本文選題：特利加壓素 + 大量腹腔穿刺術(shù)�。� 參考：《鄭州大學(xué)》2017年碩士論文

【摘要】：目的:觀察對(duì)比特利加壓素聯(lián)合腹腔穿刺術(shù)和單獨(dú)使用腹腔穿刺術(shù)對(duì)肝硬化頑固性腹水患者的治療效果,為頑固性腹水探索更有效、安全的治療方案,并分析腹水應(yīng)答的預(yù)測(cè)因素。方法:將2015年3月-2016年9月鄭州大學(xué)第一附屬醫(yī)院感染科一病區(qū)收治的肝硬化頑固性腹水患者按納入和剔除標(biāo)準(zhǔn)納入研究,所有患者完全隨機(jī)分為對(duì)照組和治療組,治療組給予一般治療(病因治療、限制水鈉攝入、保肝及對(duì)癥治療)、腹腔穿刺術(shù)完全放腹水和輸注白蛋白,并給予特利加壓素1mg/Q12H緩慢靜脈注射。對(duì)照組在一般治療和腹腔穿刺術(shù)聯(lián)合白蛋白基礎(chǔ)上給予100ml生理鹽水作為對(duì)照,治療療程為1周,并在治療1周結(jié)束時(shí)和4周時(shí)各隨訪一次,觀察比較兩種方案對(duì)患者腹水治療效果及對(duì)腎功能、血流動(dòng)力學(xué)的影響,并分析腹水治療應(yīng)答的預(yù)測(cè)因素。結(jié)果:1.一般資料:共92例患者完成研究,治療組48例,對(duì)照組44例,兩組患者在年齡、性別、病因,治療前體重、腹圍、平均動(dòng)脈壓、心率等基線值無差異,具有可比性(P0.05)。治療組腹腔穿刺術(shù)后放腹水(5.49±0.73)L,對(duì)照組放腹水(5.58±0.64)L(t=-0.636,P=0.659)。2.對(duì)腹水治療的效果:1周隨訪時(shí)治療組應(yīng)答率(93.75%)與對(duì)照組應(yīng)答率(84.09%)差異無統(tǒng)計(jì)學(xué)意義(χ2=1.326,P=0.249);治療組完全應(yīng)答率(66.67%)明顯高于對(duì)照組(43.18%)(χ2=5.125,P=0.024)。4周隨訪時(shí)治療組應(yīng)答率(33.33%)明顯高于對(duì)照組(11.36%)(χ2=6.290,P=0.012);治療組完全應(yīng)答率(10.41%)與對(duì)照組(2.27%)無顯著差異(χ2=1.340,P=0.247)。1周隨訪時(shí)應(yīng)答的患者中治療組腹水早期復(fù)發(fā)率(64.44%,29例)明顯低于對(duì)照組(86.49%,32例)(χ2=5.178,P=0.023)。3.對(duì)腎功能的影響在第一次隨訪時(shí),治療組患者腎小球?yàn)V過率估計(jì)值(estimated glomerular filtration rate,eGFR)升高,對(duì)照組患者eGFR下降,較基線值均無統(tǒng)計(jì)學(xué)意義(P0.05);治療組患者eGFR高于對(duì)照組(P0.05)。第4周時(shí)治療組患者eGFR較1周時(shí)下降但仍高于基線值,而且高于對(duì)照組,但差異均無統(tǒng)計(jì)學(xué)意義(P0.05)。兩組患者24小時(shí)尿量和尿鈉在早期較基線值均明顯升高(P0.05),而且治療組尿量、尿鈉明顯高于對(duì)照組患者(P0.05)。4周隨訪中發(fā)現(xiàn)兩組患者尿量、尿鈉都開始減少,但治療組仍明顯高于對(duì)照組患者(P0.05)。1周隨訪時(shí),治療組患者血漿腎素活性(plasma renin activity,PRA)較對(duì)照組和基線值明顯降低(P0.05);對(duì)照組患者治療后較基線值無差異明顯(P0.05)。4周隨訪時(shí),治療組患者PRA仍低于基線值,兩組無顯著差異(P0.05),但較1周隨訪時(shí)明顯升高(P0.05)。4周時(shí)治療組PRA明顯低于對(duì)照組,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。4.對(duì)血流動(dòng)力學(xué)影響治療組患者在1周時(shí)平均動(dòng)脈壓(mean artery pressure,MAP)較基線值明顯升高(P0.05);對(duì)照組MAP較基線值下降但無明顯差異(P0.05);治療組患者M(jìn)AP明顯高于對(duì)照組患者(P0.05)。4周隨訪時(shí),治療組患者M(jìn)AP較1周時(shí)明顯下降(P0.05),仍高于基線值和對(duì)照組患者,差異有統(tǒng)計(jì)學(xué)意義(P0.05)。治療組患者在第一次隨訪時(shí)心率(heart rate,HR)較基線水平明顯下降(P0.05);對(duì)照組患者心率較基線值無差異(P0.05),治療組心率明顯低于對(duì)照組(P0.05)。4周隨訪時(shí),治療組患者心率較1周隨訪時(shí)無明顯下降(P0.05),仍低于基線值和對(duì)照組患者,兩組間差異顯著(P0.05)。1周隨訪時(shí),治療組患者門靜脈寬度較基線值明顯下降(P0.05),對(duì)照組患者較基線值無明顯差異(P0.05);治療組患者門靜脈寬度明顯低于對(duì)照組(P0.05)。4周隨訪時(shí),治療組患者門靜脈寬度較1周時(shí)上升,但差異不明顯(P0.05),仍低于基線值水平,差異有統(tǒng)計(jì)意義(P0.05);兩組之間在4周隨訪時(shí)門靜脈寬度變化沒有統(tǒng)計(jì)學(xué)差異(P0.05)。5.腹水治療應(yīng)答的二分類多自變量logistic回歸分析尿量、尿鈉、MAP和治療方案是治療是否應(yīng)答的早期預(yù)測(cè)因素。尿量、尿鈉和MAP每增加一個(gè)單位,患者產(chǎn)生應(yīng)答的可能性分別增大1.005倍、1.351倍和1.384倍;采用聯(lián)合特利加壓素的治療方案,患者產(chǎn)生應(yīng)答的可能性增加552.21倍。6.不良反應(yīng)治療組和對(duì)照組均為出現(xiàn)嚴(yán)重的不良事件。結(jié)論:1.特利加壓素聯(lián)合腹腔穿刺術(shù)能早期、有效、持續(xù)、安全的控制頑固性腹水癥狀,效果優(yōu)于單獨(dú)使用腹腔穿刺術(shù)。2.特利加壓素聯(lián)合腹腔穿刺術(shù)可改善患者有效循環(huán)血量,降低門靜脈血流灌注,提高M(jìn)AP;增加患者腎臟血流灌注,降低腎素-血管緊張素-醛固酮系統(tǒng)(renin-angiotensin-aldosterone system,RAAS)活性,促進(jìn)患者水鈉排出。3.患者基線水平尿鈉、尿量、MAP和聯(lián)合特利加壓素治療是頑固性腹水患者產(chǎn)生應(yīng)答的早期預(yù)測(cè)因素。
