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奥曲肽联合加大补液量治疗肝硬化难治性腹水的效果观察
Clinical effect of octreotide combined with an increased amount of fluid infusion in treatment of intractable cirrhotic ascites
文章发布日期:2017年12月09日  来源:  作者:戈宏焱,李培霞,张洋洋,等  点击次数:498次  下载次数:86次

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【摘要】:目的 通过观察奥曲肽联合加大补液量对肝硬化难治性腹水的疗效,为临床提供新的诊疗思路。方法 收集2016年2月-2017年5月就诊于内蒙古民族大学附属医院的肝硬化难治性腹水患者65例,随机分为对照组(n=31)和观察组(n=34)。对照组给予常规治疗;观察组在常规治疗的基础上给予奥曲肽0.6 mg,1次/12 h,持续泵入3 d后,改为0.2 mg,1次/8 h,皮下肌注,连续应用7~10 d,并加大补液量,其余治疗根据患者自身症状及机体耐受情况给予对症处理。观察治疗期间患者的生命体征、腹围、体质量及腹水消退时间,统计患者住院天数及并发症的发生率。计量资料组间比较采用t检验;计数资料组间比较采用χ2检验。结果 观察组患者腹水消退时间及住院天数均短于对照组,差异均有统计学意义[(6.13±1.25) d vs (11.61±1.34) d,t=-4.06,P<0.001;(10.01±1.46) d vs (16.10±1.57) d,t=-7.65,P<0.001];腹围平均每天减少量、体质量平均每天减少量均高于对照组,差异均有统计学意义[(4.01±0.75) cm vs (2.42±0.35) cm,t=4.69,P<0.001;(1.67±0.42) kg vs (0.97±0.54) kg,t=4.58,P<0.001]。观察组上消化道出血和电解质紊乱的发生率明显低于对照组,差异均有统计学意义(5.88% vs 32.26%, χ2=7.49,P<0.05;8.82% vs 38.71%, χ2=8.56,P<0.05)。结论 在常规治疗难治性腹水的基础上,应用奥曲肽联合加大补液量,能促进自发性利尿,可显著减少患者腹水量,缩短腹水消退时间,减少并发症,改善病情。
【Abstract】:Objective To investigate the clinical effect of octreotide combined with an increased amount of fluid infusion in the treatment of intractable cirrhotic ascites, and to provide new thoughts for clinical diagnosis and treatment. Methods A total of 65 patients with intractable cirrhotic ascites who visited Affiliated Hospital of Inner Mongolia University for The Nationalities from February 2016 to May 2017 were enrolled and randomly divided into control group with 31 patients and observation group with 34 patients. The patients in the control group were given conventional treatment, and those in the observation group were given continuous pumping of octreotide 0.6 mg once every 12 hours for 3 days, followed by intramuscular injection of octreotide 0.2 mg once every 8 hours for 7-10 consecutive days, and an increased amount of fluid infusion, in addition to the conventional treatment. Symptomatic treatment was given based on patients′ symptoms and tolerance. Vital signs, abdominal circumference, body weight, and time to ascites regression were observed during treatment, and the length of hospital stay and incidence rate of complications were analyzed. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the observation group had significantly shorter time to ascites regression (6.13±1.25 d vs 11.61±1.34 d, t=-4.06, P<0.001) and length of hospital stay (10.01±1.46 d vs 16.10±1.57 d, t=-7.65, P<0.001), as well as significantly greater average daily reductions in abdominal circumference (4.01±0.75 cm vs 2.42±0.35 cm, t=4.69, P<0.001) and body weight (1.67±0.42 kg vs 0.97±0.54 kg, t=4.58, P<0.001). The observation group had significantly lower incidence rates of upper gastrointestinal bleeding and electrolyte disturbance than the control group (upper gastrointestinal bleeding: 5.88% vs 32.26%, χ2=7.49, P<0.05; electrolyte disturbance: 8.82% vs 38.71%, χ2=8.56, P<0.05). Conclusion In addition to the conventional treatment of intractable ascites, octreotide combined with an increased amount of fluid infusion can promote spontaneous dieresis, significantly reduce the amount of ascites, shorten the time to ascites regression, reduce complications, and improve patients′ conditions.
【关键字】:肝硬化;腹水;奥曲肽;补液疗法;治疗结果
【Key words】:liver cirrhosis; ascites; octreotide; fluid therapy; treatment outcome
【引证本文】:GE HY, LI PX, ZHANG YY, et al. Clinical effect of octreotide combined with an increased amount of fluid infusion in treatment of intractable cirrhotic ascites[J]. J Clin Hepatol, 2018, 34(1): 97-100. (in Chinese)
戈宏焱, 李培霞, 张洋洋, 等. 奥曲肽联合加大补液量治疗肝硬化难治性腹水的效果观察[J]. 临床肝胆病杂志, 2018, 34(1): 97-100.

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