腹水超滤浓缩腹腔回输治疗肝硬化顽固性腹水35例

肝硬化顽固性腹水是肝硬化由失代偿早期转化为晚期的一个重要标志。患者对利尿剂反应差,承受巨大痛苦。我们于1999年以来对顽固性腹水行腹水超滤浓缩腹腔回输治疗,共进行了35例74次,取得了较好的近期效果。现报道如下。 1 材料和方法 1.1 病例选择 所有病例均为我院肝病科1999年以来住院的肝硬化腹水患者。其中男30例,女5例;年龄42～72岁;肝病病程5个月～20年;腹水持续时间2个月～5年;总胆红素<100μmol/L,生命体征稳定。所有患者病毒学检测均为HBV     

排放腹水治疗肝硬化顽固性腹水32例分析

目的　观察排放腹水治疗肝硬化顽固性腹水的疗效。方法　对 6 4例肝硬化顽固性腹水患者 ,随机分成两组 ,两组均给以补充人体白蛋白、复方丹参注射液、限钠、限水 ,同时注意维持内环境的平衡。治疗组排放腹水 ,对照组使用利尿合剂。结果　治疗组显效 6 2 .50 % ( 2 0 / 32 ) ,有效 31.2 5% ( 10 / 32 ) ,无效 6 .2 5% ( 2 / 32 ) ,总有效率 93.75% ( 30 / 32 ) ;对照组显效 37.50 % ( 12 / 32 ) ,有效 34 .38% ( 11/ 32 ) ,无效 2 8.12 % ( 9/ 32 ) ,总有效率71.88% ( 2 3/ 32 )。治疗组明显优于对照组。严重并发症 (血钾 <3.0 ml/ L、肝肾综合征、肝性脑病等 )的发生率 ,治疗组为 15.6 3% ,对照组为 59.38%。治疗组并发症明显少于对照组。结论　排放腹水的治疗方法可能是治疗肝硬化顽固性腹水的一种较好的方法 ,且并发症较少     

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…     

复方卡托普利治疗顽固性肝硬化腹水

复方卡托普利治疗顽固性肝硬化腹水贾奎平，崔勇，崔新科，刘玉芹（河南医科大学医院郑州４５００５２）顽固性肝硬化腹水影响因素众多，临床上缺乏确切有效地治疗方法，处理上十分困难。我们曾用卡托普利片（Ｃａｐｔｏｐｒｉｌ，又名巯甲丙脯胺酸）治疗肝硬化腹水，取得...     

综合利尿疗法治疗肝硬化顽固性腹水25例

肝硬化腹水属中医“膨胀”病范畴,为临床难治病症之一,尤其是肝硬化顽固性腹水,治疗颇为棘手。笔者采用综合利尿疗法治疗肝硬化顽固性腹水25例,收到较好疗效,现报告如下。1 病例选择 ①符合1995年北京全国传染病寄生虫病学术会议制定的肝硬化诊断标准。②腹水量多,增长迅速。③腹水持续超过1     

顽固性肝硬化腹水48例护理体会

1999年5月～2004年2月，我们收治肝硬化顽固性腹水患者48例，治疗效果满意，现将护理体会报告如下。     

五苓散联合生长激素治疗肝硬化顽固性腹水60例

我们应用五苓散和生长激素治疗肝硬化顽固性腹水患者60例,取得较为满意的效果,现报告如下.     

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。     

新型毛细管腹水浓缩器治疗顽固性肝硬化腹水23例报告

本文报告应用新型毛细管腹水浓缩嚣(PsU-Ⅰ型),作腹水浓缩回输治疗顽固性肝硬化腹水,共23例30人次,总有效率65.2%。该浓缩器由高分子聚砚膜材料制成,毛细管内径0.8mm,壁厚0.1mm,长350mm,膜总面积0.42m~2,超滤连率5000ml/h(水测试),蛋白截留率大于90%,腹水浓缩倍数1～20倍可自由选择,采用内压式,毛细管抗压力可大于101kPa(760mmHg)仍不破膜,适合腹水浓缩专用,属国内临床首次使用。     

