“水臌贴”敷脐联合托伐普坦等治疗慢性乙型肝炎肝硬化顽固性腹水的临床研究  

Clinical research of “Shuigu Cataplasm ” umbilical compressing combined with Tolvaptan in treatment of refractory cirrhosis ascites

作　　者：祝峻峰[1] 王灵台[2] 

机构地区：[1]上海中医药大学附属市中医医院肝病科,上海200071 [2]上海中医药大学附属曙光医院肝病科,上海201203

出　　处：《上海中医药杂志》2016年第4期37-40,共4页Shanghai Journal of Traditional Chinese Medicine

基　　金：国家中医药管理局第五批全国名老中医药专家学术经验继承项目(lh130004);上海市卫计委中医;中西医结合临床重点扶持项目(ZY3-JSFC-1-1017)

摘　　要：目的观察"水臌贴"敷脐联合托伐普坦等治疗慢性乙型肝炎肝硬化顽固性腹水的临床疗效。方法将65例慢性乙型肝炎肝硬化顽固性腹水患者随机分为治疗组(33例)和对照组(32例)。对照组予托伐普坦等常规西药,治疗组在对照组治疗方案基础上加用"水臌贴"敷脐。两组疗程均为14天,观察临床疗效,比较临床体征(24 h尿量、腹围、体质量)、彩超下相关指标(门静脉血流量、脾静脉血流量及腹水暗区深度等)、肝功能及钠水平(血钠、尿钠)的变化情况。结果 1治疗组、对照组临床总有效率分别为81.82%和62.50%;组间临床疗效比较,治疗组显著优于对照组(P<0.05)。2治疗前与随访后组内比较,两组24 h尿量均明显增多(P<0.05),腹围均明显缩小(P<0.05);组间随访后比较,24 h尿量、腹围水平差异有统计学意义,治疗组改善程度优于对照组(P<0.05)。3治疗前后组内比较,治疗组门静脉血流量、脾静脉血流量及腹水暗区深度差异均有统计学意义(P<0.05);组间治疗后比较,门静脉血流量、脾静脉血流量及腹水暗区深度差异有统计学意义,治疗组改善程度优于对照组(P<0.05)。4治疗前后组内比较,治疗组肝功能指标差异均有统计学意义(P<0.05),对照组除GGT、A/G以外,其余指标差异均有统计学意义(P<0.05);组间治疗后比较,GGT、TBIL、ALB、A/G水平差异有统计学意义(P<0.05)。5治疗前后组内比较,两组血钠和尿钠水平均差异有统计学意义(P<0.05);组间治疗后比较,血钠和尿钠水平差异无统计学意义(P>0.05)。结论 "水臌贴"敷脐联合托伐普坦等治疗慢性乙型肝炎肝硬化顽固性腹水的疗效较佳,可显著缓解临床体征,减少腹水量。Objective To observe the clinical efficacy of＂Shuigu Cataplasm＂umbilical compressing combined with Tolvaptan in treatment of refractory cirrhosis ascites. Methods 65 cases of patients with refractory cirrhosis ascites were randomized into treatment group（ 33 cases） and control group（ 32 cases）. The control group was treated with Tolvaptan orally; the treatment group was treated with＂Shuigu Cataplasm＂umbilical compressing based on the treatment of control group. Two groups were treated for 14 days. The clinical efficacy was observed. The changes of clinical sign（ 24 h urine volume,abdominal girth,body mass）,index of correlation tested with color Doppler ultrasound（ blood flow volume of portal vein,blood flow volume of splenic vein,depth of ascites dark space）,liver function,levels of sodium in blood and urine. Results 1The total effective rate of the treatment group and control group were 81. 82% 和 62. 50% respectively;the difference of clinical efficacy between the two groups was statistically significant（ P 0. 05）. 2Compared before treatment and after follow-up,the difference of24 h urine volume,abdominal girth of the two groups were significant（ P 0. 05）; after the follow-up,the difference of 24 h urine volume,abdominal girth between the two groups were significant（ P 0. 05）. 3Compared before and after the treatment,the difference of blood flow volume of portal vein,blood flow volume of splenic vein and depth of ascites dark space of the two groups were significant（ P 0. 05）; after the treatment,the difference of blood flow volume of portal vein,blood flow volume of splenic vein and depth of ascites dark space between the two groups were significant（ P 0. 05）. 4Compared before and after the treatment,the difference of liver function index of the treatment group were all significant（ P 0. 05）,while only the difference of GGT,TBIL,ALB,A / G levels of control group were significant（ P 0. 05）. After the treatment,the difference of GGT,TBIL,ALB,A / G levels betwe

关 键 词：肝硬化 顽固性腹水 慢性乙型肝炎 水臌贴 托伐普坦 敷脐疗法 门/脾静脉血流量 腹水暗区深度 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]