固性腹水对肾素-血管紧张素Ⅱ-醛固酮系统(RAAS)的影响。方法21例肝硬化顽固性腹水患者,经皮穿刺导丝引导法置入中心静脉导管,通过该导管隔日大量引流一次腹水,同时联合内科综合治疗,检测腹水引流前后肾素、血管紧张素Ⅱ和醛固酮水平及体重、腹围、尿量和肾功能。结果所有患者感腹胀、纳差、呼吸困难症状均完全缓解或者部分缓解;置管治疗能迅速减少腹围,显效33.3%,总有效率达71.4%;治疗后腹围及体重显著低于治疗前,而肾功能有所恢复;并且血浆肾素、血管紧张素Ⅱ和醛固酮水平显著减低(P<0.05);引流不畅3例(占14.3%),穿刺点腹水渗漏2例(占9.5%),无其他严重并发症。结论中心静脉导管腹腔置入术联合内科综合治疗是肝硬化顽固性腹水的有效治疗方法,能迅速消除腹水,抑制RAAS系统活性,并发症少,安全可靠。Objective To evaluate the effects of therapeutic paracentesis by percutaneous placement of central venous cath- eter （CVC） on renin -angiotensin -aldosterone system （RAAS） in hepatic cirrhosis patients with refractory ascites. Methods 21 patients with hepatic cirrhosis and refractory ascites were admitted into this study. The patients were detained CVC in the abdominal cavity, performed serial large - volume paracentesis and given the liver protective and combined supportive treatment. The effects on RAAS, weight, abdomen circumference, urinary volume and renal function were evaluated. Re- suits The symptoms of abdominal distension, loss of appetite, dyspnea were complete or partial remission in all patients. The weight and abdomen circumference after theapy were significantly lower than before therapy, and the concentration of RAAS in plasma were decreased significantly, however, the renal function was partial recuperative. No serious complication happened, but with 3 cases of unfluent drainage and 2 cases of persistent leakage around the catheter. Conclusions Percu- taneous placement of CVC combined supportive treatment, which could eliminate the ascites and suppress the activity of RAAS, was safe, simple, and effective method for palliative drainage of patients with hepatic cirrhosis and refractory ascites.

关 键 词：中心静脉导管 顽固性腹水 肾素 血管紧张素Ⅱ 醛固酮 

分 类 号：R575.2[医药卫生—消化系统]