RESUMEN
Objective To investigate the clinical value of re-using ultrafiltrated and concentrated ascites fluid for refractory ascites in patients with hepatitis B cirrhosis. Methods A retrospective study was conducted, one hundred and thirteen patients with intractable ascites (all patients received intraperitoneal reinfusion of ultrafiltrated and concentrated ascites fluid therapy) admitted to the Department of Gastroenterology of No.254 Hospital of the Chinese People's Liberation Army from December 2013 to November 2016 were enrolled and assigned as the study group, fifty-two patients with intractable ascites admitted in the same period as above group in this hospital without undergoing above ascites fluid reinsfusion were served as the control group. Both groups were given conventional therapies, including measures for hepatoprotection, increase of plasma osmotic pressure, correction of hypoproteinemia (intravenous injection albumin 10 g, 3 times a week), reduction of portal venous pressure (octreotide 0.2 mg, q8 h), improvement of microcirculation, correction of water and electrolyte balance disorders, diuresis (furosemide 100 mg/d), etc. On the basis of the above conventional treatment, the system with ascites ultrafiltration, concentration and reinfusion into abdominal cavity was applied to carry out the concentrated ascites fluid reinfusion therapy in the study group. The relieve of abdominal bloating, conscious, blood pressure, 24-hour urine output, endogenous creatinine clearance rate (CCr), serum potassium ion (K+), serum sodium ion (Na+), ascites albumin quantity, serum albumin levels before treatment and after treatment for 1 week, abdominal infection situation after treatment for 1 week were observed in the study group. The difference in incidence of abdominal infection between the study group and control group (at the end of 12 weeks after treatment) was compared. Results In the study group, after treatment, the patients with abdominal bloating had different degrees of relief, 24-hour urine output was increased compared with that before treatment (mL: 1291.3±123.4 vs. 1265.0±61.5, P = 0.051), no cases with conscious changes, blood pressure instable. There were no statistical significant difference in blood K+ and Na+ (P > 0.05). And ascites albumin concentration was increased compared with before treatment (g/L: 19.1±2.9 vs. 17.2±4.1, P = 0.000); 1 week after treatment, CCr was significantly higher than that before treatment (μmol/L: 71.2±8.7 vs. 56.1±5.4, P = 0.000); serum albumin was increased after 3 times of treatment in 1 week (g/L: 25.7±4.4 vs. 24.6±3.0), but the difference was not statistically significant (P = 0.054). No abdominal infection occurred within 1 week after treatment were observed in patients of study group. There was no statistical significant difference in the incidence of abdominal infection between the study group and control group in 12 weeks after treatment [9.7% (11/113) vs. 13.6% (7/52), P = 0.476]. Conclusions The re-using of ultrafiltrated and concentrated ascites fluid can effectively relieve the abdominal bloating symptom, improve CCr, be beneficial to the re-use of ascites albumin, and does not increase the incidence of abdominal infection within 12 weeks after the therapy, therefore the treatment has relatively high therapeutic value for intractable ascites in patients with hepatitis B cirrhosis.
RESUMEN
Objective To investigate the clinical value of re-using ultrafiltrated and concentrated ascites fluid for refractory ascites in patients with hepatitis B cirrhosis. Methods A retrospective study was conducted, one hundred and thirteen patients with intractable ascites (all patients received intraperitoneal reinfusion of ultrafiltrated and concentrated ascites fluid therapy) admitted to the Department of Gastroenterology of No.254 Hospital of the Chinese People's Liberation Army from December 2013 to November 2016 were enrolled and assigned as the study group, fifty-two patients with intractable ascites admitted in the same period as above group in this hospital without undergoing above ascites fluid reinsfusion were served as the control group. Both groups were given conventional therapies, including measures for hepatoprotection, increase of plasma osmotic pressure, correction of hypoproteinemia (intravenous injection albumin 10 g, 3 times a week), reduction of portal venous pressure (octreotide 0.2 mg, q8 h), improvement of microcirculation, correction of water and electrolyte balance disorders, diuresis (furosemide 100 mg/d), etc. On the basis of the above conventional treatment, the system with ascites ultrafiltration, concentration and reinfusion into abdominal cavity was applied to carry out the concentrated ascites fluid reinfusion therapy in the study group. The relieve of abdominal bloating, conscious, blood pressure, 24-hour urine output, endogenous creatinine clearance rate (CCr), serum potassium ion (K+), serum sodium ion (Na+), ascites albumin quantity, serum albumin levels before treatment and after treatment for 1 week, abdominal infection situation after treatment for 1 week were observed in the study group. The difference in incidence of abdominal infection between the study group and control group (at the end of 12 weeks after treatment) was compared. Results In the study group, after treatment, the patients with abdominal bloating had different degrees of relief, 24-hour urine output was increased compared with that before treatment (mL: 1291.3±123.4 vs. 1265.0±61.5, P = 0.051), no cases with conscious changes, blood pressure instable. There were no statistical significant difference in blood K+ and Na+ (P > 0.05). And ascites albumin concentration was increased compared with before treatment (g/L: 19.1±2.9 vs. 17.2±4.1, P = 0.000); 1 week after treatment, CCr was significantly higher than that before treatment (μmol/L: 71.2±8.7 vs. 56.1±5.4, P = 0.000); serum albumin was increased after 3 times of treatment in 1 week (g/L: 25.7±4.4 vs. 24.6±3.0), but the difference was not statistically significant (P = 0.054). No abdominal infection occurred within 1 week after treatment were observed in patients of study group. There was no statistical significant difference in the incidence of abdominal infection between the study group and control group in 12 weeks after treatment [9.7% (11/113) vs. 13.6% (7/52), P = 0.476]. Conclusions The re-using of ultrafiltrated and concentrated ascites fluid can effectively relieve the abdominal bloating symptom, improve CCr, be beneficial to the re-use of ascites albumin, and does not increase the incidence of abdominal infection within 12 weeks after the therapy, therefore the treatment has relatively high therapeutic value for intractable ascites in patients with hepatitis B cirrhosis.
RESUMEN
Objective To explore and identify the correlation of CTP classification,MELD score of patients with cirrhosis after hepatitis between different TCM syndromes.Methods For 135 patients comply with hepatitis B cirrhosis standard,standardized TCM syndrome differentiation and laboratory tests is executed so as to analyze the correlation of CTP classification,MELD score of patients with cirrhosis after hepatitis between different TCM syndromes.Results The liver function CTP classification in liver Qi stagnation syndrome and dump-heat accumulation syndrome patients mainly scores to Class A,and the MELD score less than 10 points-based.The liver function CTP classification in Yin deficiency of Liver and kidney,Yang deficiency of spleen and kidney and blood stasis syndromes mainly scores to Class B-C,and the MELD scores more than 10 points basically.Yin deficiency of Liver and kidney,Yang deficiency of spleen and kidney and blood stasis syndromes take majority in advanced cirrhosis patients compared with liver Qi stagnation syndrome and dump-heat accumulation syndrome take majority in early stage cirrhosis patients.Conclusion Matches the traditional view in TCM that form Qi stagnation,to damp heat-water stopped,to blood stasis-Yang and Yin deficiency is the regular pathogenesis evolution pattern of post-hepatitis cirrhosis.