腹水浓缩回输治疗肝癌合并顽固性腹水47例

目的观察腹水浓缩腹腔回输治疗肝癌合并顽固性腹水的并发症与疗效。方法对47例肝癌合并顽固性腹水患者进行73次腹水超滤浓缩,经腹腔回输体内。结果腹水回输相关事件8次,占10.9%(8/73);轻中度并发症7例,占9.5%(7/73);严重并发症6例次,占8.2%(6/73);治疗后腹围(92.8±4.5)cm与治疗前(98.7±7.3)cm比较,明显下降(P<0.05),治疗后每日尿量(1880.5±201.6)mL与治疗前(986.8±158.5)mL比较,明显增加(P<0.05);腹胀明显缓解且血压无明显下降。首次腹水回输后3～5d内死亡5例,15d、1个月病死率分别为23.9%、41.3%;3个月、1年病死率分别为78.2%、93.4%。结论腹水浓缩回输对肝癌合并顽固性腹水减轻症状有一定疗效,但不能改善患者预后。     

自体腹水浓缩回输腹腔联合多巴胺治疗肝硬化顽固性腹水疗效观察

目的探讨自体腹水浓缩回输腹腔联合多巴胺在治疗肝硬化顽固性腹水中的应用价值。方法对51例肝硬化顽固性腹水患者在常规治疗基础上,加用自体腹水浓缩回输腹腔联合多巴胺治疗,评价其临床疗效及并发症。结果51例肝硬化顽固性腹水患者应用自体腹水浓缩回输腹腔联合多巴胺治疗,有效42例,总有效率达82．35％;对比单纯自体腹水浓缩回输腹腔治疗33例,有效23 例,总有效率69．70％,两组有效率差异有显著性,P<0．05。且两组治疗后内生肌酐清除率差异亦有显著性,P<0．05。结论自体腹水浓缩回输腹腔联合多巴胺治疗肝硬化顽固性腹水不仅见效快,且安全稳定,值得推广应用。     

腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水32例临床分析

目的 探讨腹水超滤浓缩腹腔回输治疗肝硬化顽固性腹水的有效性。方法 分析32例肝硬化顽固性腹水患者接受腹水超滤浓缩腹腔回输治疗,随访3个月的疗效。结果 超滤回输后患者体重下降,腹围缩小,尿量增加,血尿素氮、肌酐水平下降,总蛋白、白蛋白上升（P〈0．05）。结论 腹水超滤浓缩腹腔回输是治疗顽固性腹水非常有效的措施之一。     

腹水超滤浓缩回输治疗肝硬化顽固性腹水48例

目的探讨腹水浓缩后直接回输腹腔治疗肝硬化顽固性腹水的疗效。方法应用北京伟力888-WLXGX血液净化-人工肝支持系统及管路中空纤维滤过器,对48例顽固性腹水患者进行自体腹水浓缩回输腹腔治疗。结果治疗后患者腹围、体重明显下降（P〈0.01）,腹水中钠、钾、氯、钙无明显改变（P〉0.05）,血浆中钠、钾、氯、钙亦无明显改变（P〉0.05）,血浆中白蛋白有所增高（P〈0.01）,总有效率为70.8%。结论腹水浓缩后直接回输腹腔是治疗肝硬化顽固性腹水的一种有效方法。     

腹水浓缩回输术治疗肝硬化腹水42例的护理

目的总结腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水的护理要点及注意事项。方法对42例肝硬化顽固性腹水患者行腹水超滤浓缩回输腹腔治疗，治疗前后进行心理护理，严格无菌技术操作，保持管路通畅，密切观察病情，预防并发症等护理措施。结果42例患者均顺利完成治疗，治疗前后症状、腹围、尿量、血浆白蛋白及腹水蛋白都有显著性差异，自觉症状明显减轻，无护理并发症发生。结论应用腹水超滤浓缩回输腹腔治疗肝硬化顽固性腹水是一种安全有效的方法，加强术前、术中、术后护理是保证治疗顺利进行并获得良好疗效的重要条件。     

腹水超滤浓缩回输治疗顽固性腹水84例

目的观察腹水超滤浓缩静脉或腹腔回输治疗顽固性肝硬化腹水的疗效与安全性。方法采用FCN-01型腹水超滤浓缩回输系统对84例顽固性腹水患者采用腹水超滤浓缩腹腔或者静脉回输治疗。观察、随访3个月。结果患者治疗后尿量增加,血浆白蛋白提高,肌酐水平下降,体重减轻,腹围减小。结论腹水超滤浓缩回输治疗顽固性腹水方法简单易行,安全有效。     

