不同利尿方案对肝癌患者肝切除术后相关指标的影响

发布时间：2018-10-05 19:11

【摘要】：目的:探讨不同利尿方案对肝癌患者肝切除术后相关指标的影响。方法:60例拟行肝癌肝切除手术的患者随机分为研究组(30例)和对照组(30例)。术后在常规治疗的基础上,研究组患者给予螺内酯片100 mg,qd+呋塞米片40 mg,qd,于每日早饭后服用;对照组患者给予螺内酯片100 mg,bid,于每日早饭后和下午16时口服+呋塞米片20 mg,qd,于每日早饭后口服。两组患者均每3日复查电解质及肝肾功能,并根据体质量和液体出入量变化调整利尿方案。观察两组患者利尿治疗有效性指标(体质量减轻、利尿治疗有效例数、静脉使用利尿药频次、羟乙基淀粉使用频次、夜间排尿频次、术后住院时间、腹水消退时间),治疗前后血钠、血钾、血肌酐、血尿素氮、血白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、谷酰转肽酶及不良反应发生情况。结果:研究组患者夜间排尿频次显著少于对照组,差异均有统计学意义(P0.05);两组患者体质量减轻、利尿治疗有效例数、静脉使用利尿药频次、羟乙基淀粉使用频次、术后住院时间、腹水消退时间等比较,差异均无统计学意义(P0.05)。治疗后,两组患者血钠、血白蛋白水平均显著低于同组治疗前;两组患者血钾、血尿素氮、丙氨酸转氨酶、天冬氨酸转氨酶、谷酰转肽酶水平均显著高于同组治疗前,差异均有统计学意义(P0.05);但两组间血钠、血钾、血尿素氮、血白蛋白、丙氨酸转氨酶、天冬氨酸转氨酶、谷酰转肽酶及治疗前后血肌酐比较,差异均无统计学意义(P0.05)。两组患者利尿相关不良反应发生率比较,差异无统计学意义(P0.05)。结论:在常规治疗的基础上,两种利尿方案均可有效避免肝癌患者肝切除术后腹水形成,减少相关并发症的发生,但螺内酯100 mg,qd+呋塞米40 mg,qd,每日早饭后服药的给药方法能显著降低患者夜间排尿次数,提高用药依从性。
[Abstract]:Objective: to investigate the effect of different diuretic regimen on liver cancer patients after hepatectomy. Methods 60 patients with liver cancer were randomly divided into study group (n = 30) and control group (n = 30). On the basis of routine treatment, patients in the study group were given 100 mg,qd furosemide tablets for 40 mg,qd, daily after breakfast. Patients in the control group were given spironolactone tablets for 100 mg,bid, after breakfast and 20 mg,qd, after breakfast at 16:00. Electrolytes and liver and kidney function were reexamined every 3 days in both groups, and diuretic regimen was adjusted according to the changes of body mass and fluid volume. The effective indexes of diuretic therapy (body mass reduction, effective cases of diuretic therapy, frequency of intravenous diuretics, frequency of use of hydroxyethyl starch, frequency of urination at night, hospitalization time after operation) were observed. Serum sodium, serum potassium, serum creatinine, blood urea nitrogen, serum albumin, alanine aminotransferase, aspartate transpeptidase and adverse reactions occurred before and after treatment. Results: the frequency of nocturnal urination in the study group was significantly lower than that in the control group (P0.05). Postoperative hospitalization time, ascites regression time, the difference was not statistically significant (P0.05). After treatment, the levels of serum sodium and albumin in both groups were significantly lower than those before treatment, and the levels of serum potassium, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase and glutamyl transferase in both groups were significantly higher than those before treatment. The differences were statistically significant (P0.05), but there was no significant difference between the two groups in blood sodium, serum potassium, blood urea nitrogen, serum albumin, alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase and serum creatinine before and after treatment (P0.05). There was no significant difference in the incidence of diuretic related adverse reactions between the two groups (P0.05). Conclusion: on the basis of routine treatment, two diuretic regimens can effectively prevent ascites formation after hepatectomy in patients with liver cancer and reduce the incidence of related complications. But the administration of spironolactone 100 mg,qd furosemide 40 mg,qd, per day after breakfast could significantly reduce the number of nocturnal urination and improve the drug compliance.
【作者单位】：南京大学医学院附属鼓楼医院;南京医科大学附属淮安第一医院;
【分类号】：R735.7

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