[Abstract]:Objective: To observe and compare the therapeutic effect of teripressin combined with celiac puncture and celiac puncture on refractory ascites in liver cirrhosis, to explore more effective and safe treatment for intractable ascites, and to analyze the predictors of ascites response. Methods: the First Affiliated Hospital of Zhengzhou University, March 2015, September, is the First Affiliated Hospital of Zhengzhou University. All patients were divided into the control group and the treatment group at random into the control group and the treatment group. The treatment group was given general treatment (etiological treatment, restriction of sodium intake, liver preservation and symptomatic treatment), abdominal puncture and infusion of albumin, and terripressin 1mg/Q1. 2H was given a slow intravenous injection. The control group was treated with 100ml physiological saline on the basis of general treatment and celiac puncture combined with albumin. The treatment course was 1 weeks, and followed up at the end of the 1 week and 4 weeks. The effects of the two schemes on the treatment of the ascites and the renal function and hemodynamics were observed and compared, and the abdomen was analyzed and the abdomen was analyzed. The prediction factors of water treatment response. Results: 1. general data: a total of 92 patients completed the study, 48 cases in the treatment group and 44 cases in the control group. The two groups had no difference in age, sex, etiology, weight, abdominal circumference, mean arterial pressure, heart rate and other baseline values, and had comparability (P0.05). The treatment group had ascites after abdominal puncture (5.49 + 0.73) L, the control group was placed in the control group. The effect of ascites (5.58 + 0.64) L (t=-0.636, P=0.659).2. on the treatment of ascites: there was no significant difference between the response rate of the treatment group (93.75%) and the control group response rate (84.09%) during the 1 week follow-up, and the total response rate (66.67%) in the treatment group was significantly higher than that of the control group (43.18%) (x 2=5.125, P=0.024) during the.4 week follow-up (33.33%). Obviously higher than the control group (11.36%) (x 2=6.290, P=0.012), the total response rate of the treatment group (10.41%) and the control group (2.27%) had no significant difference (x 2=1.340, P=0.247) in the patients with.1 week follow-up (64.44%, 29 cases) significantly lower than the control group (86.49%, 32 cases) (x 2=5.178, P=0.023).3. on the renal function in the first At the secondary follow-up, the estimated value of glomerular filtration rate (estimated glomerular filtration rate, eGFR) in the treatment group was higher than that in the control group, and the eGFR decreased compared with the baseline value (P0.05), and the eGFR in the treatment group was higher than the control group (P0.05). The eGFR of the treatment group was lower than the baseline at fourth weeks but still higher than the baseline, and higher than the control group. The difference was not statistically significant (P0.05). The 24 hours urine volume and urine sodium in the two groups were significantly higher in the early than the baseline (P0.05), and the urine volume of the treatment group and the urine sodium were significantly higher than that of the control group (P0.05). The urine volume was found in two groups of patients during the.4 week follow-up, but the urine sodium began to decrease, but the treatment group was still significantly higher than that of the control group (P0.05).1 weeks. During the follow-up, the plasma renin activity (plasma renin activity, PRA) of the patients in the treatment group was significantly lower than that of the control group and the baseline value (P0.05). There was no difference between the control group and the baseline value (P0.05) after.4 week. The