腹水超滤浓缩腹腔回输治疗顽固性腹水临床观察

目的观察自体腹水超滤浓缩回输腹腔治疗顽固性腹水的效果。方法 57例经常规治疗无效的顽固性腹水患者在利尿等支持治疗的基础上加用腹水浓缩回输治疗,并与53例传统治疗的患者进行对比,观察疗效。结果腹水浓缩腹腔回输治疗患者腹水完全消退45例（78.9%）,平均住院时间13天,用白蛋白30g/例,传统治疗患者腹水完全消退30例（56.6%）,平均住院时间25.5天,用白蛋白90g/例;腹水浓缩回输治疗患者血清白蛋白、尿量明显增加,体重、腹围明显降低（P〈0.01）,血钾、钠、氯等无明显变化。结论采用闭路循环式腹水浓缩回输治疗顽固性腹水有一定的疗效。     

特利加压素联合前列地尔辅助腹水超滤浓缩回输治疗肝硬化并发难治性腹水患者疗效分析*

目的 探讨应用特利加压素联合前列地尔辅助腹水超滤浓缩回输治疗肝硬化并发难治性腹水患者的临床效果。方法 2017年3月～2018年6月我院感染病科住院治疗的104例肝硬化并发难治性腹水患者被随机分为腹水回输治疗组52例和综合治疗组52例,分别给予腹水超滤浓缩回输腹腔治疗,综合治疗组则在此基础上加用前列地尔和特利加压素治疗。观察6个月。结果 治疗后一周,综合治疗组门静脉血流速度(Vpv)和脾静脉血流速度(Vsv)分别为(25.6±1.5)cm/s和(27.3±2.7)cm/s,显著快于腹水回输组【分别为(21.4±1.3)cm/s和(25.4±2.1)cm/s, P<0.05】;治疗后,综合治疗组血清一氧化氮、内皮素-1和内毒素水平分别为(13.4±2.1)μmol/L、(53.2±10.3)pg/mL和(31.4±13.2)pg/mL,与腹水回输组【分别为(16.2±2.3)μmol/L、(68.3±12.6)pg/mL和(49.5±14.1)pg/mL,P<0.05】比,差异显著;治疗后,综合治疗组腹围、腹水量和24 h尿量分别为(98.6±7.2)cm、(35.2±9.3)mm和(1531.4±234.2)mL,与腹水回输组【分别为(102.7±6.4)cm、(48.3±11.5)mm和(1249.5±215.1)mL, P<0.05】比,差异显著;治疗后6个月,综合治疗组腹水消退35例(67.3%),显著高于腹水浓缩回输组的14例(26.9%,P<0.05)。结论 应用特利加压素联合前列地尔辅助腹水超滤浓缩回输腹腔治疗肝硬化并发难治性腹水患者具有较好的临床治疗效果,可显著改善患者血液微循环和肝肾功能,有助于促进腹水消退,维持疗效。     

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。     

自体腹水浓缩后腹腔回输治疗顽固性腹水

自体腹水浓缩后腹腔回输治疗顽固性腹水杨晋辉余曙光尤丽英常江李俊徐嫦玉自体腹水超滤浓缩后腹腔回输是用于治疗肝硬化顽固性腹水的一种方法［１］。作者在国内首先将这一方法用于治疗肝硬化张力性腹水［２］，在此基础上，将应用范围扩大到各种原因所致顽固性腹水。治疗...     

Treatment for cirrhotic ascites

Common complications of decompensated liver cirrhosis are esophageal varices, hepatic encephalopathy and ascites. After the onset of complications, the prognosis worsens. In patients with ascites, the 5‐year mortality rate is 44%. Furthermore, hyponatremia, spontaneous bacterial translocation and hepatorenal syndrome also greatly worsen the prognosis. Effective treatment of cirrhotic ascites improves the quality of life and survival rate. Recently, the newly produced diuretic, tolvaptan (vasopressin V2 receptor antagonist), was reported to be effective in the treatment of refractory ascites in liver cirrhosis; however, there has not been an associated positive effect on the prognosis. There are various types of treatment for ascites, such as large‐volume paracenteses, a cell‐free and concentrated ascites reinfusion therapy, a transjugular intrahepatic portosystemic shunt, and a peritoneo‐venous shunt. Although they improve the prognosis, liver transplantation remains the ultimate form of treatment. The present article discusses the therapeutic management of cirrhotic ascites.     

