中医外治法在肝硬化顽固性腹水中的应用现状
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摘要
腹水是肝硬化失代偿期最常见的并发症之一,其中10%-20%的腹水患者最终发展成顽固性腹水[1]。顽固性腹水是指对限制钠盐摄入和大剂量利尿剂治疗3个月以上无效,或药物治疗后4周内再次复发的腹水[2]。顽固性腹水患者容易并发肝肾综合征、肝性脑病等多种致命性疾病,其治疗困难,预后差[3]。目前西医缺少对该病的有效治疗方法,中医外治疗法作为中医特色疗法之一,以其副作用少,疗效显著,实施方便,同时避免了腹水患者胃肠功能较差,服用不便等优点,在临床上得到广泛应用。现将近年关于肝硬化顽固性腹水的中医外治法总结如下。
Ascites is one of the most common complications of decompensated liver cirrhosis [1]. Refractory ascites refers to the ascites that are ineffective in limiting sodium intake and large dose of diuretic treatment for more than 3 months or relapse within 4 weeks after drug treatment[2]. Patients with refractory ascites are prone to complicated with hepatorenal syndrome, hepatic encephalopathy and other fatal diseases[3]. At present, western medicine is short of effective treatment for this disease. External treatment of traditional Chinese medicine, as one of the featured therapies of traditional Chinese medicine, has been widely used in clinical practice due to its advantages such as less side effects, remarkable curative effect and convenient implementation, as well as avoiding poor gastrointestinal function and inconvenience in taking medicine in patients with ascites. The treatment of refractory ascites in recent years is summarized as follows.
Ascites is one of the most common complications of decompensated liver cirrhosis [1]. Refractory ascites refers to the ascites that are ineffective in limiting sodium intake and large dose of diuretic treatment for more than 3 months or relapse within 4 weeks after drug treatment[2]. Patients with refractory ascites are prone to complicated with hepatorenal syndrome, hepatic encephalopathy and other fatal diseases[3]. At present, western medicine is short of effective treatment for this disease. External treatment of traditional Chinese medicine, as one of the featured therapies of traditional Chinese medicine, has been widely used in clinical practice due to its advantages such as less side effects, remarkable curative effect and convenient implementation, as well as avoiding poor gastrointestinal function and inconvenience in taking medicine in patients with ascites. The treatment of refractory ascites in recent years is summarized as follows.
引文
[1]Wong F.Management of ascites in cirrhosis[J].Gastroenterol Hepatol,2012,27(1):11-20.
[2]Moore KP,Wong F,Gines P,et al.The management of ascites in cirrhosis:report on the consensus conference of the International Ascites Club[J].Hepatology,2003,38:258-266.
[3]Runyon B A,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J].Hepatology,2013,57(4):1651-1653.
[4]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterialperitonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397.
[5]赵占领,刘丹彤,等.略论《续名医类案》中甘遂运用规律[J].环球中医药,2018,11(05),749-751
[6]刘菊荣,米邵平,等.甘遂敷脐联合TDP照射治疗肝硬化腹水临床观察[J].实用中医药杂志,2012,28(9):756-757.
[7]邓永连.芒硝外敷治小儿中毒性肠麻痹[J].江苏中医,1997,18(10):20.
[8]白联缔,张晋芝.芒硝外敷治疗肝硬化腹水25例临床护理[J].齐鲁护理杂志,2009,15(23):58-59.
[9]李秋伟,贾建伟.内科基础治疗联合中药敷脐治疗肝硬化腹水18例[J].中西医结合肝病杂志,2017,27(1):55-56
[10]陈茜.中药敷脐结合辨证护理肝硬化腹水54例[J].中国中医药现代远程教育,2014,12(03):111-112.
[11]杨亚娟,孙宏,等.中药敷脐联合常规药物治疗肝硬化腹水的临床效果观察[J].临床合理用药杂志,2018,11(29),62-63.
[12]张宁,林寿宁,等.中药灌肠治疗肝硬化腹水的研究概况[J].大众科技,2015,17(185):108-109.
[13]林立武.中药灌肠治疗肝硬化顽固性腹水[J].浙江中西医结合杂志,2002,12(2):97.
[14]梁浩卫,赵文霞.消胀利水方贴敷治疗肝硬化腹水临床疗效观察[J].中西医结合肝病杂志,2016,26(6),367-368.
[15]费景兰,梁浩卫,等.荷叶中药封包治疗顽固性肝硬化腹水患者疗效观察[J].2015,30(06):1208-1210.
[16]费景兰,权春分,等.基于阴阳互根理论运用通阴三阳灸治疗肝硬化腹水临床观察[J].新中医,2018,50(10):147-150.
[17]陆军平,李胜强,等.内科常规疗法配合艾灸治疗顽固性肝硬化腹水的临床研究[J].针灸推拿研究,2016,34(8):160-162.