PRA in the treatment group was still lower than the baseline value, and there was no significant difference between the two groups (P0.05), but it was significantly higher than the 1 week follow-up (P0.05).4 week. The PRA in the treatment group was significantly lower than that of the control group. The difference was statistically significant (P0.05). The mean arterial pressure (mean artery pressure, MAP) of the patients in the hemodynamic treatment group was significantly higher than the baseline at 1 weeks (P0.05), and the control group decreased the MAP than the baseline but had no significant difference (P0.05), and the MAP of the treatment group was significantly higher than that of the control group (P0.05). During the 4 week follow-up, the MAP in the treatment group was significantly lower than the 1 week (P0.05), still higher than the baseline and the control group. The difference was statistically significant (P0.05). The heart rate (heart rate, HR) in the treatment group was significantly lower than the baseline (P0.05) in the first follow-up period (P0.05); the heart rate of the control group was no difference (P0.05), and the heart rate of the treatment group was significantly lower. In the control group (P0.05).4 week follow-up, the rate of heart rate in the treatment group was not significantly lower than that of the 1 week follow-up (P0.05), still lower than the baseline value and the control group, the difference between the two groups was significant (P0.05) at the.1 week follow-up, the portal vein width of the treatment group was significantly lower than the baseline value (P0.05), and the control group had no significant difference compared with the baseline value (P0.05); the treatment group had a significant difference (P0.05). The portal width of the portal vein was significantly lower than that of the control group (P0.05) at.4 weeks. The portal vein width in the treatment group increased at 1 weeks, but the difference was not significant (P0.05), still lower than the baseline level, the difference was statistically significant (P0.05). There was no statistical difference between the two groups at 4 weeks' follow-up (P0.05) the two classification of the response to the treatment of.5. ascites. Multiple logistic regression analysis of urine volume, urine sodium, MAP and treatment were early predictors of response to the response. Urine volume, urine sodium and MAP were increased by one unit, and the possibility of response was increased by 1.005 times, 1.351 times and 1.384 times respectively. The possibility of response was increased by 5 with a combination of terripressin therapy. 52.21 times the.6. adverse reaction treatment group and the control group were all serious adverse events. Conclusion: 1. Terry vasopressin combined with abdominal puncture can be effective, continuous and safe to control the refractory ascites symptoms, the effect is better than the single use of celiac puncture operation.2. Terry vasopressin combined abdominal puncture can improve the effective circulation blood volume of patients, descend Low portal vein perfusion, increased MAP, increased renal perfusion, reduced renin-angiotensin-aldosterone system, RAAS activity, and promoted the baseline level of sodium, urine, MAP, and combination of terepressin in patients with.3. in patients with.3. Predictors.
【學(xué)位授予單位】：鄭州大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R575.2