不同腹水超滤量对71例难治性肝硬化腹水患者的影响

目的研究不同腹水超滤量对难治性腹水临床疗效及安全性的影响。方法将符合诊断标准的71例肝硬化难治性腹水病例随机分为对照组和治疗组,对照组单次超滤量3 000~8 000 ml,3~7 d后再次或多次行腹水超滤治疗,治疗组单次超滤量8000~16 000 ml,抽尽腹水,若抽取废液量为3 000~8 000 ml,则纳入对照组。观察治疗前后临床症状、腹围、尿量、体质量、并发症、平均住院日、住院费用;治疗前、后3 d、随访3个月末检测肝肾功能、电解质等,计算Child pugh积分、Meld积分。结果 (1)治疗组、对照组腹水超滤次数分别为(2.14±1.07)次、(3.57±1.42)次,废液总量分别为(26 347.22±13 477.40)ml、(21 180.00±9 137.73)ml,平均住院日分别为(21.37±3.40)d、(26.46±2.78)d,平均住院费用分别为(15 356.12±3 526.15)元、(18 737.35±4 671.23)元,两组腹水超滤次数、平均住院日、平均住院费用相比,差异有统计学意义(P0.05),废液总量相比,差异无统计学意义(P0.05);(2)两组总有效率分别为91.67%、65.71%,差异有统计学意义(P=0.004);(3)两组发生肝性脑病、上消化道出血、肝肾综合征、原发性肝癌、死亡以及其他(局部渗血)情况相比,差异无统计学意义(P0.05)。结论腹水超滤浓缩回输术治疗单次超滤量8 000~16 000 ml比3 000~8 000 ml能显著降低腹水超滤次数、缩短住院日、降低住院费用,更有效控制腹水增长,两组治疗安全性均好,但腹水超滤浓缩回输术治疗不能阻止疾病的进展。     

Prospective study comparing human albumin vs. reinfusion of ultrafiltrate-ascitic fluid after total paracentesis in cirrhotic patients with tense ascites

Although, total paracentesis associated with human albumin substitution has shown to be a rapid, effective and safe treatment of diuretic refractory ascites in advanced liver cirrhosis, it implies high costs and has a limited availability. Therefore an alternative procedure the reinfusion of concentrated ascites has gained popularity in recent years (Smart et al. 1990; Grazioto et al. 1997). It was the aim of the study to compare human albumin substitution vs. reinfusion of ascitic-ultrafiltrate after total paracentesis. 35 patients with cirrhosis and tense ascites received total paracentesis associated with either human albumin (5-8 g/l ascites) (= group A) or reinfusion of an ascitic-ultrafiltrate fluid by means of hemofiltration technique (= group B). The mean volume of ascites removed was 9.41 (2.1-20.0) in group A and 11.41 (6.5-21.0) in group B. No significant differences in serum electrolytes, liver and renal function, coagulation profiles and hormones of the renin-angiotensin-aldosterone system were observed during hospitalization. In both groups sodium excretion increased significantly. 43% of the patients in group B developed pyrexia and chill after reinfusion of the ascitic-ultrafiltrate fluid. In one patient an anaphylactic bronchospasm occurred requiring IUC-treatment. The treatment cost in case of human albumin were 326.-DM vs. 290.-DM for each patient treated with ascitic-ultrafiltrate fluid reinfusion. The probabilities of hospital readmission and survival were similar in both groups during follow-up. The results indicate that i.v. infusion of ascitic-ultrafiltrate fluid is as effective as total paracentesis and albumin infusion in case of diuretic refractory ascites. However, according to the costs of instruments and staff and due to the significant allergic reactions caused by ascitic fluid it cannot be considered as a real alternative to albumin substitution.     

