重症肝硬化顽固性腹腔积液净化回输的临床研究(1)
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[摘要] 目的：利用血液透析原理对腹腔积液患者进行自体腹腔积液净化回输治疗。方法：39例重症肝硬化顽固性腹腔积液患者(RA)，从腹腔一侧抽出腹腔积液，净化后回输至对侧。结果：39例RA患者于腹腔积液净化回输后，平均腹围缩小27.5 cm，体重减少6 kg，腹腔积液减少或消失。结论：利用血液透析原理进行自体腹腔积液净化回输技术疗效确切，经济，简便。
[关键词] 腹腔积液回输；血液净化；肝硬化；血浆蛋白
[中图分类号] R442.5[文献标识码]A [文章编号]1673-7210(2009)05(b)-031-02
The clinical study of auto-ascites re-infusion after purification in severe cirrhosis complicated with refractory ascites
GE Tong, QIN Hao, XU Xiujie, ZHANG Dapeng
(Department of Internal Medicine, the Second Hospital of Harbin City, Harbin150056, China)
[Abstract] Objective: To treat patients with refractory ascites (RA) with auto-ascites re-infusion after purification based on the principle of hemodiafiltration. Methods: The ascites of 39 patients with severe cirrhosis complicated with RA was pumped out from one abdominal cavity and then infused into the other side of abdominal cavity after purification. Results: After the purification and re-infusion of ascites, the average abdomen circumference of 39 patients with RA was 27.5 cm, and the body weight was decreased by 6 kg than that before re-infusion, and the ascites of patients decreased obviously or even entirely disappeared. Conclusion: The therapeutic effect of purifying auto-ascites re-infusion based on the principle of hemodiafiltration is definite, economical and simple.
[Keys words] Ascites re-infusion; Hemodiafiltration; Cirrhosis; Plasma protein
腹腔积液是体液从血管与淋巴管内渗漏入腹腔内积聚而成的游离液体。腹腔积液中含有大量的可溶性蛋白，蛋白浓度约为40 mg/L，其中白蛋白占50%以上，球蛋白占20%左右，腹腔积液患者均伴有低蛋白血症及营养不良。对于肝硬化顽固性腹腔积液(RA)以及其他疾病所致的腹腔积液，以往临床上常采用利尿合剂、中西医结合治疗腹腔积液、输注白蛋白及排放腹腔积液，效果都不十分理想[1-3]。腹腔积液反弹时有发生，近年来曾有腹腔积液直接回输静脉、腹腔积液环注、腹腔积液浓缩后回输静脉的报道。我院内科消化病房2003～2008年利用血液透析原理，对39例RA患者给予腹腔积液净化回输，效果良好，现报道如下：
1 资料与方法
1.1 一般资料
39例RA患者，男29例，女10例，年龄32～58岁，平均45岁。原发病为慢性肝炎、肝硬化合并腹腔积液半年以上，上腹部局度膨隆，均用过利尿合剂、中草药、输注白蛋白和排放腹腔积液(弃去)等治疗，效果欠佳。
1.2 材料
日本产NIPRO NCU-11型血液透析机，NIPRO FB-130TGA型空心纤维透析器(下称中空)及其配套的血路管道，透析液为碳酸氢盐溶液另备输血器、透析专用16号穿刺针、0.57%碘伏棉球、2%利多卡因、5 ml注射器、单孔和双孔洞巾、止血钳、无菌纱布、胶布、肝素、无菌手套等。
1.3 方法
39例RA患者，利用血液透析原理，采用密闭式腹腔积液净化回输。先采集腹腔积液做常规化验，非脓性及血性腹腔积液均可单独采用密闭式腹腔积液净化回输法，即腹腔积液由腹腔一侧抽出净化后回输至对侧。先将血液透析机调至正常运转，中空与血路管道连接好，以生理盐水冲洗，最后以配制好的肝素水循环排气后，待用。常规消毒腹腔穿刺部位(同上)，铺双孔洞巾，用16号透析专用穿刺针行两侧腹腔穿刺(穿刺方法同上)。待两侧腹腔穿刺成功后，先取一侧腹腔穿刺针与血路管道动脉端连接，打开血液透析机的血流调节器，血泵开始运转，排掉血路管道内的肝素生理盐水后 ......
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