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
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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。
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.
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.
引文
[1]王宇明.2012年《美国肝病研究学会成人肝硬化腹水指南》更新版解读与探讨[J].胃肠病学,2014,19(10):577-582.
[2]张侠.中药联合敷脐疗法治疗肝硬化腹水效果观察[J].光明中医,2017,32(7):971-973.
[3]曾欣,林勇,谢渭芬.肝硬化腹水的处理[J].中华消化杂志,2005,25(12):757-759.
[4]俞媛,张建良,陆云飞,等.中医外治法在肝硬化腹水中的应用进展[J].临床肝胆病杂志,2016,32(4):781-784.
[5]Runyon BA,AASLD Practice Guidelines Committee.Management of adult patients with ascites due to cirrhosis:an update[J].Hepatology,2009,49(6):2087-2107.
[6]高司成,夏莉,赵钢,等.“水臌贴”敷脐联合西药治疗脾肾阳虚型肝硬化腹水随机安慰剂对照临床研究[J].上海中医药杂志,2015,49(2):28-30+33.
[7]夏莉,祝峻峰.肝硬化腹水的中医药诊治进展[J].重庆医学,2013,42(32):3961-3963,3969.
[8]杨广栋,李卫民,王健.肝硬化腹水的中医外治法研究现状[J].国际中医中药杂志,2016,38(8):765-768.
[9]中国中西医结合学会消化疾病专业委员会.肝硬化腹水的中西医结合诊疗共识意见[J].中国中西医结合杂志,2011,31(9):1171-1174.
[10]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:30.
[11]梁扩寰,李绍白.门静脉高压症[M].北京:人民军医出版社,1999:322.
[12]中华中医药学会脾胃病分会.肝硬化腹水中医诊疗规范专家共识意见(2011年,海南)[J].中国中西医结合杂志,2012,32(12):1692-1174.
[13]童光东,周大桥,贺劲松.麝黄膏脐敷治疗肝硬化难治性腹水临床研究[J].中国中西医结合消化杂志,2003,11(5):290-292.
[14]林日武.中药灌肠治疗肝硬化难治性腹水[J].浙江中西医结合杂志,2002,12(2):97.
[15]张静雯,时永全,韩英.肝硬化的治疗进展[J].临床肝胆病杂志,2015,31(3):465-468.
[2]张侠.中药联合敷脐疗法治疗肝硬化腹水效果观察[J].光明中医,2017,32(7):971-973.
[3]曾欣,林勇,谢渭芬.肝硬化腹水的处理[J].中华消化杂志,2005,25(12):757-759.
[4]俞媛,张建良,陆云飞,等.中医外治法在肝硬化腹水中的应用进展[J].临床肝胆病杂志,2016,32(4):781-784.
[5]Runyon BA,AASLD Practice Guidelines Committee.Management of adult patients with ascites due to cirrhosis:an update[J].Hepatology,2009,49(6):2087-2107.
[6]高司成,夏莉,赵钢,等.“水臌贴”敷脐联合西药治疗脾肾阳虚型肝硬化腹水随机安慰剂对照临床研究[J].上海中医药杂志,2015,49(2):28-30+33.
[7]夏莉,祝峻峰.肝硬化腹水的中医药诊治进展[J].重庆医学,2013,42(32):3961-3963,3969.
[8]杨广栋,李卫民,王健.肝硬化腹水的中医外治法研究现状[J].国际中医中药杂志,2016,38(8):765-768.
[9]中国中西医结合学会消化疾病专业委员会.肝硬化腹水的中西医结合诊疗共识意见[J].中国中西医结合杂志,2011,31(9):1171-1174.
[10]国家食品药品监督管理局.中药新药临床研究指导原则[S].北京:中国医药科技出版社,2002:30.
[11]梁扩寰,李绍白.门静脉高压症[M].北京:人民军医出版社,1999:322.
[12]中华中医药学会脾胃病分会.肝硬化腹水中医诊疗规范专家共识意见(2011年,海南)[J].中国中西医结合杂志,2012,32(12):1692-1174.
[13]童光东,周大桥,贺劲松.麝黄膏脐敷治疗肝硬化难治性腹水临床研究[J].中国中西医结合消化杂志,2003,11(5):290-292.
[14]林日武.中药灌肠治疗肝硬化难治性腹水[J].浙江中西医结合杂志,2002,12(2):97.
[15]张静雯,时永全,韩英.肝硬化的治疗进展[J].临床肝胆病杂志,2015,31(3):465-468.