夏婷 尹劍雄

摘要：目的? 探討一貫煎加減治療肝硬化腹水的臨床療效。方法? 選擇2014年9月～2017年10月我院門診和住院治療的肝硬化腹水患者65例，隨機(jī)分為治療組（35例）和對(duì)照組（30例）。對(duì)照組患者在西藥常規(guī)治療基礎(chǔ)上用六味地黃丸治療，治療組在西藥常規(guī)治療基礎(chǔ)上以一貫煎為主方，通過辯證加減治療。2個(gè)療程后觀察患者的臨床療效及血清TBiL、ALT、ALB水平差異。結(jié)果? 治療組的總有效率為94.29%，高于對(duì)照組的76.67%，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）;治療組患者血清TBiL、ALT、ALB水平改善均優(yōu)于對(duì)照組，差異有統(tǒng)計(jì)學(xué)意義（P<0.05）。結(jié)論? 一貫煎加減治療肝硬化腹水可以改善患者患者肝功能指標(biāo)，提高臨床療效，值得臨床借鑒。

關(guān)鍵詞：肝硬化腹水;一貫煎加減;六味地黃丸

中圖分類號(hào)：R256.4? ? ? ? ? ? ? ? ? ? ? ? ? ? ? 文獻(xiàn)標(biāo)識(shí)碼：A? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? DOI：10.3969/j.issn.1006-1959.2019.06.054

文章編號(hào)：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見表現(xiàn)，屬中醫(yī)“臌脹”范疇，乃中醫(yī)四大疑難雜癥“風(fēng)、癆、臌、膈”之一，是由于各種原因致肝、脾、腎受損而致氣、血、水互結(jié)停腹中引起的病癥，患者癥狀易反復(fù)且可呈進(jìn)行性加重，治療難度大，往往預(yù)后不良，目前尚無理想的治療方法。近年來，采用中西醫(yī)結(jié)合治療肝硬化腹水有逐年增加的趨勢(shì)，取得了較好的療效。有統(tǒng)計(jì)顯示一貫煎治療肝硬化腹水肝腎陰虛證使用頻次最高[1]，相關(guān)研究表明一貫煎不僅能提高肝臟生物轉(zhuǎn)化功能，減輕肝細(xì)胞變性、壞死、肝竇內(nèi)皮損傷，抑制肝臟炎癥反應(yīng)、纖維組織增生、肝星狀細(xì)胞活化，而且能改善肝組織缺氧狀態(tài)、肝臟糖代謝促進(jìn)肝細(xì)胞再生，改善肝臟循環(huán)，降低門脈高壓，調(diào)節(jié)患者的免疫調(diào)節(jié)功能，從而發(fā)揮治療肝硬化腹水的作用[1-3]。筆者結(jié)合自身臨床經(jīng)驗(yàn)與所治病例，探討西藥常規(guī)療法結(jié)合一貫煎在肝硬化腹水治療中的優(yōu)勢(shì)。