【摘要】：目的:探討不同利尿方案對肝癌患者肝切除術(shù)后相關(guān)指標的影響。方法:60例擬行肝癌肝切除手術(shù)的患者隨機分為研究組(30例)和對照組(30例)。術(shù)后在常規(guī)治療的基礎(chǔ)上,研究組患者給予螺內(nèi)酯片100 mg,qd+呋塞米片40 mg,qd,于每日早飯后服用;對照組患者給予螺內(nèi)酯片100 mg,bid,于每日早飯后和下午16時口服+呋塞米片20 mg,qd,于每日早飯后口服。兩組患者均每3日復查電解質(zhì)及肝腎功能,并根據(jù)體質(zhì)量和液體出入量變化調(diào)整利尿方案。觀察兩組患者利尿治療有效性指標(體質(zhì)量減輕、利尿治療有效例數(shù)、靜脈使用利尿藥頻次、羥乙基淀粉使用頻次、夜間排尿頻次、術(shù)后住院時間、腹水消退時間),治療前后血鈉、血鉀、血肌酐、血尿素氮、血白蛋白、丙氨酸轉(zhuǎn)氨酶、天冬氨酸轉(zhuǎn)氨酶、谷酰轉(zhuǎn)肽酶及不良反應(yīng)發(fā)生情況。結(jié)果:研究組患者夜間排尿頻次顯著少于對照組,差異均有統(tǒng)計學意義(P0.05);兩組患者體質(zhì)量減輕、利尿治療有效例數(shù)、靜脈使用利尿藥頻次、羥乙基淀粉使用頻次、術(shù)后住院時間、腹水消退時間等比較,差異均無統(tǒng)計學意義(P0.05)。治療后,兩組患者血鈉、血白蛋白水平均顯著低于同組治療前;兩組患者血鉀、血尿素氮、丙氨酸轉(zhuǎn)氨酶、天冬氨酸轉(zhuǎn)氨酶、谷酰轉(zhuǎn)肽酶水平均顯著高于同組治療前,差異均有統(tǒng)計學意義(P0.05);但兩組間血鈉、血鉀、血尿素氮、血白蛋白、丙氨酸轉(zhuǎn)氨酶、天冬氨酸轉(zhuǎn)氨酶、谷酰轉(zhuǎn)肽酶及治療前后血肌酐比較,差異均無統(tǒng)計學意義(P0.05)。兩組患者利尿相關(guān)不良反應(yīng)發(fā)生率比較,差異無統(tǒng)計學意義(P0.05)。結(jié)論:在常規(guī)治療的基礎(chǔ)上,兩種利尿方案均可有效避免肝癌患者肝切除術(shù)后腹水形成,減少相關(guān)并發(fā)癥的發(fā)生,但螺內(nèi)酯100 mg,qd+呋塞米40 mg,qd,每日早飯后服藥的給藥方法能顯著降低患者夜間排尿次數(shù),提高用藥依從性。
[Abstract]:Objective: to investigate the effect of different diuretic regimen on liver cancer patients after hepatectomy. Methods 60 patients with liver cancer were randomly divided into study group (n = 30) and control group (n = 30). On the basis of routine treatment, patients in the study group were given 100 mg,qd furosemide tablets for 40 mg,qd, daily after breakfast. Patients in the control group were given spironolactone tablets for 100 mg,bid, after breakfast and 20 mg,qd, after breakfast at 16:00. Electrolytes and liver and kidney function were reexamined every 3 days in both groups, and diuretic regimen was adjusted according to the changes of body mass and fluid volume. The effective indexes of diuretic therapy (body mass reduction, effective cases of diuretic therapy, frequency of intravenous diuretics, frequency of use of hydroxyethyl starch, frequency of urination at night, hospitalization time after operation) were observed. Serum sodium, serum potassium, serum creatinine, blood urea nitrogen, serum albumin, alanine aminotransferase, aspartate transpeptidase and adverse reactions occurred before and after treatment. Results: the frequency of nocturnal urination in the study group was significantly lower than that in the control group (P0.05). Postoperative hospitalization time, ascites regression time, the difference was not statistically significant (P0.05). After treatment, the levels of serum sodium and albumin in both groups were significantly lower than those before treatment, and the levels of serum potassium, blood urea nitrogen, alanine aminotransferase, aspartate aminotransferase and glutamyl transferase in both groups were significantly higher than those before treatment. The differences were statistically significant (P0.05), but there was no significant difference between the two groups in blood sodium, serum potassium, blood urea nitrogen, serum albumin, alanine aminotransferase, aspartate aminotransferase, glutamyl transpeptidase and serum creatinine before and after treatment (P0.05). There was no significant difference in the incidence of diuretic related adverse reactions between the two groups (P0.05). Conclusion: on the basis of routine treatment, two diuretic regimens can effectively prevent ascites formation after hepatectomy in patients with liver cancer and reduce the incidence of related complications. But the administration of spironolactone 100 mg,qd furosemide 40 mg,qd, per day after breakfast could significantly reduce the number of nocturnal urination and improve the drug compliance.
【作者單位】： 南京大學醫(yī)學院附屬鼓樓醫(yī)院;南京醫(yī)科大學附屬淮安第一醫(yī)院;
【分類號】：R735.7

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