芪遂逐水膏穴位敷贴对肝硬化顽固性腹水患者生存质量的影响

[目的]探讨芪遂逐水膏穴位敷贴疗法对肝硬化顽固性腹水（RAC）患者生存质量（Quality of life,QOL）的影响。[方法]将105例RAC患者随机分为2组,对照组（35例）给予限水、限钠、休息及腹水超滤浓缩回输术治疗,治疗组（70例）在对照组治疗基础上加用芪遂逐水膏穴位敷贴,疗程为1个月,随访期为3个月;应用WHOQOL评定量表简表（WHOQOL-BREF）中文版对每组患者在入组时、1个月后、随访3个月后QOL进行评定,并通过观察症状、尿量、生化指标、腹水复发率等进行疗效评定。[结果]治疗组有效率78．57％,对照组有效率62．85％,差异有统计学意义（P〈0．05）;治疗组在治疗后及随访期WHOQOL-BREF各领域的评分及总分与对照组比较,差异均有统计学意义（P〈0．05）。[结论]芪遂逐水膏穴位敷贴疗法能促进腹水消退,降低复发率,显著提高并维持RAC患者获得较高的QOL。     

Biochemical evaluation of processed ascites in patients undergoing cell‐free and concentrated ascites reinfusion therapy

The biochemical composition of processed ascites is not well researched and may differ among institutions. This prospective study was conducted to evaluate the biochemical characteristics of processed ascites of 11 patients with liver cirrhosis and carcinoma who underwent cell‐free and concentrated ascites reinfusion therapy. The ascites due to carcinoma were more acidic and had higher lactate dehydrogenase activity than those due to liver cirrhosis. The ascites due to liver cirrhosis contained a higher amount of immunoglobulin than those due to carcinoma. Immunoglobulin preparations were approximately 2.95% IgG in liver cirrhosis ascites and 2.25% IgG in carcinoma ascites. Moreover, the concern about IgA infusion in the patient with IgA deficiency made it important to identify the source of the ascites. The present study provided fundamental information regarding the safety of cell‐free and concentrated ascites reinfusion therapy.     

Treatment of ascites

Opinion statement Ascites is the most common complication of cirrhosis and occurs in more than half of all patients with cirrhosis. The development of ascites indicates progression of the underlying cirrhosis and is associated with a 50% 2-year survival rate. Conventional therapies used for the treatment of ascites include sodium restriction (<88 mmol/d), diuretics, and large volume paracentesis (LVP) (>5 L). The most effective diuretic combination is that of a potassium-sparing, distal-acting diuretic (eg, spironolactone) with a loop diuretic (eg, furosemide). LVP provides rapid resolution of symptoms with minimal complications and is well tolerated by most patients. Post-paracentesis circulatory dysfunction (PPCD) may occur after LVP and is characterized by hyponatremia, azotemia, and an increase in plasma renin activity. PPCD is associated with an increased mortality and may be prevented by administration of albumin intravenously (6 to 8 g/L of ascites removed) along with LVP. The development of either diuretic-resistant or diuretic-intractable ascites occurs in approximately 5% to 10 % of all cases of ascites. This is a poor prognostic sign, as 50% of such patients die within 6 months of its development. The only definitive therapy for refractory ascites with cirrhosis is orthotopic liver transplantation. The other options that are available include LVP, peritoneovenous shunts, and transjugular intrahepatic portosystemic shunts (TIPS). The TIPS procedure has not been shown to have any influence on survival in patients with cirrhosis and refractory ascites, and TIPS is contraindicated in patients who have advanced liver failure because it can hasten death in such individuals. Peritoneovenous shunts are associated with a high incidence of complications and frequent occlusion. They are, therefore, rarely used for refractory ascites. Spontaneous bacterial peritonitis (SBP) is a common complication of cirrhotic ascites. It may precipitate hepatorenal syndrome. The overall mortality rate from an episode of SBP is approximately 20%. Following an episode of SBP, the 1-year mortality rate approaches 70%. Hospitalized patients should be treated with intravenous third-generation cephalosporins (eg, cefotaxime), and patients at risk should receive prophylaxis with either orally administered quinolones (eg, norfloxacin) or cotrimoxazole.     

