麝黄膏敷脐联合中药口服辅助治疗肝硬化腹水的临床效果(1)

http://www.100md.com 2018年1月15日 《世界中医药》 20182

     摘要 目的：探讨麝黄膏敷脐联合中药口服辅助治疗肝硬化腹水的临床疗效。方法：选取2015年1月至2016年3月在深圳市中医院住院的肝硬化腹水患者共120例，随机分为观察组和对照组，每组60例，对照组予以西医常规综合治疗(包括限钠、保肝、利尿等)，观察组在对照组基础上加用麝黄膏敷脐及口服利水软肝中药汤剂。2组疗程均为14 d，比较2组患者治疗前后中医症候积分变化及体质量、腹围、24 h尿量、门脉血流动力学变化，观察临床疗效，记录不良反应。结果：观察组总有效率83.33%，对照组总有效率65%，观察组疗效优于对照组，差异有统计学意义(P<0.05)；观察组中医症候积分及体质量、腹围、24 h尿量改善情况优于对照组(P<0.05)；观察组治疗后门脉血流动力学变化情况与对照组治疗后比较，差异有统计学意义(P<0.05)。结论：麝黄膏敷脐联合中药口服辅助治疗肝硬化腹水疗效满意，安全性良好，值得推广使用。

    关键词 肝硬化腹水；麝黄膏；敷脐；临床研究

    Abstract Objective：To observe the effect of the Chinese herbs and Shehuang paste paved on the Umbilicus in the treatment of ascites due to liver cirrhosis. Methods：A total of 120 cases with ascites due to liver cirrhosis were randomly divided into treatment group and control group with 60 cases in each. The control group was given the conventional treatment of western medicine (including sodium restriction， liver protection and diuretic therapy)， and the treatment group was added Shehuang paste applying on the umbilicus combined with Chinese medicine decoction that draining water and softening the liver. The course of treatment last 14 days. And then the TCM symptom scores and changes of clinical signs such as weight， circumference of abdomen， amount of urine for 24 hours and portal hemodynamic were compared between the two groups. The total effective rate and occurrence rate of adverse reactions were also observed in both groups. Results：The total effective rate of the treatment group was 83.33%， and the total effective rate of the control group was 65%， with a significant difference (P<0.05). The improvement of scores of TCM symptom scores， weight， abdominal circumference and amount of urine for 24 hours in the treatment group were better than those in the control group， and the differences were statistically significant (P<0.05). Compared with the control group， the change of portal hemodynamic after treatment in the treatment group was statistically significant (P<0.05). Conclusion：The combination of Shehuang paste paved on the umbilicus and Chinese herbal decoction has curative effect and good security， and it is worthy of clinical promotion.

    Key Words Ascites due to liver cirrhosis； Shehuang paste； Umbilical application； Clinical research

    中圖分类号：R242；R575文献标识码：Adoi：10.3969/j.issn.1673-7202.2018.02.025

    腹水是肝硬化3大并发症(腹水、肝性脑病、消化道出血)中最常见的一种，也是导致患者入院的常见并发症，其防治一直是临床研究的热点与难点[1-2]。肝硬化患者初次诊断后10年内腹水发生率超过50%，并发腹水的患者，其3年生存率不足50%，难治性腹水1年病死率超过50%[3-4]。又因本病常易并发消化道出血、腹腔感染、电解质紊乱以及肝肾综合征，疗效和预后往往不佳[5-6]。西医对于本病的治疗，主要以保肝及利尿等方法为主，利尿剂虽起效快，但长期单纯使用易引起水电解质紊乱、易发生耐药，且复发率高，因而尚不能从根本上治疗本病。随着对该病认识的深入，中医药与现代医学相结合的治疗方案研究已有一些进展[7-8]。在西医常规治疗的基础上辅以中医药治疗方法，对于减少利尿剂用量及降低其不良反应具有重要意义。本研究采用麝黄膏敷脐联合中药口服辅助西医常规治疗，对肝硬化腹水疗效较好，现报道如下。(王露 陈英杰 彭立生)

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