特利加压素联合前列地尔辅助腹水超滤浓缩回输治疗肝硬化并发难治性腹水患者疗效分析  

Clinical efficacy of ultrafiltration,concentration and reinfusion of ascites and alprostadil and terlipressin combination in treatment of patients with cirrhosis complicated by refractory ascites

作　　者：张惠勇[1] 吴秀欣 徐成润[1] Zhang Huiyong;Wu Xiuxin;Xu Chengrun(Department of Infectious Diseases,Southeast Hospital Affiliated to Xiamen University,Xiamen 363000,Fujian Province,China)

机构地区：[1]厦门大学附属东南医院感染病科

出　　处：《实用肝脏病杂志》2020年第2期244-247,共4页Journal of Practical Hepatology

基　　金：福建省科技厅科研计划重点项目(编号:ZHYF2016125)

摘　　要：目的探讨应用特利加压素联合前列地尔辅助腹水超滤浓缩回输治疗肝硬化并发难治性腹水患者的临床效果。方法2017年3月~2018年6月我院感染病科住院治疗的104例肝硬化并发难治性腹水患者被随机分为腹水回输治疗组52例和综合治疗组52例,分别给予腹水超滤浓缩回输腹腔治疗,综合治疗组则在此基础上加用前列地尔和特利加压素治疗。观察6个月。结果治疗后一周,综合治疗组门静脉血流速度(Vpv)和脾静脉血流速度(Vsv)分别为(25.6±1.5)cm/s和(27.3±2.7)cm/s,显著快于腹水回输组[分别为(21.4±1.3)cm/s和(25.4±2.1)cm/s,P<0.05];治疗后,综合治疗组血清一氧化氮、内皮素-1和内毒素水平分别为(13.4±2.1)μmol/L、(53.2±10.3)pg/mL和(31.4±13.2)pg/mL,与腹水回输组[分别为(16.2±2.3)μmol/L、(68.3±12.6)pg/mL和(49.5±14.1)pg/mL,P<0.05]比,差异显著;治疗后,综合治疗组腹围、腹水量和24 h尿量分别为(98.6±7.2)cm、(35.2±9.3)mm和(1531.4±234.2)mL,与腹水回输组[分别为(102.7±6.4)cm、(48.3±11.5)mm和(1249.5±215.1)mL,P<0.05]比,差异显著;治疗后6个月,综合治疗组腹水消退35例(67.3%),显著高于腹水浓缩回输组的14例(26.9%,P<0.05)。结论应用特利加压素联合前列地尔辅助腹水超滤浓缩回输腹腔治疗肝硬化并发难治性腹水患者具有较好的临床治疗效果,可显著改善患者血液微循环和肝肾功能,有助于促进腹水消退,维持疗效。Objective The aim of this study was to investigate the clinical efficacy of ultrafiltration,concentration and reinfusion of ascites(UCRA)and alprostadil and terlipressin combination in treatment of patients with cirrhosis complicated by refractory ascites(RA).Methods 104 patients with cirrhosis complicated with RA were recruited in the Department of Infectious Diseases in our hospital between March 2017 and June 2018,and were randomly divided into two groups,with 52 in each,receiving UCRA and synthetical treatment,e.g.combination of UCRA and intravenous administration of alprostadil and terlipressin.All patients were followed-up for six months.Results At the end of one week treatment,the velocity of main portal vein and velocity of splenic vein in synthetical treatment group were(25.6±1.5)cm/s and(27.3±2.7)cm/s,significantly rapider than[(21.4±1.3)cm/s and(25.4±2.1)cm/s,respectively,P<0.05]in patients receiving UCRA treatment alone;serum nitric oxide(NO),endothelin-1(ET-1)and endotoxin were(13.4±2.1)μmol/L,(53.2±10.3)pg/mL and(31.4±13.2)pg/mL,significantly different as compared to[(16.2±2.3)μmol/L,(68.3±12.6)pg/mL and(49.5±14.1)pg/mL,respectively,P<0.05]in UCRA-treated groups;the abdominal circumference,ascites depth and urine volume/24 h were(98.6±7.2)cm,(35.2±9.3)mm and(1531.4±234.2)mL,significantly different as compared to[(102.7±6.4)cm,(48.3±11.5)mm and(1249.5±215.1)mL,respectively,P<0.05]in the subsided rate in the latter;at the end of six month observation,the ascites synthetical treatment group was 67.3%,significantly higher than 26.9%in the UCRA-treated group(P<0.05).Conclusion The application of alprostadil and terlipressin might assist ultrafiltration,concentration and reinfusion of ascites in treatment of patients with liver cirrhosis and RA,and the long-term efficacy should be observed.

关 键 词：肝硬化 难治性腹水 腹水超滤浓缩回输 前列地尔 特利加压素 治疗 

分 类 号：R575.2[医药卫生—消化系统]