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

【摘要】：目的:觀察對比特利加壓素聯(lián)合腹腔穿刺術和單獨使用腹腔穿刺術對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,并分析腹水應答的預測因素。方法:將2015年3月-2016年9月鄭州大學第一附屬醫(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準納入研究,所有患者完全隨機分為對照組和治療組,治療組給予一般治療(病因治療、限制水鈉攝入、保肝及對癥治療)、腹腔穿刺術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。對照組在一般治療和腹腔穿刺術聯(lián)合白蛋白基礎上給予100ml生理鹽水作為對照,治療療程為1周,并在治療1周結束時和4周時各隨訪一次,觀察比較兩種方案對患者腹水治療效果及對腎功能、血流動力學的影響,并分析腹水治療應答的預測因素。結果:1.一般資料:共92例患者完成研究,治療組48例,對照組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)。治療組腹腔穿刺術后放腹水(5.49±0.73)L,對照組放腹水(5.58±0.64)L(t=-0.636,P=0.659)。2.對腹水治療的效果:1周隨訪時治療組應答率(93.75%)與對照組應答率(84.09%)差異無統(tǒng)計學意義(χ2=1.326,P=0.249);治療組完全應答率(66.67%)明顯高于對照組(43.18%)(χ2=5.125,P=0.024)。4周隨訪時治療組應答率(33.33%)明顯高于對照組(11.36%)(χ2=6.290,P=0.012);治療組完全應答率(10.41%)與對照組(2.27%)無顯著差異(χ2=1.340,P=0.247)。1周隨訪時應答的患者中治療組腹水早期復發(fā)率(64.44%,29例)明顯低于對照組(86.49%,32例)(χ2=5.178,P=0.023)。3.對腎功能的影響在第一次隨訪時,治療組患者腎小球濾過率估計值(estimated glomerular filtration rate,eGFR)升高,對照組患者eGFR下降,較基線值均無統(tǒng)計學意義(P0.05);治療組患者eGFR高于對照組(P0.05)。第4周時治療組患者eGFR較1周時下降但仍高于基線值,而且高于對照組,但差異均無統(tǒng)計學意義(P0.05)。兩組患者24小時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照組患者(P0.05)。1周隨訪時,治療組患者血漿腎素活性(plasma renin activity,PRA)較對照組和基線值明顯降低(P0.05);對照組患者治療后較基線值無差異明顯(P0.05)。4周隨訪時,治療組患者PRA仍低于基線值,兩組無顯著差異(P0.05),但較1周隨訪時明顯升高(P0.05)。4周時治療組PRA明顯低于對照組,差異有統(tǒng)計學意義(P0.05)。4.對血流動力學影響治療組患者在1周時平均動脈壓(mean artery pressure,MAP)較基線值明顯升高(P0.05);對照組MAP較基線值下降但無明顯差異(P0.05);治療組患者MAP明顯高于對照組患者(P0.05)。4周隨訪時,治療組患者MAP較1周時明顯下降(P0.05),仍高于基線值和對照組患者,差異有統(tǒng)計學意義(P0.05)。治療組患者在第一次隨訪時心率(heart rate,HR)較基線水平明顯下降(P0.05);對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照組(P0.05)。4周隨訪時,治療組患者心率較1周隨訪時無明顯下降(P0.05),仍低于基線值和對照組患者,兩組間差異顯著(P0.05)。1周隨訪時,治療組患者門靜脈寬度較基線值明顯下降(P0.05),對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照組(P0.05)。4周隨訪時,治療組患者門靜脈寬度較1周時上升,但差異不明顯(P0.05),仍低于基線值水平,差異有統(tǒng)計意義(P0.05);兩組之間在4周隨訪時門靜脈寬度變化沒有統(tǒng)計學差異(P0.05)。5.腹水治療應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答的早期預測因素。尿量、尿鈉和MAP每增加一個單位,患者產(chǎn)生應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)生應答的可能性增加552.21倍。6.不良反應治療組和對照組均為出現(xiàn)嚴重的不良事件。結論:1.特利加壓素聯(lián)合腹腔穿刺術能早期、有效、持續(xù)、安全的控制頑固性腹水癥狀,效果優(yōu)于單獨使用腹腔穿刺術。2.特利加壓素聯(lián)合腹腔穿刺術可改善患者有效循環(huán)血量,降低門靜脈血流灌注,提高MAP;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)生應答的早期預測因素。
[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.
【學位授予單位】：鄭州大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R575.2

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