【作者】 周大桥；

【Author】 Zhou Daqiao Shenzhen hospital of Traditional Chinese Medicine

【机构】 深圳市中医院肝病重点专科；

【摘要】 难治性肝硬化腹水是肝硬化失代偿由早中期转化为晚期的重要表现,约占肝硬化腹水的10%,病人极其痛苦,且易出现各种并发症。其临床治疗十分棘手,预后极差,1年病死率达75%。其一般治疗仍以限钠限水、停用利尿剂、消除诱因为主,近年来发展起来的现代疗法有自身腹水滤过浓缩回输治疗、大量腹腔穿刺放腹水、腹腔一静脉分流术、经颈静脉肝内门体分流术,但上述各种疗法虽对难治性腹水有一定疗效,但只能被认为是一种应急措施。肝移植是唯一能治愈本病的根本措施,但存在肝源不足、费用太高等问题。难治性肝硬化腹水属中医臌胀范畴,为四大顽症之一。治疗上多采用辨证论治,能收到一定疗效。中药敷脐、灌肠等特色疗法,在治疗难治性腹水上有较大优势,为临床所常用。我们运用基础治疗,加自制麝黄膏敷脐结合中药保留灌肠治疗难治性腹水,进行了多中心、随机、对照研究,观察治疗前后患者的体重、24 h尿量和尿电解质、肝功能以及血清一氧化氮含量,门、脾静脉的血流动力学变化,1年内肝肾综合征的发生率及死亡率。结果显示具有较好的疗效。更多还原

【Abstract】 Refractory ascites following cirrhosis of liver which accounts for 10%of Liver cirrhosis with ascites is the vital manifestation of liver cirrhosis which experiences the change from early or middle stage to the terminal stage.The patients with refractory ascites are in distress and easy to have different complications.It is very difficult to treat such a disease whose prognosis is awkward and whose death rate is nearly 75%in one year.Common treatments include the limits of intake of Natrium and water,suspension of diuretics,removal of certain inducements.Some recent modern therapeutical methods cover the method of Ultrafiltration of ascites and Reinfusion,Large-volume paracentesis, peritoneovenous shunt,Transjugular Intrahepatic Portosystemic shunt as well.Although all the methods mentioned above are effective to a certain extent in treating the refractory ascites,they can only be used in urgent conditions.Liver transplant is the only way to cure such disease,but it is costly and the provisions are not adequate.Refractory ascites caused by Liver cirrhosis belongs to Guzhang in Traditional Chinese Medicine which is considered to be one of the four refractory diseases.Identifying the patterns before administering the treatments has been proved to be effective.Covering the umbilicus with Traditional herbal medications,clystering,etc.are commonly used.We took some basic medical measures plus self-made Sehuang Ointment covering the umbilicus and clystering with herbal medications to treat refractory ascites on the basis of multi-center,random and control.We also weighed the patients before and after the treatment,measured the urine volume round the clock and tested the electrolytes in the urine,Liver Function,Nitric Oxide in the serum,changes of the haemodynamics of the portal and splenic veins,calculated the incidence and death rate of Live-Kidney Syndrome in one year.The result shows that the combined therapeutical method is highly effective.更多还原