黄体酮治疗顽固性肝硬化腹水16例

采用黄体酮治疗晚期血吸虫病和肝炎后肝硬化腹水16例。治后6个月随访,15例未再出现腹水,1例有轻度腹水。     

恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水的效果观察

目的观察恩替卡韦与前列地尔联合治疗乙型肝炎肝硬化腹水的临床疗效。方法选取2012年5月-2014年2月德州市中医院收治的乙型肝炎肝硬化腹水患者100例,随机分为治疗组与对照组,每组各50例,两组均常规给予保肝、利尿、间断补充白蛋白(Alb)治疗,其中治疗组加用恩替卡韦0.5 mg口服,1次/d,联合前列地尔20μg+5%葡萄糖注射液100 ml静滴,1次/d,观察组只加用恩替卡韦0.5 mg口服,1次/d。住院治疗4周,观察两组治疗前后腹水消退情况、ALT、TBil、Alb、血液尿素氮(BUN)、肌酐(Cr)、凝血酶原活动度(PTA)、HBV DNA水平变化。出院后两组患者继续口服恩替卡韦0.5 mg,1次/d,随访3个月观察远期疗效。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果两组患者治疗后腹水量较治疗前均有不同程度降低,治疗组总有效率(84%)高于对照组(64%),差异有统计学意义(χ2=6.018,P0.05);两组患者肝肾功能各项指标(ALT、TBil、Alb、BUN、Cr)及PTA治疗后较治疗前均有不同程度改善,且治疗组疗效优于对照组,两组治疗后各项指标相比差异均有统计学意义(t值分别为7.567、6.875、-4.782、6.786、8.542、8.976,P值均0.01);两组患者治疗后HBV DNA水平均较治疗前有不同程度下降,差异均有统计学意义(t值分别为8.976、5.758,P值均0.01)),但两组间治疗后比较差异无统计学意义(P0.05);患者出院后随访3个月,治疗组在肝肾功能稳定、腹水反复方面优于对照组。结论恩替卡韦联合前列地尔治疗乙型肝炎肝硬化腹水疗效确切,远期疗效较好,值得临床应用与推广;恩替卡韦单用对肾功能改善不明显,但肝功能可获得明显改善。     

Rifaximin improves survival in cirrhotic patients with refractory ascites: A real-world study

BACKGROUND Rifaximin has been shown to reduce the incidence of hepatic encephalopathy and other complications in patients with cirrhosis.However,few studies have investigated the effect of rifaximin in cirrhotic patients with refractory ascites.AIM To evaluate the effects of rifaximin in the treatment of refractory ascites and to preliminarily explore its possible mechanism.METHODS A total of 75 cirrhotic patients with refractory ascites were enrolled in the study(50 in a rifaximin and 25 in a control group).Patients in the rifaximin group were divided into two subgroups according to the presence of spontaneous bacterial peritonitis and treatment with or without other antibiotics(19 patients treated with rifaximin and 31 patients treated with rifaximin plus intravenous antibiotics).All patients received conventional treatment for refractory ascites,while patients in the rifaximin group received oral rifaximin-α200 mg four times daily for at least 2 wk.The ascites grade,fasting weight,liver and kidney function,and inflammatory factors in the plasma were evaluated before and after treatment.In addition,the gut microbiota was determined by metagenomics sequencing to analyse the changes in the characteristics of the gut microbiota before and after rifaximin treatment.The patients were followed for 6 mo.RESULTS Compared with the control group,the fasting weight of patients significantly decreased and the ascites significantly subsided after treatment with rifaximin(P=0.011 and 0.009,respectively).The 6-mo survival rate of patients in the rifaximin group was significantly higher than that in the control group(P=0.048).The concentration of interferon-inducible protein 10 decreased significantly in the rifaximin group compared with that in the control group(P=0.024).The abundance of Roseburia,Haemophilus,and Prevotella was significantly reduced after rifaximin treatment,while the abundance of Lachnospiraceae_noname,Subdoligranulum,and Dorea decreased and the abundance of Coprobacillus increased after treatment with rifaximin plus intravenous antibiotics.The gene expression of virulence factors was significantly reduced after treatment in both subgroups treated with rifaximin or rifaximin plus intravenous antibiotics.CONCLUSION Rifaximin mitigates ascites and improves survival of cirrhotic patients with refractory ascites.A possible mechanism is that rifaximin regulates the structure and function of intestinal bacteria,thus improving the systemic inflammatory state.     

Octreotide in the treatment of refractory ascites of cirrhosis

Dietary sodium restriction and diuretic treatment have been shown to be effective in the treatment of ascites in the majority of cirrhotic patients. However, approximately 5 to 10% of patients develop refractory ascites, which is defined as ascites that does not respond to intensive diuretic therapy (diuretic-resistant) or ascites that cannot be controlled because the patient develops diuretic-induced complications that prevent the use of an effective diuretic dose (diuretic-intractable). Current therapeutic approaches for refractory ascites include repeated large-volume paracentesis and transjugular intrahepatic portosystemic shunting. In the present report, subcutaneous octreotide treatment improved renal function and hemodynamics and diuretic response in two patients with refractory ascites in line with a marked decrease in renin and aldosterone secretion. We consider that octreotide could be of value in the management of refractory ascites in cirrhotic patients.     

肝硬化难治性腹水的诊治与血管收缩药物的应用

<正>腹水是肝硬化最常见的并发症。在诊断为代偿期肝硬化后,约75%患者在10年内出现腹水症状[1]。在因腹水住院的肝硬化患者中,1 a生存率约为85%,5a生存率接近50%。腹水导致肝硬化患者的生存率显著下降,预期寿命明显缩短[2]。难治性腹水在肝硬化腹水患者中的发生率约为5%~10%,倘若进展为难治性腹水则其中位生存期仅6个月左右[3]。难治性腹水作为终末期肝硬化的临床表现,一旦诊断,则应尽可能     

