肝硬化腹水患者抗凝治疗的临床疗效及安全性分析  

The clinical efficacy and safety of anticoagulation in patients with ascites due to cirrhosis

作　　者：徐鹏 王一飞 张丽航 王善娟 XU Peng;WANG Yi-fei;ZHANG Li-hang;WANG Shan-juan(epartment of Gastroenterology,The Central Hospital of Jiading Affiliated to Shanghai Health Medical College,Shanghai 201800,China)

机构地区：[1]上海市健康医学院附属嘉定中心医院消化内科

出　　处：《临床药物治疗杂志》2019年第9期46-49,共4页Clinical Medication Journal

基　　金：上海市嘉定区科学技术发展基金(2017ZD01)

摘　　要：目的探讨抗凝治疗对肝硬化腹水患者的临床疗效及安全性。方法选取2015年12月至2017年12月在上海市健康医学院附属嘉定中心医院住院治疗的160例肝硬化腹水患者,按随机数字表法分为抗凝治疗组(90例)、规范治疗组(60例)和空白组(10例)。规范治疗组入院后即给予利尿、限盐、纠正低蛋白血症等规范化治疗,抗凝治疗组在规范化治疗基础上每日皮下注射低分子肝素,空白组在规范化治疗基础上每日皮下注射同等剂量的0.9%氯化钠溶液。观察对比3组患者的临床疗效、出血风险以及不良反应发生情况。结果治疗后,抗凝治疗组腹水消退时间、D-二聚体水平少于规范治疗组和空白组,差异具有统计学意义(P<0.05);3组患者的门静脉主干内径比较,差异无统计学意义(P>0.05)。治疗前后行组内比较,3组患者治疗后腹水量均少于各组治疗前,差异有统计学意义(P<0.05);抗凝治疗组治疗后D-二聚体低于治疗前,差异具有统计学意义(P<0.05);3组患者治疗前后的门静脉主干内径比较,差异均无统计学意义(P>0.05)。抗凝治疗组不良反应包括13例局部出血(14.4%)、1例局部过敏(1.1%),经多因素Logistic回归分析,高龄、男性、糖尿病、高血清腹水白蛋白梯度、吸烟史、血凝常规异常是出血的危险因素。规范治疗组以及空白组未有出血及其他不良反应发生。结论肝硬化腹水患者规范化治疗基础上加用低分子肝素,可使腹水消退时间明显缩短,凝血状态明显改善,安全性较好,但对门静脉主干内径无显著影响。Objective:To explore the clinical efficacy and safety of anticoagulation in patients with ascites due to cirrhosis.Methods:A totally 160 patients with ascites due to cirrhosis in The Central Hospital of Jiading Affiliated to Shanghai Health Medical College from December 2015 to December 2017 were randomly divided into anticoagulation treatment group(90 cases),standardized treatment group(60 cases),and blank group(10 cases).After admission,the patients in standardized treatment group were treated by standardized treatment,which included diuresis,salt restriction,and hypoproteinemia correction.The patients in anticoagulation treatment group were subcutaneously injected with low molecular weight heparin daily on the basis of standardized treatment,while the blank group was subcutaneously injected with the same dose of 0.9% sodium chloride solution daily on the basis of standardized treatment.The clinical efficacy,bleeding risk and adverse reactions of the 3 groups were observed and compared.Results:After treatment,the ascites fading time and D-dimer level in the anticoagulation treatment group were less than those in the standardized group and the blank group(P <0.05),and there was no significant difference of portal vein trunk diameter among the three groups(P>0.05).After treatment,the amount of ascites in the 3 groups was less than before,the difference was statistically significant(P <0.05);D-dimer in the anticoagulation treatment group was lower than that before treatment,the difference was statistically significant(P <0.05);there was no statistically significant difference of the portal vein trunk diameter in the 3 groups before and after treatment(P> 0.05).The adverse reactions in the anticoagulation treatment group included 13 cases local hemorrhage(14.4%) and 1 case local allergy(1.1%).Multivariate logistic regression analysis showed that elderly,male,diabetes mellitus,high serum-ascites albumin gradient(SAAG),smoking history and abnormal blood coagulation routine were the risk factors for hemorrhage.Hemorrh

关 键 词：肝硬化 腹水 低分子肝素 D-二聚体 

分 类 号：R575.2[医药卫生—消化系统]