一贯煎加减治疗肝硬化腹水的疗效观察

夏婷 尹剑雄

摘要：目的  探討一贯煎加减治疗肝硬化腹水的临床疗效。方法  选择2014年9月～2017年10月我院门诊和住院治疗的肝硬化腹水患者65例，随机分为治疗组（35例）和对照组（30例）。对照组患者在西药常规治疗基础上用六味地黄丸治疗，治疗组在西药常规治疗基础上以一贯煎为主方，通过辩证加减治疗。2个疗程后观察患者的临床疗效及血清TBiL、ALT、ALB水平差异。结果  治疗组的总有效率为94.29%，高于对照组的76.67%，差异有统计学意义（P<0.05）;治疗组患者血清TBiL、ALT、ALB水平改善均优于对照组，差异有统计学意义（P<0.05）。结论  一贯煎加减治疗肝硬化腹水可以改善患者患者肝功能指标，提高临床疗效，值得临床借鉴。

关键词：肝硬化腹水;一贯煎加减;六味地黄丸

中图分类号：R256.4                              文献标识码：A                                    DOI：10.3969/j.issn.1006-1959.2019.06.054

文章编号：1006-1959（2019）06-0166-03

Abstract：Objective  To investigate the clinical efficacy of consistent decoction plus subtractive in the treatment of ascites due to cirrhosis. Methods   65 patients with cirrhosis and ascites from our hospital from September 2014 to October 2017 were randomly divided into treatment group （35 cases） and control group （30 cases）. The patients in the control group were treated with Liuwei Dihuang Pill on the basis of conventional western medicine treatment. The treatment group was treated with traditional decoction on the basis of conventional western medicine， and was treated by dialectical addition and subtraction. After 2 courses of treatment， the clinical efficacy and serum levels of TBiL， ALT and ALB were observed.Results   The total effective rate of the treatment group was 94.29%， which was higher than that of the control group 76.67%，the difference was statistically significant （P<0.05）. The serum levels of TBiL， ALT and ALB in the treatment group were better than those in the control group，the difference was statistically significant （P<0.05）.Conclusion  Consistent decoction plus subtractive and treatment of ascites due to cirrhosis can improve the liver function of patients and improve clinical efficacy， which is worthy of clinical reference.

Key words：Liver cirrhosis ascites;Consistent decoction plus subtractive;Liuwei Dihuang Pill

腹水是肝硬化后期的常见表现，属中医“臌胀”范畴，乃中医四大疑难杂症“风、痨、臌、膈”之一，是由于各种原因致肝、脾、肾受损而致气、血、水互结停腹中引起的病症，患者症状易反复且可呈进行性加重，治疗难度大，往往预后不良，目前尚无理想的治疗方法。近年来，采用中西医结合治疗肝硬化腹水有逐年增加的趋势，取得了较好的疗效。有统计显示一贯煎治疗肝硬化腹水肝肾阴虚证使用频次最高[1]，相关研究表明一贯煎不仅能提高肝脏生物转化功能，减轻肝细胞变性、坏死、肝窦内皮损伤，抑制肝脏炎症反应、纤维组织增生、肝星状细胞活化，而且能改善肝组织缺氧状态、肝脏糖代谢促进肝细胞再生，改善肝脏循环，降低门脉高压，调节患者的免疫调节功能，从而发挥治疗肝硬化腹水的作用[1-3]。笔者结合自身临床经验与所治病例，探讨西药常规疗法结合一贯煎在肝硬化腹水治疗中的优势。