特利加压素联合前列地尔治疗肝硬化难治性腹水的疗效观察

发布时间：2018-11-24 15:05

【摘要】：目的：观察特利加压素联合前列地尔对肝硬化难治性腹水患者的临床疗效、肾功能、门静脉系统血流动力学、平均动脉压及心率的影响，进而评价治疗的有效性和安全性。方法：肝硬化难治性腹水患者42例，随机分为治疗组和对照组。治疗组22例，应用特利加压素联合前列地尔，对照组20例，单用前列地尔。两组基础治疗为限钠、限水、保肝、利尿、营养支持、补充白蛋白等，治疗疗程均为2周。前列地尔l0ug，qd，，iv，特利加压素1mg，q8h，iv。疗程结束后观察比较两组患者24h尿量、腹围、腹水深度、尿素氮、血肌酐、平均动脉压、心率、门静脉内径及脾静脉内径各项指标的变化，并进行统计学分析。结果： 1.一般资料治疗前治疗组与对照组的年龄、体重、性别、肝硬化的病因、Child-Pugh分级及评分、白蛋白、总胆红素、肾功能、凝血功能、平均动脉压、心率、血钠浓度、门静脉内径及脾静脉内径、腹水深度等比较，差异均无统计学意义。 2.治疗前后肾功能指标比较治疗组治疗后较治疗前BUN及SCr数值下降，两者比较P＜0.05，有统计学差异；对照组治疗后较治疗前BUN及SCr数值下降，两者比较P＜0.05，有统计学差异；治疗后，两组SCr比较P＜0.05，有统计学差异；BUN比较P＞0.05，无统计学差异。 3.治疗前后尿量、腹水变化比较治疗组治疗后较治疗前尿量增多、腹围减小、腹水深度减小，治疗前后比较P＜0.05，均有统计学差异；对照组治疗后较治疗前尿量增多、腹围减小、腹水深度减小，治疗前后比较有统计学差异，P＜0.05；治疗后，两组尿量增多、腹围减小、腹水深度减小程度比较P＜0.05，有统计学差异。 4．两组门静脉及脾静脉内径治疗前后比较治疗组门静脉及脾静脉内径治疗前后比较均缩小，差异有统计学意义（P0.05）。对照组门静脉及脾静脉内径治疗前后比较无明显缩小，差异无统计学意义（P0.05）。 5．两组血流动力学指标（MAP及HR）治疗前后比较治疗组与对照组平均动脉压、心率治疗前后均无明显改变，无统计学意义（P0.05）。结论：l、特利加压素联合前列地尔治疗肝硬化难治性腹水可减少门静脉及脾静脉血流量，改善肾功能，增加尿量，减少腹水量，效果好于单用前列地尔。 2、单用前列地尔可以改善肾功能，增加尿量，但不能明显减少门静脉及脾静脉血流量。 3、特利加压素对血压、心率影响较小。
[Abstract]:Objective: to evaluate the efficacy and safety of trivasopressin combined with alprostadil in the treatment of patients with refractory ascites due to cirrhosis, including renal function, portal vein hemodynamics, mean arterial pressure and heart rate. Methods: 42 patients with refractory ascites were randomly divided into treatment group and control group. The treatment group (22 cases) were treated with trivasopressin combined with alprostadil, and the control group (20 cases) were treated with alprostadil alone. The two groups were treated with sodium limitation, water limitation, liver protection, diuretic, nutritional support and albumin supplementation. The course of treatment was 2 weeks. Alprostadil l0ugn QD iv, 1 mg / g, 1 mg / g, Q8h, iv. et al. The changes of 24h urine volume, abdominal circumference, depth of ascites, urea nitrogen, serum creatinine, mean arterial pressure, heart rate, portal vein diameter and splenic vein diameter were observed and analyzed statistically. Results: 1. General data: age, body weight, sex, etiology of cirrhosis, Child-Pugh grade and score, albumin, total bilirubin, renal function, coagulation function, mean arterial pressure, heart rate, serum sodium concentration before treatment and control group. There was no significant difference in portal vein diameter, splenic vein diameter and ascites depth. 2. The indexes of renal function before and after treatment were lower than those before and after treatment in the treatment group (P < 0.05). The value of BUN and SCr in control group was lower than that before treatment (P < 0.05, P < 0.05), after treatment, SCr in two groups was lower than that before treatment (P < 0.05), and there was no significant difference in BUN (P > 0.05). 3. Before and after treatment, the urine volume and ascites change were increased, abdominal circumference decreased and ascites depth decreased in the treatment group compared with before and after treatment (P < 0.05). After treatment, the urine volume, abdominal circumference and ascites depth in the control group increased, and there were significant differences before and after treatment (P < 0.05). After treatment, the urine volume increased, the abdominal circumference decreased and the depth of ascites decreased in both groups (P < 0.05). 4. Comparison of portal vein and splenic vein before and after treatment in two groups; the comparison of portal vein and splenic vein before and after treatment decreased in treatment group, the difference was statistically significant (P0.05). In the control group, the diameter of portal vein and splenic vein was not significantly reduced before and after treatment, and the difference was not statistically significant (P0.05). 5. Comparison of hemodynamic indexes (MAP and HR) before and after treatment in the treatment group and the control group, the mean arterial pressure and heart rate were not significantly changed before and after treatment (P0.05). Conclusion: 1.Trevasopressin combined with alprostadil can reduce portal and splenic venous blood flow, improve renal function, increase urine volume and decrease ascites volume, and the effect is better than that of alprostadil alone. 2. Alprostadil alone can improve renal function and increase urine volume, but can not significantly reduce portal and splenic venous blood flow. The effect of treponectin on blood pressure and heart rate was small.
【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2

【参考文献】