中药联合自身腹水超滤浓缩回输静脉治疗肝硬化难治性腹水的临床研究

目的观察中药联合自身腹水超滤浓缩回输静脉治疗肝硬化难治性腹水的疗效。方法选择肝硬化难治性腹水患者,分别给予中药联合自身腹水超滤浓缩回输静脉和单纯自身腹水超滤浓缩回输静脉治疗,观察治疗前和治疗4周后患者的症状、体征、血钠、尿钠、肝功能及彩色多普勒测定腹水量和门脉血流量的变化。结果联合治疗组腹水消退的总有效率为86.7%,而对照组为59.2%,且对照组中没有腹水消退I级者,有显著性差异（P〈0.01）;联合治疗组治疗4周后肝功能明显改善,门脉血流量明显下降（P〈0.05）,而对照组无明显改善（P〉0.05）。结论中药联合自身腹水超滤浓缩回输静脉治疗肝硬化难治性腹水有效,比单纯自身腹水超滤浓缩回输静脉治疗好。     

五皮饮加味联合腹水回输治疗肝硬化难治性腹水的临床观察

[目的]探讨五皮饮加味联合腹水超滤浓缩回输治疗肝硬化难治性腹水的疗效及安全性.[方法]选择肝硬化难治性腹水住院患者86例,随机分成2组,各43例,治疗组采用五皮饮加味联合腹水回输疗法,对照组采用单纯腹水回输疗法,腹水回输每2周1次,每次3 000～5 000 ml,疗程均为2个月,治疗后观察患者体重、腹围、尿量、血浆白蛋白、肝功能、腹水等变化.[结果]2组患者症状均明显好转,其中治疗组总有效率达81.39％,对照组为48.84％,2组比较差异有统计学意义(P＜0.05);治疗组患者肝功能、白蛋白、腹围、体重均明显改善,与对照组比较差异有统计学意义(P＜0.05).[结论]五皮饮加味联合腹水回输治疗肝硬化难治性腹水是安全、有效的方法,具有较好的疗效.     

腹水超滤浓缩-细菌过滤回输腹腔治疗肝炎肝硬化合并自发性细菌性腹膜炎的临床疗效分析

目的 评估腹水超滤浓缩-细菌过滤回输腹腔技术治疗肝炎肝硬化合并自发性细菌性腹膜炎患者的临床疗效.方法 110例肝炎肝硬化合并自发性细菌性腹膜炎患者随机分为研究组和对照组,两组患者均采用保肝、利尿、对症、支持及静脉滴注抗生素等常规治疗,疗程2周.研究组在常规治疗基础上,采用腹水超滤浓缩-细菌过滤回输腹腔治疗;对照组在常规治疗基础上,采用腹腔穿刺放液治疗.结果 治疗后研究组腹水蛋白及补体C3水平明显高于对照组(P＜0.01),研究组血清白蛋白水平明显高于对照组(P＜0.01),研究组临床疗效明显好于对照组(P＜0.01).结论 腹水超滤浓缩-细菌过滤回输腹腔技术治疗肝炎肝硬化合并自发性细菌性腹膜炎患者的临床疗效明显好于腹腔穿刺放液治疗.     

腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水疗效评价

目的 评估腹水超滤浓缩回输腹腔术治疗肝炎肝硬化顽固性腹水患者临床疗效。方法75例肝硬化顽固性腹水患者分为治疗组（50例）和对照组（25例）,两组患者均采用保肝、利尿、对症、支持等常规治疗,疗程4周。对照组在常规治疗基础上,采用多次治疗性腹穿放液治疗;治疗组在常规治疗基础上,采用腹水超滤浓缩回输腹腔治疗,观察并比较两组治疗后体重、腹围、24h尿量和尿钠排出量、肝功能、肾功能、血电解质及不良反应。结果治疗4周后治疗组腹围、体重、24h尿量优于对照组（P〈0．01）;血清白蛋白、肾小球滤过率及24h尿钠量高于对照组（P〈0．01）,肌酐、胱抑素c水平低于对照组（P〈0．05。P〈0．01）;治疗组显效率（48．0％）和总有效率（80．0％）明显好于对照组（24．0％和52．0％）（P〈0．05）：两组均未出现严重不良反应。结论腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水患者临床疗效优于多次治疗性腹穿放液。     

