麝黄膏外敷神阙与中药结肠透析保留灌肠联合西药治疗难治性肝硬化腹水多中心随机平行对照研究  

Multicenter Randomized Parallel-group Study of Shehuang Paste Paved on the Umbilicus combined with Chinese herbal Colon Dialysis and Clyster Combined Western Medicine in Treatment of Refractory Cirrhotic Ascites

作　　者：翟芬芬[1] 邢宇锋[2] 童光东[2] 贺劲松[2] 周大桥[2] 

机构地区：[1]深圳市福田区慢性病防治院社康中心,深圳518033 [2]深圳市中医院肝病科,深圳518033

出　　处：《实用中医内科杂志》2013年第5期60-63,共4页Journal of Practical Traditional Chinese Internal Medicine

摘　　要：[目的]观察麝黄膏外敷神阙与中药结肠透析保留灌肠联合西药治疗肝硬化难治性腹水疗效。[方法]使用多中心随机平行对照方法,将120例住院患者按随机数字表随机分为两组,对照组60例保肝（五脂胶囊,2片/次,3次/d）、利尿（速尿、安体舒通,二者用量之比为1：2）、支持疗法（20%人体白蛋白50ml,1次/d）;腹膜炎加抗生素。治疗组60例①麝黄膏外敷神阙穴,换药1次/d（田螺肉30g,麝香、人工牛黄各1g,葱白、甘遂各10g,葱白2根。田螺去壳,烘干,研粉,其它诸药研成粉末,制成巴布贴）。②结肠透析：大黄、槐米、金银花、蒲公英、煅牡蛎各30g。甘露醇1200mL与腹透液1200mL灌肠≥2h,随后结肠透析方药液200mL保留灌肠30~60min,自然排出。隔日1次。西药治疗同对照组。连续治疗30d为1疗程。观测临床症状、体重、腹围、24 h尿量,门、脾静脉血流动力学变化、不良反应。连续治疗1疗程,判定疗效。[结果]腹水两组均有消减,治疗组消减优于对照组（P〈0.05）;治疗组一般症状均有不同程度改善,腹胀、双下肢浮肿、尿少等均有改善,腹围减少,体重减轻,其中腹胀、尿少等改善最为显著;肝掌、蜘蛛痣、肝病面容,乏力、纳差等变化不明显;对照组患者腹胀、双下肢浮肿、腹围较治疗前改善,余症状和体征变化不明显。PVD、PVQ、SVD、SVQ对照组无明显变化（P〉0.05）,治疗组明显改善（P〈0.01）,治疗组改善优于对照组（P〈0.01）;两组均无严重不良事件。[结论]麝黄膏外敷神阙与中药结肠透析保留灌肠联合西药治疗肝硬化难治性腹水疗效明显,优于单纯西药治疗。[ Objective ] To observe the effect of the Shehuang-paste paved on the umbilicus combined with Chinese herbal colon dialysis and clyster combined western medicine in treatment of refractory cirrhotic ascites in muhicenter randomized parallel-group Study. [ Methods ] With the method of muhicenter randomized parallel- group, 120 inpatients with refractory cirrhosis ascites were randomly divided into two groups according to random number table. 60 cases of the control group were treated with protecting liver （ five fat capsule, 2 pieces/time, 3 times/d ）,diuretics （ furosemide, spironolactone diuresis, both the dosage ratio of 1 ： 2 ）.Supporting therapy （ 20% human albumin 50 mL, 1 time / d ） ;Peritonitis with antibiotics. 60 cases were the treatment group （1）Shehuang- paste paved on the umbilicus , changing herbal 1 time/d （ field snail meat 30g, artificial bezoar, musk each lg , scallion, euphorbia kansui each 10g, scallion 2 root. Field snail was shelled , dried, grinded powder, other various medicine was also grinded into powder, at last all the medicine was made into cloth paste ） .（2）colon dialysis： rhubarb, sophora japonica, honeysuckle, dandelion, calcined oyster each 30g. Mannitol 1200 mL and extraneal 1200 mL were clystered more than 2h, then the 200mL colon dialysis liquids was reserved enema 30 - 60 minutes, natural discharged. Once a day. Western medicine treatment was same to the control group. Continuous treatment 30d was 1 treatment course. Clinical symptoms, body weight, abdomen circumference, 24h urinary output, the dynamic variation of portal and splenic venous blood flow, adverse reactions were was reduced in both groups, and the treatment group was better than the control group （P 〈 0.05 ） .General symptoms of treatment group were improved to different degrees, abdominal distension, the edema of lower limbs, less urine all had improved, abdomen circumference reduced, weight lost, abdominal distention, less urinary were the most significantly improved, the change

关 键 词：难治性肝硬化腹水 臌胀 麝黄膏 穴位贴敷 神阙 结肠透析 保留灌肠 中西医结合治疗 多中心随机平行对照研究 

分 类 号：R256.42[医药卫生—中医内科学]