特利加压素联合腹腔穿刺术治疗肝硬化顽固性腹水的疗效分析

发布时间：2018-06-28 17:59

本文选题：特利加压素 + 大量腹腔穿刺术　；参考：《郑州大学》2017年硕士论文

【摘要】：目的:观察对比特利加压素联合腹腔穿刺术和单独使用腹腔穿刺术对肝硬化顽固性腹水患者的治疗效果,为顽固性腹水探索更有效、安全的治疗方案,并分析腹水应答的预测因素。方法:将2015年3月-2016年9月郑州大学第一附属医院感染科一病区收治的肝硬化顽固性腹水患者按纳入和剔除标准纳入研究,所有患者完全随机分为对照组和治疗组,治疗组给予一般治疗(病因治疗、限制水钠摄入、保肝及对症治疗)、腹腔穿刺术完全放腹水和输注白蛋白,并给予特利加压素1mg/Q12H缓慢静脉注射。对照组在一般治疗和腹腔穿刺术联合白蛋白基础上给予100ml生理盐水作为对照,治疗疗程为1周,并在治疗1周结束时和4周时各随访一次,观察比较两种方案对患者腹水治疗效果及对肾功能、血流动力学的影响,并分析腹水治疗应答的预测因素。结果:1.一般资料:共92例患者完成研究,治疗组48例,对照组44例,两组患者在年龄、性别、病因,治疗前体重、腹围、平均动脉压、心率等基线值无差异,具有可比性(P0.05)。治疗组腹腔穿刺术后放腹水(5.49±0.73)L,对照组放腹水(5.58±0.64)L(t=-0.636,P=0.659)。2.对腹水治疗的效果:1周随访时治疗组应答率(93.75%)与对照组应答率(84.09%)差异无统计学意义(χ2=1.326,P=0.249);治疗组完全应答率(66.67%)明显高于对照组(43.18%)(χ2=5.125,P=0.024)。4周随访时治疗组应答率(33.33%)明显高于对照组(11.36%)(χ2=6.290,P=0.012);治疗组完全应答率(10.41%)与对照组(2.27%)无显著差异(χ2=1.340,P=0.247)。1周随访时应答的患者中治疗组腹水早期复发率(64.44%,29例)明显低于对照组(86.49%,32例)(χ2=5.178,P=0.023)。3.对肾功能的影响在第一次随访时,治疗组患者肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)升高,对照组患者eGFR下降,较基线值均无统计学意义(P0.05);治疗组患者eGFR高于对照组(P0.05)。第4周时治疗组患者eGFR较1周时下降但仍高于基线值,而且高于对照组,但差异均无统计学意义(P0.05)。两组患者24小时尿量和尿钠在早期较基线值均明显升高(P0.05),而且治疗组尿量、尿钠明显高于对照组患者(P0.05)。4周随访中发现两组患者尿量、尿钠都开始减少,但治疗组仍明显高于对照组患者(P0.05)。1周随访时,治疗组患者血浆肾素活性(plasma renin activity,PRA)较对照组和基线值明显降低(P0.05);对照组患者治疗后较基线值无差异明显(P0.05)。4周随访时,治疗组患者PRA仍低于基线值,两组无显著差异(P0.05),但较1周随访时明显升高(P0.05)。4周时治疗组PRA明显低于对照组,差异有统计学意义(P0.05)。4.对血流动力学影响治疗组患者在1周时平均动脉压(mean artery pressure,MAP)较基线值明显升高(P0.05);对照组MAP较基线值下降但无明显差异(P0.05);治疗组患者MAP明显高于对照组患者(P0.05)。4周随访时,治疗组患者MAP较1周时明显下降(P0.05),仍高于基线值和对照组患者,差异有统计学意义(P0.05)。治疗组患者在第一次随访时心率(heart rate,HR)较基线水平明显下降(P0.05);对照组患者心率较基线值无差异(P0.05),治疗组心率明显低于对照组(P0.05)。4周随访时,治疗组患者心率较1周随访时无明显下降(P0.05),仍低于基线值和对照组患者,两组间差异显著(P0.05)。1周随访时,治疗组患者门静脉宽度较基线值明显下降(P0.05),对照组患者较基线值无明显差异(P0.05);治疗组患者门静脉宽度明显低于对照组(P0.05)。4周随访时,治疗组患者门静脉宽度较1周时上升,但差异不明显(P0.05),仍低于基线值水平,差异有统计意义(P0.05);两组之间在4周随访时门静脉宽度变化没有统计学差异(P0.05)。5.腹水治疗应答的二分类多自变量logistic回归分析尿量、尿钠、MAP和治疗方案是治疗是否应答的早期预测因素。尿量、尿钠和MAP每增加一个单位,患者产生应答的可能性分别增大1.005倍、1.351倍和1.384倍;采用联合特利加压素的治疗方案,患者产生应答的可能性增加552.21倍。6.不良反应治疗组和对照组均为出现严重的不良事件。结论:1.特利加压素联合腹腔穿刺术能早期、有效、持续、安全的控制顽固性腹水症状,效果优于单独使用腹腔穿刺术。2.特利加压素联合腹腔穿刺术可改善患者有效循环血量,降低门静脉血流灌注,提高MAP;增加患者肾脏血流灌注,降低肾素-血管紧张素-醛固酮系统(renin-angiotensin-aldosterone system,RAAS)活性,促进患者水钠排出。3.患者基线水平尿钠、尿量、MAP和联合特利加压素治疗是顽固性腹水患者产生应答的早期预测因素。
[Abstract]:Objective: To observe and compare the therapeutic effect of teripressin combined with celiac puncture and celiac puncture on refractory ascites in liver cirrhosis, to explore more effective and safe treatment for intractable ascites, and to analyze the predictors of ascites response. Methods: the First Affiliated Hospital of Zhengzhou University, March 2015, September, is the First Affiliated Hospital of Zhengzhou University. All patients were divided into the control group and the treatment group at random into the control group and the treatment group. The treatment group was given general treatment (etiological treatment, restriction of sodium intake, liver preservation and symptomatic treatment), abdominal puncture and infusion of albumin, and terripressin 1mg/Q1. 2H was given a slow intravenous injection. The control group was treated with 100ml physiological saline on the basis of general treatment and celiac puncture combined with albumin. The treatment course was 1 weeks, and followed up at the end of the 1 week and 4 weeks. The effects of the two schemes on the treatment of the ascites and the renal function and hemodynamics were observed and compared, and the abdomen was analyzed and the abdomen was analyzed. The prediction factors of water treatment response. Results: 1. general data: a total of 92 patients completed the study, 48 cases in the treatment group and 44 cases in the control group. The two groups had no difference in age, sex, etiology, weight, abdominal circumference, mean arterial pressure, heart rate and other baseline values, and had comparability (P0.05). The treatment group had ascites after abdominal puncture (5.49 + 0.73) L, the control group was placed in the control group. The effect of ascites (5.58 + 0.64) L (t=-0.636, P=0.659).2. on the treatment of ascites: there was no significant difference between the response rate of the treatment group (93.75%) and the control group response rate (84.09%) during the 1 week follow-up, and the total response rate (66.67%) in the treatment group was significantly higher than that of the control group (43.18%) (x 2=5.125, P=0.024) during the.4 week follow-up (33.33%). Obviously higher than the control group (11.36%) (x 2=6.290, P=0.012), the total response rate of the treatment group (10.41%) and the control group (2.27%) had no significant difference (x 2=1.340, P=0.247) in the patients with.1 week follow-up (64.44%, 29 cases) significantly lower than the control group (86.49%, 32 cases) (x 2=5.178, P=0.023).3. on the renal function in the