中药联合腹水超滤浓缩回输法治疗肝硬化顽固性腹水的临床研究

目的：观察中药联合腹水超滤浓缩回输法治疗肝硬化顽固性腹水的疗效。方法：选择肝硬化顽固性腹水住院患者62例，随机分为两组，治疗组32例，采用中药＋腹水超滤浓缩回输＋基础治疗；对照组30-ff0，采用腹水超滤浓缩回输＋基础治疗。疗程均为1个月．腹水超滤浓缩回输的频率为2周1次，1次超滤的腹水为3000ml-8000ml，观察治疗前后患者的体重、腹围、24小时尿量、血浆白蛋白、腹水白蛋白、门脉主干的血流动力学变化及患者血浆和腹水中内毒素水平的变化。结果：两组患者的临床症状均得到较好改善，患者体重及腹围显著下降，24小时尿量增加，血浆及腹水中蛋白量增加，治疗组患者门静脉、脾静脉内径及血流量、血浆中内毒素水平较治疗前显著下降，对照组患者则无明显改善，两组比较差异有显著性意义（P〈0．05）；治疗组患者腹水Ⅰ级消退者18例，占56．3％，对照组只有4例，占13.3％，两组比较差异有显著性意义（P〈0．05）。结论：中药联合腹水超滤浓缩回输治疗肝硬化顽固性腹水有较好疗效，其作用机制可能与改善患者血浆内毒素水平有关。     

腹水超滤浓缩回输治疗肝硬化难治性腹水108例分析

腹水是肝硬化患者最常见的并发症,部分患者经限钠、限水、利尿等治疗后效果仍不理想,最终发展为难治性腹水。大量腹水可影响呼吸和循环功能,易发生上消化道出血、肝肾综合征、肝性脑病及自发性细菌性腹膜炎等并发症,预后差,病死率高。我院对108例肝硬化并发难治性腹水患者在常规内科综合治疗的基础上采用腹水超滤浓缩回输腹腔治疗,取得一定疗效,总结如下。     

腹水直接回输和卡托普利联合治疗肝硬化顽固性腹水50例

顽固性肝硬化腹水长期以来是肝硬化患者治疗的棘手问题，常规利尿治疗很难奏效，单纯穿刺放腹水或腹水回输能暂时缓解病人症状，但腹水容易复发。如用超滤浓缩法，需一定设备，疫区基层血防机构没有这种条件。为了救治晚期血吸虫病患者，本站采取直接回输，体内浓缩，结合卡托普利治疗顽固性腹水取得了较好的疗效，现报告如下。     

腹水超滤浓缩回输腹腔术对肝硬化顽固性大量腹水并发Ⅱ型肝肾综合征的疗效探讨

[目的]探讨腹水超滤浓缩回输腹腔术对肝硬化顽固性大量腹水患者并发Ⅱ型肝肾综合征的疗效。[方法]将66例肝硬化顽固性大量腹水同时并发Ⅱ型肝肾综合征的患者随机分为治疗组(34例)和对照组(32例);治疗组采用腹水超滤浓缩回输腹腔术治疗,对照组采用腹腔穿刺放液治疗。[结果]2组治疗后,在改善24h尿量、降低血清尿素氮、降低血清K+方面均较治疗前有效,但治疗组明显优于对照组(P0.05);2组不良反应发生率比较差异无统计学意义(P0.05)。[结论]合理应用腹水超滤浓缩回输腹腔术是一种治疗肝硬化顽固性大量腹水并发Ⅱ肝肾综合征的有效措施,可迅速改善患者肾脏功能,明显增加尿量,缓解氮质血症,解除高钾血症。     

腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水疗效分析

目的 探讨腹水超滤浓缩回输腹腔术治疗肝硬化顽固性腹水的疗效。方法 将56例肝硬化顽固性腹水患者随机分为2组,均给予保肝、利尿及抗病毒治疗。在此基础上,对治疗组行腹水超滤浓缩回输腹腔术加小剂量人血白蛋白静脉滴注(静滴)(每滤出1000ml腹水,静滴人血白蛋白4g),对对照组行大量放腹水加大剂量人血白蛋白静滴(每抽出1000ml腹水,静滴人血白蛋白8g)。结果 术后第14天,治疗组患者24h尿量、血清ALB水平均高于对照组(P均<0.05),且治疗组总有效率高于对照组(P<0.05)。结论 腹水超滤浓缩回输腹腔术是一种安全有效的治疗肝硬化顽固性腹水的方法。     

腹水浓缩超滤回输治疗肝硬化顽固性腹水42例

腹水浓缩超滤静脉回输是治疗肝硬化顽固性腹水比较有效的方法[1] ,但是以往对感染性腹水的回输多有顾虑 ,故主张不宜作此治疗。为了更好地解决这一问题 ,我们于2 0 0 1年 4月开始应用天津净美联合处理设备厂生产的HAUF Ⅱ型腹水浓缩机对 4 2例肝硬化顽固性感染性腹水进行腹腔回输治疗 ,同时配合多巴胺、速尿联合腹腔注射取得了较满意的疗效 ,现报道如下。对象与方法一、病例选择4 2例肝炎肝硬化皆为我科住院的患者 ,诊断符合 1995年全国修订的病毒性肝炎诊断标准[2 ] ,其中男 2 8例 ,女 14例 ,年龄 4 5～ 73岁 ,腹水常规化验符合渗出液诊…     

Eosinophilic ascites

Summary Hypereosinophilic syndrome is a multisystem disease with progressive valvular dysfunction as a prominent feature. Ascites has not been recognized as a part of this syndrome. This paper presents a patient with hypereosinophilic syndrome who initially developed ascites and was recognized to have cardiac disease. The differential diagnosis of eosinophilic ascites is discussed.     

