连续性静脉-静脉血液滤过联合奥曲肽治疗肝肾综合征临床疗效观察

摘要

目的：：评估连续性静脉-静脉血液滤过联合奥曲肽治疗肝肾综合征的临床疗效。方法：43例肝硬化腹水后出现肝肾综合征的患者采用随机数字表法随机分为干预组和对照组。两组患者在正常治疗同时,干预组采用奥曲肽联合连续性静脉-静脉血液滤过,对照组采用常规连续性静脉-静脉血液治疗。治疗14d后观察两组患者症状改善、生化指标及门脉内径的变化及治疗效果。结果：两组基线特征无明显差异(P>0.05)。所有患者治疗后症状较之前明显改善,有显著统计学差异(P<0.05)。组间比较干预组患者少尿、恶心/呕吐症状改善明显(P<0.05),其他症状比较如黄染、水肿、腹胀、纳差、气促等症状无明显差异(P>0.05)。两组患者治疗后肾功能较之前明显改善,24h尿量显著增加,有显著统计学差异(P<0.01)。治疗组患者治疗后尿素氮及血肌酐下降、24h尿量增加,与对照组比较差异有统计学意义(P<0.05)。干预组患者治疗后门静脉的内径均缩小,与治疗前比较差异有统计学意义(P<0.05)。对照组患者治疗前后门静脉内径差异无统计学意义(P>0.05)。干预组患者治疗效果明显高于对照组,差异有统计学意义(P<0.05)。结论：连续性静脉-静脉血液滤过联合奥曲肽治疗肝肾综合征明显改善肾功能情况,加用奥曲肽能进一步改善肾功能并降低门静脉的压力,两者联合应用能明显提高HRS的近期治疗效果。%Objective:To evaluate the effect of continuous vein-vein hemodialysis combined with octreotide on hepatorenal syndrome.Methods:43 patients with hepatorenal syndrome using random number table,were randomly divided into treatment group (23 cases)and control group (20 cases),the two groups were both given a routine medical treatment.Treatment group were treated with continuous vein-vein hemodialysis combined with octreotide,the control group treated with continuous vein-vein hemodialysis.The changes of clinical symptoms,biochemical index,diameters of portal vein were observed after 14 days of treatment.Results:No difference between the two groups of baseline characteristics (P>0.05).The symptomatic evaluation scores improved significantly in all patients after 14 days(P<0.05).Some better symptomatic evaluation scores in the treatment group were seen compared to that of patients who control underwent,including oliguria,nausea,vomiting(P<0.05),Others including jaundice,edema and so on have not statistically significant differences between the two groups(P>0.05).In the two groups,the level of serum creatinine and blood urea nitrogen was decreased and the volume of 24h urine output was increased after 14 days of treatment,the differences were statistically significant (P<0.01),the blood urea nitrogen level was decreased more significantly and the volume of 24h urine output was increased more notablely in the treatment group than that of in the control group (P<0.05). The diameters of portal vein were reduced in the treatment group after treatment,which can not be seen in the control group,the differences were statistically significant (P<0.05).Conclusion:The findings support the effectiveness of continuous vein-vein hemodialysis combined with octreotide on hepatorenal syndrome,which can improve the renal function,reduce portal pressure.We can observed the combination of continuous vein-vein hemodialysis and octreotide have favorable short-term effects.