摘要
目的观察麝黄膏敷脐配合中药结肠透析治疗难治性肝硬化腹水合并氮质血症临床疗效。方法采用多中心、随机、双盲和1:1平行对照的试验方法。将120例患者随机分为治疗组和对照组,每组各60例。两组皆在西医常规治疗的基础上加用敷脐配合结肠透析。其中对照组采用安慰剂敷脐+生理盐水结肠透析;治疗组用麝黄膏敷脐配合中药结肠透析。两组敷脐为每日1次;结肠透析为隔日1次,1个月为1个疗程。观察腹水消减、肝肾功能、血钠、尿钠、尿钾、血管活性物质的变化以及门静脉血流动力性改变。结果治疗组腹水消退总有效率71.7%(43/60例),对照组总有效率为18.3%(11/60例),两组间差异有统计学意义(P<0.01)。治疗组治疗后血肌酐与尿素氮下降,血钠、尿钠/尿钾比值升高,与治疗前比较,差异有统计学意义(P<0.01),与对照组治疗后比较差异也有统计学意义(P<0.01,P<0.05)。治疗组治疗后门静脉血流量下降(P<0.01),与对照组治疗后比较差异也有统计学意义(P<0.01)。治疗组治疗后心房利钠肽、肾素、醛固酮、一氧化氮、内毒素、血管紧张素含量比治疗前显著下降(P<0.01),与对照组治疗后比较差异也有统计学意义(P<0.05或P<0.01)。1年随访观察结果,腹水消减有效率治疗组为38.3%(23/60例),对照组为0;而肝肾综合征的发生率治疗组为23.3%(14/60例),对照组为41.7%(25/60例),两组比较差异有统计学意义(P<0.05)。结论麝黄膏敷脐配合中药结肠透析能有效地消减腹水,改善门静脉及脾静脉血流动力性,减少血浆血管活性物质与氨、内毒素等有害物质,可降低肝肾综合征的发生率。
Objective To observe the clinical efficacy of combined therapy of Shehuang Paste （SHP） with colonic dialysis in treating patients with refractory cirrhotic ascites complicated with azotemia. Methods Adopting a multi-centered, randomized, double blinded and 1：1 parallel controlled trial, 120 patients were equally random- ized into 2 groups, the control group was treated by conventional basic therapy （umbilical application of placebo paste and colonic dialysis with normal saline） , and the treatment group by, besides the same basic therapy, umbilical application of SHP once a day and colonic dialysis with herbal medicine once every other day. The course was I month for both groups. Changes of ascites volume, renal function, serum and urinary levels of Na ＋ and K ＋ , blood vasoactive substance, and portal dynamics in patients before and after treatment were observed. Results The total effective rate for ascites was 71.7% （43/60 cases） in the treatment group and 18.3% （ 11/60 cases） in the control group, showing significant difference between groups （P 〈 0.01 ）. Significant difference of blood creatinine, urea nitrogen, serum Na ＋ levels, and urinary Na＋/K ＋ ratio were shown in the treatment group （P 〈 0.01 ） before and after treatment, and between groups after treatment （P 〈0.05, P 〈0.01 ）. Portal vein blood flow was significantly lowered in the treatment group after treatment （P 〈 0.01 ） , which showed significant difference as compared with that in the control group （P 〈 0.01 ）. Besides, levels of atrial natriuretic peptide, renin, angiotensin, nitric oxide, and aldosterone decreased and endotoxemia improved remarkably in the treatment group （P 〈 0.01 ）. One-year follow-up showed that the ascites eliminating rate and the incidence of hepato-renal syndrome in the treatment group was 38.3% （23/60 cases） and 23.3% （ 14/60 cases） respectively, while in the control group 0 and 41.7% （25/60 cases） respectively, all showed statistical difference between groups （all P 〈0.05）. Conclusion Combined therapy of SHP and colonic dialysis with herbal medicine could effectively eliminate the ascites, improve the hemodynamic condition of portal and splenic veins, reduce the content of vasoactive substance and noxious substances like ammonia and endotoxin in blood, and lower the incidence of hepatoenal syndrome.
出处
《中国中西医结合杂志》
CAS
CSCD
北大核心
2008年第9期788-792,共5页
Chinese Journal of Integrated Traditional and Western Medicine
基金
国家中医药管理局资助项目(No．02-03LP40)
关键词
难治性腹水
氮质血症
血管活性物质
麝黄膏
敷脐
结肠透析
refractory ascites
azotemia
vasoactive substance
Shehuang Paste
umbilical application
colonic dialysis
