利用血透装置进行自体腹水浓缩回输治疗肝硬化顽固性腹水论文

利用血透装置进行自体腹水浓缩回输治疗肝硬化顽固性腹

水

【中图分类号】r575【文献标识码】a【文章编号】1672－3783(2011)08－0014－02

【摘要】目的：探讨肝硬化顽固性腹水患者腹水浓缩自体回输治疗的疗效。方法：对48例顽固性腹水患者，进行142次自体腹水超滤浓缩回输腹腔治疗。结果：腹水超滤前后对腹水电解质无明显影响，治疗后对临床症状改善明显，患者血中白蛋白.总蛋白浓度较治疗前明显增高,差异具有非常显著性(p>0.01)，治疗后显效36（75%），有效10（20.8%）,无效2例（4.2%）总有效95.8%。结论：腹水浓缩自体回输术治疗肝硬化顽固性腹水有肯定的疗效，不良反应少,方法简单、易行，并能减轻患者的经济负担，可以在临床上广泛应用。

【关键词】肝硬化顽固性腹水腹水自体回输治疗血透装置how to treat the cirrhosis refractory ascites by the method of ascites concentration of autologous transfusion through hemodialyzer

by yang yongzheng

【abstract】purpose: in this essay, the curative effect on how to treat the cirrhosis patients who suffer from refractory ascites by the method of ascites concentration of autologous transfusion is mainly discussed. method: 48

cirrhosis patients have been treated 142 times by the method of ascites concentration of autologous transfusion. result: there’s no obvious effect on the electrolyte before or after the ultrafiltration of ascites. after the treatment, the clinical symptom of the patients are bettered obviously. the thickness of the albumin, total protein in the patients’blood has been improved a lot after the treatment. the difference is obvious (p>0.01), 36 of the 48 patients’curative effect is obvious ( about 75%), 10 of the 48 patients’curative effect is effective（about 20.8%）, and only two patient is no effect（4.2%）. in general, about 95.8% of the patients who have been treated by this method is effective. conclusion:the curative effect on how to treat the cirrhosis patients who suffer from refractory ascites by the method of ascites concentration of autologous transfusion is positive and there is a little negative effect. what’s more the method is simple and feasible. and best of all, the patients just pay less money for it. therefore, this method can be generally adopted in clinic.

【key words】cirrhosis; refractory ascites;ascites concentration of autologous transfusion; treatment; hemodialyzer.

肝硬化腹水是常见病、多发病，经常规治疗无效(利尿.输人白蛋白或血浆等),以往最后多采用放腹水的方法治疗，但此种方法存在易并发肝昏迷，低血压休克、水电解质紊乱、丢失大量蛋白、放腹水完备后腹水增长迅速等副作用。我院采用利用血液透析技术进行腹腔对腹腔的腹水超滤浓缩回输技术治疗肝硬化腹水48例，取

得了较好的效果，现报告如下。

1 资料与方法

1.1 临床资料. 48例均为肝硬化并大量顽固性腹水患者，临床诊断均符合2000年修订的病毒性肝炎防治方案的诊断标准，其中男性25例，女性23例，年龄40~70岁岁，本组病例腹水持续时间3个月以上，经过限水、限钠、利尿、补充白蛋白和放腹水等常规治疗效果欠佳。病例均无心脏疾病.重度黄疸、肝昏迷先兆、腹水感染及近期消化出血。

1.2 材料与方法. 应用血液透析器。患者术前常规行b超了解平卧时肝脏、脾脏位置及腹水水平，以确保穿刺的安全性和有效性。患者取平卧位，以脐与左髂前上棘中外1/3处为第1穿刺点，用14号多个侧孔的针头避开血管迷路进针刺入腹腔，作为输出端，随后以脐平线右侧2 cm做第2穿刺点，用14号单孔的针头避开血管迷路进针刺入腹腔，作为回输端。然后将两个穿刺针分别与血液透析器连接，开机后常规抽液4000~6000ml,在病人能赖受的情况下尽可能多抽,抽取的腹水按8~10倍超滤回输, 超滤为300~600ml回输入腹腔。术毕拔出穿刺针，腹带加压包扎腹部。整个操作过程为闭路