中药脐贴联合苓桂术甘汤化载内服辨治脾肾阳虚证肝硬化腹水的临床效果

摘要

目的:研究中药脐贴(芫花、甘遂、莱菔子)联合苓桂术甘汤化载内服辨治脾肾阳虚证肝硬化腹水的临床效果.方法:选取我院2014年4月至2015年5月我院收治的90例乙肝后肝硬化证属脾阳虚患者,随机分为空白组、治疗组组和阳性组各30例,空白组采取常规的西医基础治疗,主要包括呋塞米片、人血白蛋白、复方甘草酸苷针、螺内酯片;治疗组采取口服苓桂术甘汤联合中药脐贴再合并西医基础治疗;阳性组采取淀粉脐贴联合西医基础治疗.同时观察3组患者的肝功能、症状、彩超指导下腹水、体征、腹围、远期疗效、白蛋白、腹水复发情况等.结果:治疗组总有效人数为28人,空白组总有效人数为22人,阳性组总有效人数为18人,差异比较有统计学意义(χ2=9.1444;P=0.010).治疗组治疗后有2人仍然乏力,空白组有9人,阳性组有4人;治疗组治疗后有2人仍然纳差,空白组有9人,阳性组有3人;治疗组治疗后有1人仍然下肢肿,空白组有8人,阳性组有5人;3组患者乏力、纳差、下肢肿人数差异比较有统计学意义(χ2=6.240,P=0.044;χ2=7.274,P=0.026;χ2=6.260,P=0.044).结论:中药脐贴联合苓桂术甘汤化载内服辨治脾肾阳虚证肝硬化腹水可以显著缩短腹水消退时间,使门静脉压力减轻,改善门脉血流情况.%Objective:To observe the clinical effect of TCM umbilical paste joint Linggui Shugan decoction in the treatment of cir -rhosis ascites .Methods:A total of 90 cases of patients enrolled from April 2014 to May 2015 to our hospital with cirrhosis after hepatitis B of spleen yang deficiency were randomly divided into blank group , treatment group and positive group , with 30 cases in each.The blank group was given conventional western therapy including furosemide tablets , human albumin, glycosides compound glycirrhizin injection , and spironolactone .The treatment group was given Guiling Shugan decoction , TCM umbilical pastes as well as conventional western therapy .The positive group was given starch pastes and conventional western medicine .The indexes of liv-er function, symptom, ascites under color Doppler Ultrasound , signs, abdominal girth, long-term effect, albumin and ascites were observed and compared .Results:The total effective number of the treatment group was 28, blank group 22 and positive group 18, with statistical significance .(χ2 =9.1444;P=0.010) There are 1 people with edema in lower limbs in the treatment group , 8 in the blank group and 5 in the positive group .The differences among the three groups in the aspects of fatigue , poor appetite , and lower limb edema were significantly different .(χ2 =6.240,P=0.044;χ2 =7.274,P=0.026;χ2 =6.260,P=0.044) Conclu-sion:TCM umbilical paste joint Linggui Shugan decoction in the treatment of cirrhosis ascites can significantly shorten the time of ascites regression .