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。

Influence of different ascites ultrafiltration volume on refractory ascites in patients with liver cirrhosis

Objective To explore the efficacy and safety of removal large volume ascites with ultrafiltration and reinfusion of concentrated ascites for refractory ascites in patients with liver cirrhosis.Methods Seventy-one patients with refractory ascites of liver cirrhosis were randomly divided into the control group and study group.The single ultrafiltration removal ascites volume was 3 000 ～ 8 000 ml in the control group （n =35）,and 8 000 ～ 16 000 ml in the study group （n =36）,3 ～ 7 days later again.Clinical symptoms,abdominal circumference,urine volume,weight,complications,average days of hospitalization,hospital costs were observed.Liver and kidney function,electrolyte calculate,Child pugh scores,Meld scores were evaluated before the treatment,three days and three months after the treatment.Results （1） There were statistically significant differences between the study group and control group in the number of ultrafiltration and reinfusion of concentrated ascites （2.14 ± 1.07） vs （3.57 ± 1.42） times,P =0.000）],average days of hospitalization （21.37 ±3.40） vs （26.46 ±2.78） days,P =0.032）],the average hospital costs 15 356.12 ±3 526.15） vs （18 737.35 ±4 671.23）yuan,P =0.041].But no significant difference was found in volume of ultrafiltration removal ascites （26 347.22 ±13 477.40） vs （21 180.00 ±9 137.73） ml].（2）The total efficiency were 91.67％,65.71％ in two groups,respectively,there was significant difference （P =0.004）.（3） Primary endpoints were defined as hepatic encephalopathy,upper gastrointestinal haemorrhage,hepatorenal syndrome,hepatocarcinoma,death and other endpoint （oozing of blood led by abdominal paracentesis）.There were no significant differences in primary endpoint between two groups （P ＞0.05）.Conclusion By ultrafiltration and reinfusion of concentrated ascites for refractory ascites of liver cirrhosis,the study group with volume of removal ascites of 8 000 ～ 16 000 ml may more effectively reduce the number of abdom