【相似文獻(xiàn)】

相關(guān)期刊論文 前10條

1 秦玉彩,馮忖;腹腔穿刺術(shù)應(yīng)用要點(diǎn)[J];中國(guó)臨床醫(yī)生;2000年09期

2 付洪德,武傳葉;診斷性腹腔穿刺術(shù)98例體會(huì)[J];中原醫(yī)刊;2003年17期

3 徐桂龍;診斷性腹腔穿刺術(shù)在外科中的應(yīng)用[J];中國(guó)全科醫(yī)學(xué);2004年20期

4 楊鳳明;羅特利;;腹腔穿刺術(shù)在外科的診斷與應(yīng)用[J];哈爾濱醫(yī)藥;2006年02期

5 胡麗娟,葉賽娟;巧用小瓶塞治療腹腔穿刺術(shù)后腹水滲出[J];實(shí)用護(hù)理雜志;2002年03期

6 荊得明,張秀勇;診斷性腹腔穿刺術(shù)的正確應(yīng)用[J];中國(guó)基層醫(yī)藥;2002年05期

7 祝明福;腹腔穿刺術(shù)在基層醫(yī)院的實(shí)施體會(huì)[J];現(xiàn)代醫(yī)藥衛(wèi)生;2005年17期

8 劉建軍;;腹腔穿刺術(shù)在腸破裂診治中的應(yīng)用[J];河北醫(yī)藥;2007年08期

9 祁文禮;王慧芳;;診斷性腹腔穿刺術(shù)207例臨床分析[J];現(xiàn)代診斷與治療;2009年02期

10 劉連新;孟憲志;;腹腔穿刺術(shù)在急性彌漫性腹膜炎鑒別診斷中的應(yīng)用[J];中國(guó)實(shí)用外科雜志;2009年06期

相關(guān)會(huì)議論文 前8條

1 池肇春;;腹腔穿刺術(shù)[A];廣東省肝臟病學(xué)會(huì)2007年年會(huì)論文集[C];2007年

2 孫邦旭;;胸腹腔穿刺術(shù)在急性多發(fā)傷病人院前急救中應(yīng)用價(jià)值[A];中華醫(yī)學(xué)會(huì)急診醫(yī)學(xué)分會(huì)第十三次全國(guó)急診醫(yī)學(xué)學(xué)術(shù)年會(huì)大會(huì)論文集[C];2010年

