特利加压素治疗肝性胸水的体会(附2例报告)

Experience of Terlipressin in the Treatment of Hepatic Hydrothorax (a Report of 2 Cases)

摘要: 目的：探讨肝硬化肝性胸水的临床诊治。方法：2例肝硬化失代偿期顽固性腹水并肝性胸水患者，经限制钠盐的摄入、利尿、补充白蛋白、营养支持、保肝及腹腔穿刺抽液等综合治疗1周以上临床无效，在此基础上加用特利加压素(例1胸腹水合并肝肾综合征，特利加压素按照1 mg q6h持续泵入3天，血清肌酐水平下降15.68%未达标，第4天剂量加倍2 mg q6h持续泵入治疗4天停药；例2顽固性腹水并胸水，特利加压素2 mg q12h静点治疗7天停药)治疗7天，治疗后观察临床症状、胸腹水及尿量变化情况。结果：根据治疗前后超声及胸片观察胸水及腹水的变化，评估疗效。2例患者均经基础治疗1周无效后加用特利加压素治疗1周，肾功、尿量、腹水及胸水均得到有效改善及控制，短期内无反复，前后对比疗效有显著差异。结论：临床观察结果表明，特利加压素对肝硬化肝性胸水有一定临床疗效，有进一步研究的价值。

Abstract: Objective: To explore the clinical diagnosis and treatment of Cirrhosis Hepatic Hydrothorax. Methods: Two patients, with refractory ascites of liver cirrhosis and hepatic hydrothorax, showed no clinical ineffectiveness with limited sodium salt intake, diuretic, albumin supplementation, nutritional support, liver protection and abdominal puncture drainage for more than one week. On the basis, we treated patients with Terlipressin for 7 days (e.g. Patient 1 with hydrothorax and ascites plus hepatorenal syndrome, Terlipressin 1 mg q6h, continuous pumping treatment for three days, the serum creatinine level decreased by 15.68%, double Terlipressin dose in the fourth day: 2 mg q6h, continuous pumping treatment for 4 days; e.g. Patient 2 with refractory ascites complicated with pleural effusion, Terlipressin 2 mg q12h for intravenous treatment, 7 days) and observed their clinical symptoms, hydrothorax and ascites, urine output after treatment. Results: To observe changes in hydrothorax and ascites to evaluate the efficacy according to ultrasound before and after treatment. Two patients were treated with Terlipressin for one week after basic treatment (7days). Their renal function, urine volume, ascites and pleural effusion were effectively improved and controlled. In addition, there was no recurrence in the short term, and there was significant difference before and after treatment. Conclusion: The clinical effect showed that Terlipressin has effect on Cirrhosis Hepatic Hydrothorax, which displayed further value to research.