血液透析联合腹水回输治疗顽固性腹水的临床观察

目的探讨血液透析并腹水静脉回输在尿毒症顽固性腹水患者中的临床疗效。方法回顾性研究2010年10月至2013年9月在我科接受血液透析并腹水静脉浓缩回输治疗的尿毒症患者,11例,41例次,通过分析比较治疗前后体重、腹围、血压、血浆白蛋白、尿素氮、肌酐等各项指标的变化,探讨血液透析并腹水静脉回输在尿毒症顽固性腹水患者中的临床疗效。结果 1例行2次治疗后腹水消失,1例行7次治疗后胸腔积液及腹水均消失,水肿消退,11例患者治疗后均有明显效果,表现为腹胀、活动受限等腹水压迫症状明显改善,浮肿消失,夜间阵发性呼吸困难、睡眠明显好转,食欲增加,腹围、体重明显减少（P〈0.05）,血浆尿素氮、肌酐明显下降（P〈0.01）,血浆白蛋白明显升高（P〈0.01）。结论血液透析并腹水静脉回输能显著改善尿毒症并顽固性腹水患者的临床症状,提高其生存质量,延长生存时间,临床疗效确切。

Clinical observation of hemodialysis combined with ascites reinfusion in treatment of refractory ascites

Objective To investigate the clinical efficacy of hemodialysis combined with intravenous ascites reinfusion in the treatment of patients with uremia associated with refractory ascites. Methods Eleven patients （41 person-times） with uremia who received hemodialysis combined with intravenous ascites rein_fusion treatment in our department from October 2010 to September 2013 were analyzed retrospectively. Through analyzing and comparing the changes in weight, abdominal girth, blood pressure, plasma albumin, urea nitrogen, creatinine and other indicators between before and after the treatment, the clinical efficacy of hemodialysis combined with intravenous ascites reinfusion for the pa- tients with uremic refractory ascites was investigated. Results Ascites of 1 patient disappeared after 2 times of treat- ment; Pleural effusion and ascites of 1 patient disappeared and edema faded away after 7 times of treatment; The treat- ment effects were obvious for 11 patients, manifesting as obvious improvement of abdominal distension, motion limita- tion and other ascites pressure symptoms, significant improvement of edema, paroxysmal nocturnal dyspnea and sleep, increased appetite, obvious decrease of abdominal girth and weight （P〈0.01）, significant decrease of plasma urea nitro- gen and creatinine （P〈0.01）, and significant increase of plasma albumin （P〈0.01）. Conclusion Hemodialysis combined with intravenous ascites reinfusion can significantly improve the clinical symptoms of the patients with uremia associated with refractory ascites, improve their quality of life and prolong their survival time, which shows accurate clinical efficacy.