3 張曉利;顧瑩瑩;;診斷性腹腔穿刺術(shù)在腹部外傷及急腹癥的應(yīng)用體會(huì)[A];低碳經(jīng)濟(jì)與科學(xué)發(fā)展——吉林省第六屆科學(xué)技術(shù)學(xué)術(shù)年會(huì)論文集[C];2010年

4 黃續(xù);;腹腔穿刺術(shù)在外科學(xué)急腹癥啟發(fā)式教學(xué)中的體會(huì)[A];2006年浙江省醫(yī)學(xué)教育學(xué)術(shù)年會(huì)論文匯編[C];2006年

5 韓崢;田霞;王艷芬;;特利加壓素聯(lián)合麝白散外敷治療肝硬化頑固性腹水50例療效觀察[A];第二十五屆全國(guó)中西醫(yī)結(jié)合消化系統(tǒng)疾病學(xué)術(shù)會(huì)議論文集[C];2013年

6 宋鳳卿;陳蒙華;方東明;謝露;;不同劑量加壓素在小鼠心肺復(fù)蘇中的療效比較[A];中華醫(yī)學(xué)會(huì)第五次全國(guó)重癥醫(yī)學(xué)大會(huì)論文匯編[C];2011年

7 顧鳳明;張連山;;加壓素對(duì)大鼠內(nèi)耳水通道蛋白基因表達(dá)的影響[A];中華醫(yī)學(xué)會(huì)第十次全國(guó)耳鼻咽喉-頭頸外科學(xué)術(shù)會(huì)議論文匯編（上）[C];2007年

8 王紅;張金山;丁玉強(qiáng);胡靜;;神經(jīng)激肽B受體在小鼠下丘腦室旁核和視上核與加壓素的共存關(guān)系[A];解剖學(xué)雜志——中國(guó)解剖學(xué)會(huì)2002年年會(huì)文摘匯編[C];2002年

相關(guān)重要報(bào)紙文章 前2條

1 ;腹腔穿刺術(shù)操作規(guī)范[N];農(nóng)村醫(yī)藥報(bào)（漢）;2007年

2 本報(bào)特約撰稿人 陸志城;加壓素腎上腺素 誰是心臟停搏的終結(jié)者[N];醫(yī)藥經(jīng)濟(jì)報(bào);2004年

相關(guān)博士學(xué)位論文 前2條

1 劉夕強(qiáng);炎癥體對(duì)肝臟天然免疫的調(diào)控及機(jī)制研究[D];上海交通大學(xué);2015年

2 陳霞;尾加壓素在先天性心臟病圍手術(shù)期變化[D];中國(guó)協(xié)和醫(yī)科大學(xué);2002年

相關(guān)碩士學(xué)位論文 前6條

1 李佳婧;特利加壓素與生長(zhǎng)抑素治療食管胃底靜脈曲張出血的Meta分析[D];重慶醫(yī)科大學(xué);2016年

2 孔俊杰;肝癌合并乙肝肝硬化患者術(shù)后應(yīng)用特利加壓素效果分析[D];山東大學(xué);2017年

3 李慧;特利加壓素聯(lián)合白蛋白治療Ⅰ型肝腎綜合征療效的薈萃分析[D];河南科技大學(xué);2017年

4 丁超;特利加壓素對(duì)門脈高壓癥患者血流動(dòng)力學(xué)的影響[D];南京大學(xué);2012年

5 張先位;加壓素與腎上腺素在大鼠室顫模型中的療效比較[D];廣西醫(yī)科大學(xué);2009年

6 羅鈞元;特利加壓素對(duì)比白蛋白對(duì)預(yù)防腹腔穿刺術(shù)后循環(huán)功能障礙的Meta分析[D];重慶醫(yī)科大學(xué);2014年

，

本文編號(hào)：2078861