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目的观察托伐普坦治疗终末期肝病顽固性腹水的疗效。方法 65例终末期肝病合并顽固性腹水患者,在常规给予利尿剂及白蛋白治疗的基础上,给予托伐普坦口服,治疗5~14 d。观察患者的24 h尿量、腹水消退、双下肢水肿改善及血清钠情况。结果在托伐普坦治疗结束后24 h,患者平均尿量明显高于治疗前(P<0.01);83%患者腹水明显减少,4例Ⅰ型肝肾综合征患者对托伐普坦治疗无明显效果;低钠血症患者血清钠较治疗前明显上升(P<0.05);治疗前后患者终末期肝病模型(MELD)评分、血钾水平无明显变化;该药的不良反应以口干、口渴为主,发生率为15.3%。结论对于终末期肝病顽固性腹水患者应用托伐普坦治疗,具有明显的治疗效果,可有效降低患者的钠血症状,临床应用价值很高。
Objective To observe the efficacy of tolvaptan in the treatment of refractory ascites due to end-stage liver disease. Methods A total of 65 patients with end-stage liver disease complicated with refractory ascites were given oral treatment with dihydrochloride and albumin for 5 to 14 days. Observe the patient’s 24 h urine output, ascites subsided, lower extremity edema and serum sodium status. Results After 24 hours of treatment with tolvaptan, the average urinary volume was significantly higher in patients than in before treatment (P <0.01); ascites in 83% of patients was significantly reduced; and in 4 patients with type Ⅰ hepatorenal syndrome, (P <0.05). Before and after treatment, there was no significant change in MELD score and serum potassium level. Adverse reactions of this drug were observed in patients with dry mouth and mouth Thirsty, the incidence was 15.3%. Conclusion The treatment of refractory ascites in patients with end-stage liver disease treated with tolvaptan has a significant therapeutic effect, which can effectively reduce the symptoms of sodium in patients with high clinical value.