first At the secondary follow-up, the estimated value of glomerular filtration rate (estimated glomerular filtration rate, eGFR) in the treatment group was higher than that in the control group, and the eGFR decreased compared with the baseline value (P0.05), and the eGFR in the treatment group was higher than the control group (P0.05). The eGFR of the treatment group was lower than the baseline at fourth weeks but still higher than the baseline, and higher than the control group. The difference was not statistically significant (P0.05). The 24 hours urine volume and urine sodium in the two groups were significantly higher in the early than the baseline (P0.05), and the urine volume of the treatment group and the urine sodium were significantly higher than that of the control group (P0.05). The urine volume was found in two groups of patients during the.4 week follow-up, but the urine sodium began to decrease, but the treatment group was still significantly higher than that of the control group (P0.05).1 weeks. During the follow-up, the plasma renin activity (plasma renin activity, PRA) of the patients in the treatment group was significantly lower than that of the control group and the baseline value (P0.05). There was no difference between the control group and the baseline value (P0.05) after.4 week. The PRA in the treatment group was still lower than the baseline value, and there was no significant difference between the two groups (P0.05), but it was significantly higher than the 1 week follow-up (P0.05).4 week. The PRA in the treatment group was significantly lower than that of the control group. The difference was statistically significant (P0.05). The mean arterial pressure (mean artery pressure, MAP) of the patients in the hemodynamic treatment group was significantly higher than the baseline at 1 weeks (P0.05), and the control group decreased the MAP than the baseline but had no significant difference (P0.05), and the MAP of the treatment group was significantly higher than that of the control group (P0.05). During the 4 week follow-up, the MAP in the treatment group was significantly lower than the 1 week (P0.05), still higher than the baseline and the control group. The difference was statistically significant (P0.05). The heart rate (heart rate, HR) in the treatment group was significantly lower than the baseline (P0.05) in the first follow-up period (P0.05); the heart rate of the control group was no difference (P0.05), and the heart rate of the treatment group was significantly lower. In the control group (P0.05).4 week follow-up, the rate of heart rate in the treatment group was not significantly lower than that of the 1 week follow-up (P0.05), still lower than the baseline value and the control group, the difference between the two groups was significant (P0.05) at the.1 week follow-up, the portal vein width of the treatment group was significantly lower than the baseline value (P0.05), and the control group had no significant difference compared with the baseline value (P0.05); the treatment group had a significant difference (P0.05). The portal width of the portal vein was significantly lower than that of the control group (P0.05) at.4 weeks. The portal vein width in the treatment group increased at 1 weeks, but the difference was not significant (P0.05), still lower than the baseline level, the difference was statistically significant (P0.05). There was no statistical difference between the two groups at 4 weeks' follow-up (P0.05) the two classification of the response to the treatment of.5. ascites. Multiple logistic regression analysis of urine volume, urine sodium, MAP and treatment were early predictors of response to the response. Urine volume, urine sodium and MAP were increased by one unit, and the possibility of response was increased by 1.005 times, 1.351 times and 1.384 times respectively. The possibility of response was increased by 5 with a combination of terripressin therapy. 52.21 times the.6. adverse reaction treatment group and the control group were all serious adverse events. Conclusion: 1. Terry vasopressin combined with abdominal puncture can be effective, continuous and safe to control the refractory ascites symptoms, the effect is better than the single use of celiac puncture operation.2. Terry vasopressin combined abdominal puncture can improve the effective circulation blood volume of patients, descend Low portal vein perfusion, increased MAP, increased renal perfusion, reduced renin-angiotensin-aldosterone system, RAAS activity, and promoted the baseline level of sodium, urine, MAP, and combination of terepressin in patients with.3. in patients with.3. Predictors.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R575.2

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