双重腹水超滤浓缩腹腔回输治疗肝硬化合并自发性细菌性腹膜炎患者的临床疗效观察  

Double ascites ultrafiltration and reinfusion into abdominal cavity of hepatocirrhosis patients with refractory ascites combined with spontaneous bacterial peritonitis

作　　者：邢汉前[1] 刘俊微[1] 赵鸿[1] 王开利[1] 刘素霞[1] 崔艳华[1] 白雪[1] 赵军[1] 

机构地区：[1]解放军第302医院肝衰竭诊疗与研究中心,北京100039

出　　处：《生物医学工程与临床》2013年第1期22-26,共5页Biomedical Engineering and Clinical Medicine

基　　金：解放军第302医院院内课题资助(YNKT2009010)

摘　　要：目的观察应用双重腹水超滤浓缩腹腔回输术治疗肝硬化合并自发性细菌性腹膜炎腹水的临床效果及安全性。方法选择60例肝硬化合并自发性细菌性腹膜炎患者,其中男性54例,女性6例;年龄36～76岁,平均年龄53.4岁。在内科药物治疗基础上增加双重腹水超滤回输治疗,分别于治疗前后观察患者临床症状、腹围、治疗当天尿量、24h尿量、血清尿素和肌酐、血清电解质、血清蛋白等指标的变化及治疗前后患者并发症发生情况。结果患者治疗后乏力、纳差、腹胀不适症状明显改善56例(56/60),腹围均明显缩小;同治疗前比较,治疗当天尿量及24h尿量均增加(P<0.05);治疗后患者血清尿素和肌酐有所下降,但与治疗前比较均无统计学意义(P>0.05),治疗前后血清电解质差异亦无统计学意义(P>0.05);治疗结束后腹水蛋白浓度[(16.4±5.6)g/L]明显高于治疗前[(8.4±3.2)g/L],差异有统计学意义(t=27.2,P<0.01);60例患者出院时的转归中,好转42例,无效12例,死亡6例,总有效率70.0%。并发症发生情况:术后出现头晕、乏力明显2例,肝区隐痛不适2例,无肝性脑病、消化道出血等严重并发症发生。结论双重腹水超滤浓缩腹腔回输治疗肝硬化合并自发性细菌性腹膜炎患者是安全有效的,且简便易行。Objective To observe the effect and safety of double ascites ultrafiltration and reinfusion into abdominal cavity of cirrhosis patients with refractory ascites and spontaneous bacterial peritonitis.Methods A total of 60 liver cirrhosis patients with ascites and spontaneous bacterial peritonitis were enrolled,male 54,female 6,aged 36-76 years old,mean age 53.4 years old.All the patients were treated with double ascites ultrafiltration and routine medical therapy.The clinical symptoms,abdominal perimeters,urine volume of the treatment day,24-hour urinary volume,serum urea,serum creatinine,and serum protein levels before and after treatment were compared and analyzed.Results The clinical symptoms such as fatigue and anorexia,abdominal distension were obviously improved in 56 patients,with decreased abdominal perimeters.The urine volume increased at the treatment day and 24-hours after treatment（P 0.05）.The levels of serum urea and creatinine were lower after treatment,but the difference was insignificant（P 0.05）.The difference in serum electrolytes was insignificant before and after treatment,and the level of protein in the ascites after treatment was（16.4 ± 5.6） g/L,and significantly higher than that in the ascites before treatment[（8.4 ± 3.2） g/L]（t = 27.2,P 0.01）.After discharged,42 of the 60 patients were improved,12 demonstrated no obvious effect,and 6 were dead,indicating that the effective rate was 70.0 %.Obvious dizziness and fatigue were observed in 2 cases,and 2 patients were with liver discomfort.No hepatic encephalopathy,gastrointestinal bleeding,and other serious complications were observed.Conclusion It is demonstrated that double ascites ultrafiltration and reinfusion into abdominal cavity is safe,effective and easy to operate for liver cirrhosis patients with refractory ascites and spontaneous bacterial peritonitis.

关 键 词：双重腹水超滤浓缩回输 肝硬化 自发性细菌性腹膜炎 

分 类 号：R575.2[医药卫生—消化系统]