叶永安治疗慢加急性肝衰竭验案一则
A Case of Ye Yongan's Treatment of Acute-on-Chronic Liver Failure
扫 描 看 全 文
1.清华大学玉泉医院(清华大学中西医结合医院)消化科,北京 100040
2.北京市丰台中西医结合医院消化科,北京 100072
3.北京中医药大学东直门医院脾胃病科,北京 100700
扫 描 看 全 文
宋宇, 李志国, 叶永安. 叶永安治疗慢加急性肝衰竭验案一则[DB/OL].(2023-03-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35540109&Fpath=home&index=0
SONG Yu, LI Zhiguo, YE Yongan. A Case of Ye Yongan's Treatment of Acute-on-Chronic Liver Failure[DB/OL].(2023-03-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35540109&Fpath=home&index=0
宋宇, 李志国, 叶永安. 叶永安治疗慢加急性肝衰竭验案一则[DB/OL].(2023-03-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35540109&Fpath=home&index=0 DOI:
SONG Yu, LI Zhiguo, YE Yongan. A Case of Ye Yongan's Treatment of Acute-on-Chronic Liver Failure[DB/OL].(2023-03-18)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=35540109&Fpath=home&index=0 DOI:
病史摘要,2,患者王某,男,47岁,主因“间断乏力12年半,加重伴黄疸17天”于2007年10月19日就诊于东直门医院。既往慢性乙型肝炎病史15年,入院时联合使用阿德福韦酯片、恩替卡韦治疗,12年前诊断肝硬化,门诊服用中药治疗,一般状态平稳。入院前17天无明显诱因出现巩膜轻度黄染,乏力加重,肝区胀闷,小便色黄,大便溏,黄褐色,无发热、恶心及呕吐。黄疸进行性加重,门诊中药汤剂治疗1周后黄疸未见明显消退,为进一步诊治收入院。发现血压升高3个月,曾服用“拜新同”治疗,黄疸出现后停药。中医诊断 黄疸(肝脾血瘀,湿热内蕴)西医诊断 慢加急性肝衰竭(B型,中期);慢性乙型病毒性肝炎;肝硬化失代偿期;门脉高压症(脾大、腹腔积液、食管胃底静脉曲张);肝功能Child-pugh C级;高血压病2级(中危组)干预措施 中药处方:柴胡12 g,赤芍30 g,郁金15 g,青皮10 g,党参10 g,炒白术20 g,苍术15 g,蚕砂12 g,土茯苓15 g,草河车15 g,大青叶15 g,生蒲黄10 g,三七粉6 g,当归12 g,丹参30 g,水红花子20 g,蝉衣6 g,陈皮12 g, 清半夏12 g,苏梗10 g,紫草12 g,每日1剂,水煎服,每日2次。复诊用药随证加减。西医予抗病毒、保肝、利尿、补充凝血因子及纠正电解质紊乱治疗。疗效转归 经治疗,患者黄疸消退,乏力改善,肝功能明显好转,随访14年,肝功能逐渐改善,乙肝表面抗原下降,病情平稳。
Summary of case history, Wang, male, 47 years old, was hospitalized in our hospital on October 19, 2007 due to "intermittent fatigue for 12 and a half years, aggravation with jaundice for 17 days" . The patient had a history of chronic hepatitis B for 15 years treated with Adefovir dipivoxil tablets and Entecavir, and had been diagnosed with cirrhosis 12 years ago. About 17 days before admission, there was no obvious cause of slight yellow staining of the sclera, aggravation of fatigue, accompanied by swelling of the liver area, yellow urine, sparse and yellow-brown stools, without fever, nausea and vomiting, and the jaundice was progressively aggravated. After 1 week of treatment with Chinese medicine decoction, the jaundice did not subside significantly, and was admitted to the hospital for further diagnosis and treatment. He had been diagnosed with Hpertension 3 months treated with nifedipine controlled release tablets, but stopped after jaundice appeared.,TCM diagnosis, He was diagnosed as jaundice, blood stasis of liver and spleen, dampness and heat accumulation syndrome.,Western medicine diagnosis, He was diagnosed with acute-on-chronic liver failure (type B, intermediate stage), chronic viral hepatitis B, decompensated liver cirrhosis, portal hypertension (splenomegasplenia, peritoneal effusion, esophagogastric varices), child-Pugh grade C liver function, hypertension grade 2 (medium-risk group).,Therapeutic methods, The patient was treated with a combination of Traditional Chinese and western medicine. Traditional Chinese medicine prescriptions regulate the liver and spleen, promote blood circulation and remove blood stasis, clear heat and dehumidify, while Western medicine gave anti-virus, liver-protecting, diuresis, supplementing coagulation factors and correcting electrolyte disorder.,Clinical outcomes, After treatment, the patient's jaundice subsided, fatigue improved, liver function improved significantly. After 14 years of follow-up, liver function improved gradually, hepatitis B surface antigen decreased, and the condition was stable.
慢加急性肝衰竭黄疸中西医结合叶永安
acute-on-chronic liver failurejaundiceIntegrative Chinese and western medicineYe Yongan
中华医学会感染病学分会肝衰竭与人工肝学组,中华医学会肝病学分会重型肝病与人工肝学组.肝衰竭诊治指南(2018年版)[J].中华临床感染病杂志,2018,11(6):401-410.
陈婧,苏海滨,胡瑾华.《2019年亚太肝病学会共识建议:慢加急性肝衰竭管理更新》摘译[J].临床肝胆病杂志,2019,35(9):1933-1936.
黄宁宇,李悦,皮珊珊,等. 叶永安治疗肝纤维化的学术思想与临床经验[J]. 湖南中医药大学学报,2021,41(7):1085-1088.
叶永安,江锋,赵志敏,等.慢性乙型肝炎中医证型分布规律研究[J].中医杂志,2007,48(3): 256-258.
0
浏览量
15
下载量
0
CSCD
关联资源
相关文章
相关作者
相关机构