Myxedema ascites

Summary A 74-year-old man presented with mental obtundation and massive ascites without evidence of significant impairment of liver function. Thyroid function studies suggested hypothyroidism. Aspirated ascitic fluid had the characteristics of an exudate. Thyroid replacement therapy resulted in rapid clinical improvement with resolution of the ascites. Prompt recognition of myxedema ascites may prevent the inappropriate use of diuretic agents, therapeutic paracentesis, and sometimes unnecessary laparotomy.     

乳糜性腹水

乳糜性腹水是指乳状或奶油状的腹腔渗液 ,富含甘油三酯 ,是胸内和肠道淋巴液进入腹腔所致。乳糜性腹水临床发生率不高 ,国外[1,2 ] 的临床观察显示其大约占住院病例的两万分之一 (1∶2 0 0 0 0～ 1∶10 0 0 0 0 )。然而 ,由于进展性心肺疾患、腹部外科手术的增多和肿瘤患者的存活期延长 ,其发生率已经增加。北京协和医院[3 ] 乳糜性腹水近十年就检出 2 2例 ,远高于过去六十七年的 17例 ,当然这也可能和临床对它的认识提高有关。一、病理生理学乳糜性腹水形成和淋巴系统的破坏有关 ,主要是由于创伤性的损伤和阻塞引起。病因可能是良性或恶性…     

Myelomatous ascites

Ascites is an unusual feature of multiple myeloma. We report a case of ascites occurring early in the course of a patient with myeloma in whom there was no evidence of intra-abdominal plasmacytoma, and the skeleton was relatively spared. The serum contained predominantly polymeric IgA, a feature not investigated in previous cases. We reviewed the relevant literature and will discuss the suggestion that human myelomas presenting with the triad of ascites, relative or absolute sparing of the skeleton, and an IgA paraprotein bear an analogy to mouse myelomas induced by intraperitoneal instillation of irritants. The relevance of polymeric IgA is discussed with respect to tissue origin of the paraprotein. Seventeen cases were identified consistent with a definition of "myelomatous ascites" (malignant myeloma in which plasma cells and/or monoclonal immunoglobulin can be demonstrated in ascitic fluid). IgA immunoglobulin class was present at three times the incidence seen in myelomas in general (five of seven cases were specified). In twelve patients there was no identifiable intra-abdominal plasmacytoma although liver infiltration was common. Amyloidosis was reported in only one case, and no cases of uncomplicated plasma cell leukemia were noted. Ascites was a presenting feature in five cases. In each of these five there was absolute or relative sparing of the skeleton, four had no evidence of plasmacytoma, and the paraprotein was IgA in three, IgG in one, and unreported in one. In no case was there a known history of chronic intra-abdominal irritation.     

Refractory ascites

Patients with cirrhosis have significant abnormalities in their fluid and electrolyte balance; this is manifested mainly by the development of ascites and edema. Ascites is the most common complication of patients with cirrhosis and its development constitutes the first and most important manifestation of the disease. With disease progression, patients with advanced cirrhosis and severe urinary sodium retention develop refractory ascites, a condition in which patients do not respond to diuretics or develop severe side effects to these that preclude their use. This condition occurs in 5-10% of cases admitted to the hospital for treatment of ascites. Approximately half of these patients will die within 1 year if not transplanted; therefore, the best therapy is liver transplantation in suitable candidates. During the last two decades, significant advances have been made in regard to pathogenesis and treatment of refractory ascites. The re-introduction of therapeutic paracentesis with plasma expansion in the 1980s was a milestone in the treatment of these patients. In addition, the introduction of transjugular intrahepatic portosystemic shunts as a therapy for refractory ascites has certainly provided a reasonable alternative for those patients with preserved liver function and unwilling to undergo several taps per month. This article will discuss the pathophysiology, clinical features and therapy of refractory ascites in cirrhosis.     

Chylous ascites

Summary The present study reports a patient with chylous ascites, edema, and hypoalbuminemia, which had appeared after pelvic surgery and irradiation for adenocarcinoma of the endocervix. The administration of a diet high in fat aggravated the degree of hypoalbuminemia and the extent of the edema. A reduction of the edema and of the ascites, and a rise in serum albumin to normal levels, followed the institution of a diet low in fat content. The dietary fat (LCT) was replaced isocalorically with MCT. Recurrence of the ascites, edema, and hypoalbuminemia occurred after a lymphangiogram, as the oily contrast medium transiently obstructed an already compromised lymphatic system.Supported in part by Grant AM-5156 from the NIH, US Public Health Service. The patient was studied at Yale Clinical Research Center, Grant FR-00125, US Public Health Service.