李文忠+周清文+张宏博

【摘要】 目的：探讨肝性胸水的发病机制及奥曲肽治疗的临床疗效。方法：收集45例肝性胸水患者，随机分为治疗组23例和对照组22例，对照组采用常规限制水、钠盐摄入，补充血浆或白蛋白，利尿及营养支持治疗，治疗组在常规治疗基础上给予奥曲肽0.1 mg皮下注射，8 h/次治疗，疗程2周，治疗后观察临床症状、胸水及尿量变化情况。结果：根据胸片观察胸水的变化，评估疗效，治疗组总有效率86.9%，明显高于对照组68.1%，两组比较差异有统计学意义（P<0.05）。治疗组24 h尿量（2045±352）mL较对照组24 h尿量（1468±187）mL明显增加，两组比较差异有统计学意义（P<0.05）。结论：奥曲肽通过降低门静脉压力，增加肾血流灌注，能有效治疗肝性胸水。

【关键词】 肝性胸水； 发病机制； 奥曲肽； 治疗

【Abstract】 Objective：To investigate the pathogenesis of hepatic hydrothorax and the clinical efficacy of octreotide treatment for hepatic hydrothorax.Method：45 patients with hepatic hydrothorax were collected and randomly divided into treatment group of 23 cases and control group of 22 cases.The control group was treated with routine restriction of water and sodium，plasma or albumin infusion，applying diuretics and nutritional support.On the basis of routine treatment，the treatment group received Octreotide 0.1 mg subcutaneous injection，3 times daily for 2 weeks.After treatment，the clinical symptoms，hydrothorax and urine output of two groups were observed.Result：According to X-ray，evaluate the change of hydrothorax，the total effective rate was 86.9% in the treatment group，which was significantly higher than that control group of 68.1%，the difference was statistically significant（P<0.05）.The 24 h urine output in the treatment group was （2445±352）mL significantly increased than that of control group（1468±187）mL，the difference was statistically significant（P<0.05）.Conclusion：Octreotide can effectively treat hepatic hydrothorax by reducing portal venous pressure and increasing renal blood flow.

【Key words】 Hepatic hydrothorax； Pathogenesis； Octreotide； Treatment

First-authors address：Changan Hospital，Xian 710016，China

doi：10.3969/j.issn.1674-4985.2017.34.038

肝性胸水是肝硬化失代偿期的并发症之一，多在腹水的基础上出现，主要表现为胸闷、气促、呼吸困难，早期症状不明显，容易忽视，随着病情发展，胸水量增多，症状的出现，治疗比较困难。本院采用奥曲肽治疗肝性胸水，并与常规治疗比较，疗效显著，现报道如下。

1 资料与方法

1.1 一般资料 收集本院2013年6月-2017年5月收治的肝性胸水患者45例，男32例，女13例；年龄31～76岁，平均（57.6±9.3）岁；其中乙肝肝硬化33例，丙肝肝硬化5例，酒精性肝硬化3例，原发性胆汁性肝硬化2例，不明原因肝硬化2例；肝功能Child-pugh分级：B级19例，C级26例。入选条件：（1）腹部B超或CT检查提示肝硬化门静脉宽度﹥1.2 cm，排除門静脉血栓及海绵样变性；（2）胸片检查提示胸腔积液，胸水穿刺化验为漏出液，排除结核、肿瘤等原因引起的胸腔积液；（3）治疗前1周未出现上消化道出血、肝性脑病，未合并感染或感染得到控制。45例患者呼吸道临床症状为胸闷、气促、呼吸困难，胸……