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。     

腹水浓缩回输治疗124例顽固性肝硬化腹水疗效

目的观察腹水浓缩腹腔回输治疗顽固性肝硬化腹水的并发症与疗效。方法对124例顽固性肝硬化腹水患者进行215次腹水超滤浓缩后,经腹腔回输体内。结果 腹水回输相关事件32次,占14.9%（32/215）;轻中度并发症56例次,占26.0%（56/215）;严重并发症18例次,占8.4%（18/215）;治疗后腹围（93.6±5.6）cm与治疗前（99.8±8.5）cm比较,明显下降（P〈0.05）,治疗后每日尿量（1 906.5±210.8）mL与治疗前（1 016.8±228.5）mL比较,明显增加（P〈0.05）;但血清白蛋白无明显增加。腹水回输后3～5 d内死亡7例,15 d、1个月死亡率分别为27.6%、34.1%;3个月、1年死亡率分别为73.1%、79.6%。结论腹水浓缩回输对顽固性肝硬化腹水减轻症状有一定疗效,但不能改善患者预后,要高度重视预防医患纠纷。     

Six-minute walk test before and after large-volume paracentesis in cirrhotic patients with refractory ascites: A pilot study

Background/AimsFunctional impairment is common among cirrhotic patients with refractory ascites, and improvement in functional impairment is an expected issue after paracentesis. The six-minute walk test (6MWT) is considered an objective test for functional activity. No published data have evaluated the 6MWT among cirrhotic patients with refractory ascites before and after large-volume paracentesis. The research aim was to assess the feasibility of performing the 6MWT among cirrhotic patients who had refractory ascites before and after large-volume paracentesis.Materials and MethodsThirty-one cirrhotic inpatients with refractory ascites were subjected to pulmonary function tests (forced expiratory volume in one second [FEV1], forced vital capacity [FVC], FEV1/FVC) and diffusion lung capacity for carbon monoxide (DLCO) before and 48 h after therapeutic large-volume paracentesis. Dyspnoea as assessed by the Borg scale and functional capacity as assessed by the 6MWT were also evaluated.ResultsPrior to paracentesis, the mean values of FVC and FEV1 were lower than the predicted values, and a significant increase was observed after paracentesis. There was improvement in the mean DLCO values after paracentesis (P < 0.05). Regarding the 6MWT, significant increases in the walked distance (6MWD) (310.7 ± 73 vs. 348.7 ± 72.3 m) and oxygen saturation after paracentesis (P = 0.001) were observed. Significant improvement in the dyspnoea scale also occurred after paracentesis (P = 0.001). A significant positive correlation between the 6MWD before paracentesis and serum albumin levels was demonstrated (r = 0.373, P = 0.039).ConclusionWe found a decrease in pulmonary function and the 6MWD in patients who had refractory ascites, which improved significantly following large-volume paracentesis. The 6MWT is useful in detecting impaired functional capacity among cirrhotic patients.     

Renal vein dilation predicts poor outcome in patients with refractory cirrhotic ascites

Aim

Renal venous hypertension is known to be associated with worsening of renal function in patients with decompensated heart failure. Intra‐abdominal hypertension including cirrhotic ascites also leads to renal venous hypertension. We aimed to clarify the effect of renal venous hypertension on cirrhotic ascites.

Methods

Two hepatologists measured the left renal vein diameter in 142 consecutive patients with refractory cirrhotic ascites using non‐contrast computed tomography. The renal vein diameter was measured at the renal vein main trunk and upstream of the confluence of collateral veins.

Results

The inter‐observer agreements were high for the measurements of the left renal vein (r = 0.918, P < 0.001). The median overall survival for patients with renal vein diameter ≥11 mm was less than that for patients with renal vein diameter <11 mm (P < 0.001; 2.5 vs. 32.0 months). One‐year survival rates were 15.3% versus 66.4%. Multivariate analysis revealed renal vein diameter ≥11 mm (hazard ratio, 2.94; P < 0.001; 95% confidence interval, 1.67–5.20) and a high Model for End‐stage Liver Disease score combined with serum sodium level (MELD‐Na) (hazard ratio, 3.39; P < 0.001; 95% confidence interval, 2.00–5.74) were significant independent predictors of mortality.

Conclusions

Renal vein dilation is a risk factor of mortality in patients with refractory cirrhotic ascites, independent of the MELD‐Na score.     

术前穿刺置管持续腹水引流对肝硬化伴顽固性腹水患者肝移植效果的影响

目的 评价术前穿刺置管持续腹水引流对拟行肝移植的肝硬化伴顽固性腹水患者肝移植效果的影响.方法 将2003年2月-2005年12月在我院行肝移植术的肝硬化伴顽固性腹水患者随机分为对照组(单纯药物治疗)和实验组(术前加穿刺置管腹水引流),分析治疗效果,并对肝移植疗效(包括随访)进行比较.结果 实验组穿刺置管腹水引流操作中无并发症发生,治疗后症状缓解率明显高于对照组,体重降低,尿量增加,尿蛋白降低,移植后半年血肌酐明显低于治疗前.对照组治疗后较治疗前MELD评分分值显著性升高.结论 术前穿刺置管持续腹水引流技术安全稳定,相比单纯药物治疗,综合治疗能够提高肝硬化伴顽固性腹水患者的术前状况.