Paracentesis vs. intraperitoneal reinfusion of concentrated ascites — effect on opsonic activity of ascites

Background. Spontaneous bacterial peritonitis is a frequent and serious complication of cirrhotic ascites. An important defense mechanism of ascites against infection is opsonic activity, where the most important part is played by specific antibodies and C3 and C4 components of complement. The authors wanted to find out whether reinfusion of concentrated ascites or paracentesis can influence this activity. Methods. Twenty-six patients with cirrhosis of the liver and refractory ascites not corresponding to salt restriction and diuretics were divided into two groups. In 14 patients, a total of 25 therapeutic paracenteses were made; in 12 patients, a total of 19 reinfusions of concentrated ascites were performed intraperitoneally. In all patients, levels of IgG, IgA, IgM, C3 and C4 components of complement were assessed in ascites before and 24 h after the intervention. Results. After paracentesis no change of the investigated parameters was found. Reinfusion of concentrated ascites, on the other hand, led to a significant rise of IgG, IgA, IgM, C3 and C4 at the 0.5% level of significance. Conclusion. Treatment of refractory ascites by ultrafiltration and reinfusion intraperitoneally seems to increase opsonic activity of ascites and could be useful in the prevention of the development of spontaneous bacterial peritonitis.     

Management of cirrhotic ascites: Seven-step treatment protocol based on the Japanese evidence-based clinical practice guidelines for liver cirrhosis 2020

Liver cirrhosis is a severe illness, associated with multiple complications, which can lead to liver failure. One of the major complications of cirrhosis is ascites. This review describes a stepped treatment approach for the management of ascites in Japanese patients with cirrhosis. It is broadly based on the 2020 update of the Japanese clinical practice guidelines for liver cirrhosis, which is briefly compared with guidelines from Europe and the United States. Step 1 is sodium restriction at a level suitable for Japanese individuals (5–7 g/day), Step 2 is albumin treatment to counteract underlying hypoalbuminemia, Step 3 is initiation of diuretic treatment with spironolactone, followed by add-on loop diuretic treatment at Step 4. Patients that are refractory to sodium restriction and sodium diuretics can be treated with tolvaptan (Step 5) – a vasopressin V2 receptor antagonist that is available in Japan. Patients at Steps 6 and 7 have refractory ascites and are treated with large volume paracentesis in combination with an albumin infusion. High-dose albumin infusion (6–8 g/L) at the time of large volume paracentesis has recently become possible in Japan. Cell-free and concentrated ascites reinfusion therapy is also an option at Step 6. Two of the treatment options at Step 7 are limited in Japan (transjugular intrahepatic portosystemic shunts are not approved, and access to liver donors is very limited), but patients can undergo a peritoneovenous shunt if no other options are available. While challenges remain in the treatment of ascites, adopting this stepwise treatment approach may improve patient outcomes.     

特利加压素联合腹水浓缩回输术治疗肝硬化并发顽固性腹水患者临床研究

目的 探讨应用特利加压素联合腹水浓缩回输术治疗肝硬化并发难治性腹水患者的临床效果。方法 2017年5月～2019年10月解放军联勤保障部队第901医院感染病科诊治的肝硬化并发顽固性腹水患者54例,采用随机数字表法将患者分为观察组(n=27)和对照组(n=27)。对照组患者接受腹水浓缩回输术治疗,观察组在对照组治疗的基础上联合应用特利加压素治疗1周,观察两组肝肾功能、体质量、腹围、腹水和尿量的变化。结果 在观察结束时,观察组和对照组腹围分别为(86.3±4.3)cm和(89.8±6.4)cm(P＜0.05),腹水深度分别为(31.5±8.4)mm和(53.3±9.4)mm(P＜0.05),血清胆红素水分别为(60.8±9.8)μmol/L和(71.5±8.7)μmol/L(P＜0.05),白蛋白水平分别为(33.3±3.0)g/L和(30.0±3.1)g/L(P＜0.05),尿素氮分别为(6.8±1.8)μmol/L和(9.8±2.8)μmol/L(P＜0.05),血清肌酐分别为(104.5±14.4)μmol/L和(133.8±15.3)μmol/L(P＜0.05),24 h尿量分别为(1088.3±285.9)mL和(1385.9±337.9)mL(P＜0.05),差异显著;观察组和对照组住院日分别为(28.8±3.7)d和(38.5±8.3)d(P＜0.05);腹水浓缩分别进行了(4.3±1.4)次和(10.7±3.2)次(P＜0.05),差异显著。结论 应用特利加压素联合腹水浓缩回输术治疗肝硬化并发顽固性腹水患者能减少腹水量、改善肝肾功能、缩短住院日,值得进一步验证。