Objective To investigate the clinical effect of octreotide combined with an increased amount of fluid infusion in the treatment of intractable cirrhotic ascites, and to provide new thoughts for clinical diagnosis and treatment. Methods A total of 65 patients with intractable cirrhotic ascites who visited Affiliated Hospital of Inner Mongolia University for The Nationalities from February 2016 to May 2017 were enrolled and randomly divided into control group with 31 patients and observation group with 34 patients. The patients in the control group were given conventional treatment, and those in the observation group were given continuous pumping of octreotide 0. 6 mg once every 12 hours for 3 days, followed by intramuscular injection of octreotide 0. 2 mg once every 8 hours for 7-10 consecutive days, and an increased amount of fluid infusion, in addition to the conventional treatment. Symptomatic treatment was given based on patients' symptoms and tolerance. Vital signs, abdominal circumference, body weight, and time to ascites regression were observed during treatment, and the length of hospital stay and incidence rate of complications were analyzed. The t-test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. Results Compared with the control group, the observation group had significantly shorter time to ascites regression ( 6. 13 ± 1. 25 d vs 11. 61 ± 1. 34 d, t =-4. 06, P < 0. 001) and length of hospital stay ( 10. 01 ± 1. 46 d vs 16. 10 ± 1. 57 d, t =-7. 65, P < 0. 001) , as well as significantly greater average daily reductions in abdominal circumference ( 4. 01 ± 0. 75 cm vs 2. 42 ± 0. 35 cm, t = 4. 69, P < 0. 001) and body weight ( 1. 67 ± 0. 42 kg vs 0. 97 ± 0. 54 kg, t = 4. 58, P < 0. 001) . The observation group had significantly lower incidence rates of upper gastrointestinal bleeding and electrolyte disturbance than the control group ( upper gastrointestinal bleeding: 5. 88% vs 32. 26% , χ2= 7. 49, P < 0. 05; electrolyte disturbance: 8. 82% vs 38. 71% , χ2= 8. 56, P < 0. 05) . Conclusion In addition to the conventional treatment of intractable ascites, octreotide combined with an increased amount of fluid infusion can promote spontaneous dieresis, significantly reduce the amount of ascites, shorten the time to ascites regression, reduce complications, and improve patients' conditions.
[1]ARROYO V, GINES P, GERBES AL, et al.Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis[J].Hepatology, 1996, 23 (1) :164-176.
|
[2]CHEN Y, ZHOU L.Research advances in treatment of cirrhotic ascites[J].J Clin Hepatol, 2016, 32 (6) :1069-1074. (in Chinese) 陈煜, 周莉.肝硬化腹水治疗的新进展[J].临床肝胆病杂志, 2016, 32 (6) :1069-1074.
|
[3]SANGIOVANNI A, PRATI GM, FASANI P, et al.The natural history of compensated cirrhosis due to hepatitis C virus:a 17-year cohort study of 214 patients[J].Hepatology, 2006, 43 (6) :1303-1310.
|
[4]GE JB, XU YJ.Internal Medicine[M].8th ed.Beijing:People's Medical Publishing House, 2013:419-428. (in Chinese) 葛均波, 徐永健.内科学[M].8版.北京:人民卫生出版社, 2013:419-428.
|
[5]LIN PC, LIN YK, LI YB, et al.Advances in the treatment of cirrhotic ascites[J].Mod J Integr Tradit Chin West Med, 2014, 23 (29) :3299-3301. (in Chinese) 林培淳, 林勇凯, 李艺滨, 等.肝硬化腹水治疗进展[J].现代中西医结合杂志, 2014, 23 (29) :3299-3301.
|
[6]OCHS A, ROSSLE M, HAAG K, et al.The transjugular intrahepatic portosystemic stent-shunt procedure for refractory ascites[J].N Engl J Med, 1995, 332 (18) :1192-1197.
|
[7]SINGHAL S, BAIKATI KK, JABBOUR II, et al.Management of refractory ascites[J].Am J Ther, 2012, 19 (2) :121-132.
|
[8]European Association for the Study of the Liver.EASL clinical practice guidelines on the management of ascites, spontaneous bacterial peritonitis, and hepatorenal syndrome in cirrhosis[J].J Hepatol, 2010, 53 (3) :397-417.
|
[9]LIU HH, LUO SQ, FU JL, et al.Advances in the treatment of intractable cirrhotic ascites[J].J Pract Hepatol, 2011, 14 (4) :317-320. (in Chinese) 刘红虹, 罗生强, 福军亮, 等.肝硬化顽固性腹水的治疗新进展[J].实用肝脏病杂志, 2011, 14 (4) :317-320.
|
[10]SCHRIER RW.Pathogenesis of sodium and water retention in high-output and low-output cardiac failure, nephrotic syndrome, cirrhosis, and pregnancy[J].N Engl J Med, 1988, 319 (17) :1127-1134.
|
[11]FORTUNE B, CARDENAS A.Ascites, refractory ascites and hyponatremia in cirrhosis[J].Gastroenterol Rep (Oxf) , 2017, 5 (2) :104-112.
|
[12]ZHANG JL, LIU JL, LI YG, et al.The treatment discussion of refractory ascites in the cirrhosis of the liver[J].J World Latest Med Inf, 2016, 16 (100) :52-53, 56. (in Chinese) 张俊立, 刘静丽, 李艳歌, 等.肝硬化难治性腹水的治疗探讨[J].世界最新医学信息文摘, 2016, 16 (100) :52-53, 56.
|
[13]GUO LX.Clinical treatment in patients with liver cirrhosis refractory ascites[J].Chin Community Doct, 2016, 32 (35) :56, 58. (in Chinese) 郭丽仙.肝硬化难治性腹水的临床治疗观察[J].中国社区医师, 2016, 32 (35) :56, 58.
|
[14]ZHANG GQ.An analysis of clinical therapies for cirrhotic ascites[J].Chin J Mod Drug Appl, 2017, 11 (3) :133-135. (in Chinese) 张桂芹.肝硬化腹水临床的治疗方法分析[J].中国现代药物应用, 2017, 11 (3) :133-135.
|
[15]ZHU Q, JIANG XH, YI F, et al.The effects of octreotide on portal hemodynamics in patients with liver cirrhosis[J].Chin J Intern Med, 2004, 43 (1) :16-18. (in Chinese) 诸琦, 江晓华, 乙芳, 等.奥曲肽对肝硬化门脉血流动力学的影响[J].中华内科杂志, 2004, 43 (1) :16-18.
|
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