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目的探讨腹腔穿刺术联合利尿剂和血容量扩张剂治疗肝硬化顽固性腹水效果。方法选取新乡市传染病医院63例肝硬化顽固性腹水患者,随机分为对照组31例和观察组32例,对照组给予呋塞米+螺内酯+人血白蛋白治疗,观察组于对照组基础上加用腹腔穿刺术(每间隔2周穿刺1次,4~6 L/次,直至腹水消失)治疗,两组均治疗1个月,比较两组临床疗效及并发症发生情况,并统计血浆一氧化氮(NO)、内皮素(ET)及内毒素水平。结果观察组治疗总有效率为87.50%(28/32),高于对照组的61.29%(19/31),差异有统计学意义(P<0.05);治疗后观察组血浆NO、ET及内毒素水平均低于对照组,差异有统计学意义(P<0.05);观察组并发症发生率为6.25%,对照组为6.45%,两组比较差异无统计学意义(P>0.05)。结论腹腔穿刺术与利尿剂和血容量扩张剂联合使用可有效改善肝硬化性顽固性腹水患者体液因子水平,提高疗效,且安全性高。
Objective To investigate the effect of peritoneal puncture combined with diuretic and blood volume expansion on refractory cirrhosis and ascites. Methods Sixty-three patients with cirrhosis and refractory ascites were randomly divided into control group (n = 31) and observation group (n = 32). The control group was treated with furosemide + spironolactone plus human serum albumin. The observation group was basal in the control group The patients were treated with paracentesis (puncture once every 2 weeks, 4 ~ 6 L / time until the ascites disappeared), and both groups were treated for 1 month. The clinical efficacy and complications of the two groups were compared, and the plasma Nitric oxide (NO), endothelin (ET) and endotoxin levels. Results The total effective rate of the observation group was 87.50% (28/32), higher than that of the control group (61.29%, 19/31), the difference was statistically significant (P <0.05) (P <0.05). The incidence of complications was 6.25% in the observation group and 6.45% in the control group, with no significant difference between the two groups (P> 0.05). Conclusions Peritoneal puncture combined with diuretic and blood volume expansion can effectively improve the level of humoral factors in cirrhotic patients with refractory ascites, improve the curative effect and have high safety.