[18]鲍继奎,厉秀云,等.针刺透穴疗法治疗肝硬化腹水80例[J].陕西中医.2012,33(2):219-220
[19]李宴杰,毛德文,等.加用甘遂末敷脐联合中药灌肠治疗肝硬化腹水的临床研究[J].广西中医药,2015,38(02):9-11.
[20]董桂芬.中药灌肠及外敷治疗肝硬化腹水疗效观察[J].山西中医,2015,31(04):41.
[21]刘光伟,费景兰,等/退黄合剂保留灌肠联合逐水方敷脐治疗肝硬化顽固性腹水临床疗效观察[J].时珍国医国药,2015,26(03):662-663.
[22]党中勤,党志博,等.黄芪泽苓颗粒口服联合逐水膏脐贴辅助治疗中重度乙型肝炎肝硬化腹水48例临床观察[J].中医杂志,2018,59(16):1396-1400.
[23]郭敏,郑华,刘光伟,等.苓桂术甘汤合三甲散联合脐贴治疗脾阳虚证肝硬化腹水[J]中成药,2014,36(12):2482-248.
[2]Moore KP,Wong F,Gines P,et al.The management of ascites in cirrhosis:report on the consensus conference of the International Ascites Club[J].Hepatology,2003,38:258-266.
[3]Runyon B A,AASLD.Introduction to the revised American Association for the Study of Liver Diseases Practice Guideline management of adult patients with ascites due to cirrhosis 2012[J].Hepatology,2013,57(4):1651-1653.
[4]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites,spontaneous bacterialperitonitis,and hepatorenal syndrome in cirrhosis[J].J Hepatol,2010,53(3):397.
[5]赵占领,刘丹彤,等.略论《续名医类案》中甘遂运用规律[J].环球中医药,2018,11(05),749-751
[6]刘菊荣,米邵平,等.甘遂敷脐联合TDP照射治疗肝硬化腹水临床观察[J].实用中医药杂志,2012,28(9):756-757.
[7]邓永连.芒硝外敷治小儿中毒性肠麻痹[J].江苏中医,1997,18(10):20.
[8]白联缔,张晋芝.芒硝外敷治疗肝硬化腹水25例临床护理[J].齐鲁护理杂志,2009,15(23):58-59.
[9]李秋伟,贾建伟.内科基础治疗联合中药敷脐治疗肝硬化腹水18例[J].中西医结合肝病杂志,2017,27(1):55-56
[10]陈茜.中药敷脐结合辨证护理肝硬化腹水54例[J].中国中医药现代远程教育,2014,12(03):111-112.
[11]杨亚娟,孙宏,等.中药敷脐联合常规药物治疗肝硬化腹水的临床效果观察[J].临床合理用药杂志,2018,11(29),62-63.
[12]张宁,林寿宁,等.中药灌肠治疗肝硬化腹水的研究概况[J].大众科技,2015,17(185):108-109.
[13]林立武.中药灌肠治疗肝硬化顽固性腹水[J].浙江中西医结合杂志,2002,12(2):97.
[14]梁浩卫,赵文霞.消胀利水方贴敷治疗肝硬化腹水临床疗效观察[J].中西医结合肝病杂志,2016,26(6),367-368.
[15]费景兰,梁浩卫,等.荷叶中药封包治疗顽固性肝硬化腹水患者疗效观察[J].2015,30(06):1208-1210.
[16]费景兰,权春分,等.基于阴阳互根理论运用通阴三阳灸治疗肝硬化腹水临床观察[J].新中医,2018,50(10):147-150.
[17]陆军平,李胜强,等.内科常规疗法配合艾灸治疗顽固性肝硬化腹水的临床研究[J].针灸推拿研究,2016,34(8):160-162.
[18]鲍继奎,厉秀云,等.针刺透穴疗法治疗肝硬化腹水80例[J].陕西中医.2012,33(2):219-220
[19]李宴杰,毛德文,等.加用甘遂末敷脐联合中药灌肠治疗肝硬化腹水的临床研究[J].广西中医药,2015,38(02):9-11.
[20]董桂芬.中药灌肠及外敷治疗肝硬化腹水疗效观察[J].山西中医,2015,31(04):41.
[21]刘光伟,费景兰,等/退黄合剂保留灌肠联合逐水方敷脐治疗肝硬化顽固性腹水临床疗效观察[J].时珍国医国药,2015,26(03):662-663.
[22]党中勤,党志博,等.黄芪泽苓颗粒口服联合逐水膏脐贴辅助治疗中重度乙型肝炎肝硬化腹水48例临床观察[J].中医杂志,2018,59(16):1396-1400.
[23]郭敏,郑华,刘光伟,等.苓桂术甘汤合三甲散联合脐贴治疗脾阳虚证肝硬化腹水[J]中成药,2014,36(12):2482-248.