【摘要】：目的：觀察特利加壓素聯(lián)合前列地爾對(duì)肝硬化難治性腹水患者的臨床療效、腎功能、門靜脈系統(tǒng)血流動(dòng)力學(xué)、平均動(dòng)脈壓及心率的影響，進(jìn)而評(píng)價(jià)治療的有效性和安全性。 方法：肝硬化難治性腹水患者42例，隨機(jī)分為治療組和對(duì)照組。治療組22例，應(yīng)用特利加壓素聯(lián)合前列地爾，對(duì)照組20例，單用前列地爾。兩組基礎(chǔ)治療為限鈉、限水、保肝、利尿、營(yíng)養(yǎng)支持、補(bǔ)充白蛋白等，治療療程均為2周。前列地爾l0ug，qd，iv，特利加壓素1mg，q8h，iv。療程結(jié)束后觀察比較兩組患者24h尿量、腹圍、腹水深度、尿素氮、血肌酐、平均動(dòng)脈壓、心率、門靜脈內(nèi)徑及脾靜脈內(nèi)徑各項(xiàng)指標(biāo)的變化，并進(jìn)行統(tǒng)計(jì)學(xué)分析。 結(jié)果： 1.一般資料 治療前治療組與對(duì)照組的年齡、體重、性別、肝硬化的病因、Child-Pugh分級(jí)及評(píng)分、白蛋白、總膽紅素、腎功能、凝血功能、平均動(dòng)脈壓、心率、血鈉濃度、門靜脈內(nèi)徑及脾靜脈內(nèi)徑、腹水深度等比較，差異均無統(tǒng)計(jì)學(xué)意義。 2.治療前后腎功能指標(biāo)比較 治療組治療后較治療前BUN及SCr數(shù)值下降，兩者比較P＜0.05，有統(tǒng)計(jì)學(xué)差異；對(duì)照組治療后較治療前BUN及SCr數(shù)值下降，，兩者比較P＜0.05，有統(tǒng)計(jì)學(xué)差異；治療后，兩組SCr比較P＜0.05，有統(tǒng)計(jì)學(xué)差異；BUN比較P＞0.05，無統(tǒng)計(jì)學(xué)差異。 3.治療前后尿量、腹水變化比較 治療組治療后較治療前尿量增多、腹圍減小、腹水深度減小，治療前后比較P＜0.05，均有統(tǒng)計(jì)學(xué)差異；對(duì)照組治療后較治療前尿量增多、腹圍減小、腹水深度減小，治療前后比較有統(tǒng)計(jì)學(xué)差異，P＜0.05；治療后，兩組尿量增多、腹圍減小、腹水深度減小程度比較P＜0.05，有統(tǒng)計(jì)學(xué)差異。 4．兩組門靜脈及脾靜脈內(nèi)徑治療前后比較 治療組門靜脈及脾靜脈內(nèi)徑治療前后比較均縮小，差異有統(tǒng)計(jì)學(xué)意義（P0.05）。對(duì)照組門靜脈及脾靜脈內(nèi)徑治療前后比較無明顯縮小，差異無統(tǒng)計(jì)學(xué)意義（P0.05）。 5．兩組血流動(dòng)力學(xué)指標(biāo)（MAP及HR）治療前后比較 治療組與對(duì)照組平均動(dòng)脈壓、心率治療前后均無明顯改變，無統(tǒng)計(jì)學(xué)意義（P0.05）。 結(jié)論：l、特利加壓素聯(lián)合前列地爾治療肝硬化難治性腹水可減少門靜脈及脾靜脈血流量，改善腎功能，增加尿量，減少腹水量，效果好于單用前列地爾。 2、單用前列地爾可以改善腎功能，增加尿量，但不能明顯減少門靜脈及脾靜脈血流量。 3、特利加壓素對(duì)血壓、心率影響較小。
[Abstract]:Objective: to evaluate the efficacy and safety of trivasopressin combined with alprostadil in the treatment of patients with refractory ascites due to cirrhosis, including renal function, portal vein hemodynamics, mean arterial pressure and heart rate. Methods: 42 patients with refractory ascites were randomly divided into treatment group and control group. The treatment group (22 cases) were treated with trivasopressin combined with alprostadil, and the control group (20 cases) were treated with alprostadil alone. The two groups were treated with sodium limitation, water limitation, liver protection, diuretic, nutritional support and albumin supplementation. The course of treatment was 2 weeks. Alprostadil l0ugn QD iv, 1 mg / g, 1 mg / g, Q8h, iv. et al. The changes of 24h urine volume, abdominal circumference, depth of ascites, urea nitrogen, serum creatinine, mean arterial pressure, heart rate, portal vein diameter and splenic vein diameter were observed and analyzed statistically. Results: 1. General data: age, body weight, sex, etiology of cirrhosis, Child-Pugh grade and score, albumin, total bilirubin, renal function, coagulation function, mean arterial pressure, heart rate, serum sodium concentration before treatment and control group. There was no significant difference in portal vein diameter, splenic vein diameter and ascites depth. 2. The indexes of renal function before and after treatment were lower than those before and after treatment in the treatment group (P < 0.05). The value of BUN and SCr in control group was lower than that before treatment (P < 0.05, P < 0.05), after treatment, SCr in two groups was lower than that before treatment (P < 0.05), and there was no significant difference in BUN (P > 0.05). 3. Before and after treatment, the urine volume and ascites change were increased, abdominal circumference decreased and ascites depth decreased in the treatment group compared with before and after treatment (P < 0.05). After treatment, the urine volume, abdominal circumference and ascites depth in the control group increased, and there were significant differences before and after treatment (P < 0.05). After treatment, the urine volume increased, the abdominal circumference decreased and the depth of ascites decreased in both groups (P < 0.05). 4. Comparison of portal vein and splenic vein before and after treatment in two groups; the comparison of portal vein and splenic vein before and after treatment decreased in treatment group, the difference was statistically significant (P0.05). In the control group, the diameter of portal vein and splenic vein was not significantly reduced before and after treatment, and the difference was not statistically significant (P0.05). 5. Comparison of hemodynamic indexes (MAP and HR) before and after treatment in the treatment group and the control group, the mean arterial pressure and heart rate were not significantly changed before and after treatment (P0.05). Conclusion: 1.Trevasopressin combined with alprostadil can reduce portal and splenic venous blood flow, improve renal function, increase urine volume and decrease ascites volume, and the effect is better than that of alprostadil alone. 2. Alprostadil alone can improve renal function and increase urine volume, but can not significantly reduce portal and splenic venous blood flow. The effect of treponectin on blood pressure and heart rate was small.
【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R575.2

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