中西医结合治疗酒精性肝硬化合并反复性腹水案例一则
增强出版A Case of Alcoholic Cirrhosis Complicated with Recurrent Ascites Treated by Integrated Traditional Chinese and Western Medicine
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1.首都医科大学附属北京中医医院肝病科,北京 100010
2.北京中医药大学,北京 100029
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李晓玲, 李柄邑, 孙凤霞. 中西医结合治疗酒精性肝硬化合并反复性腹水案例一则[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34745952&Fpath=home&index=0
LI Xiaoling, LI Bingyi, SUN Fengxia. A Case of Alcoholic Cirrhosis Complicated with Recurrent Ascites Treated by Integrated Traditional Chinese and Western Medicine[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34745952&Fpath=home&index=0
李晓玲, 李柄邑, 孙凤霞. 中西医结合治疗酒精性肝硬化合并反复性腹水案例一则[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34745952&Fpath=home&index=0 DOI:
LI Xiaoling, LI Bingyi, SUN Fengxia. A Case of Alcoholic Cirrhosis Complicated with Recurrent Ascites Treated by Integrated Traditional Chinese and Western Medicine[DB/OL].(2023-02-27)[2023-11-05].http://cccl-tcm.cacm.org.cn/thesisDetails?columnId=34745952&Fpath=home&index=0 DOI:
病史摘要,2,患者因“反复乏力、腹胀1年”前来就诊。2018年6月无明显诱因出现乏力,伴腹胀,休息后可缓解。2019年1月出现乏力、腹胀加重,伴下肢水肿,查乙肝病毒表面抗原、丙肝病毒抗体均为阴性,腹部超声提示肝硬化、脾大、腹水。患者长期饮酒30余年,摄入酒精含量约80 g/日。诊断为“酒精性肝硬化;腹腔积液;低蛋白血症”,予保肝、利尿、输注白蛋白治疗后症状好转。此后因腹胀反复出现,先后予保肝、利尿、腹水超滤回输治疗,腹水未见明显改善。目前口服螺内酯40mg,Bid+托拉塞米20mg,Qd+间断口服托伐普坦15mg 利尿治疗。既往:高血压病史10余年,长期饮酒史30余年,摄入酒精含量约80g/日。查体:面色晦暗,皮肤、巩膜无黄染,肝掌(+),蜘蛛痣(-)。腹部高度膨隆,脐疝,移动性浊音阳性,双下肢轻度水肿。舌暗红,苔白,脉沉。辅助检查:2019年5月16日肝功能:ALT: 14 U/L,AST: 25 U/L,ALB: 31 g/L,GGT: 113 U/L,ALP: 95 U/L,TBIL: 16.6 μmol/L,DBIL: 7.6 μmol/L,CHE: 3211 U/L。血常规:RBC: 3.97×10,9,/L,HGB: 129 g/L,WBC: 6.44×109/L,PLT: 151×10,9,/L。血凝:PTA60.9%。血氨:44.8 μmol/L。肿瘤标志物:AFP: 5.12 ng/ml,CA125: 387.2 U/ml。尿常规、肾功能、离子系列未见明显异常。2019年3月16日腹部B超:1.肝硬化、脾大45×145 mm、大量腹水(肝前31 mm,下腹肠间隙102 mm,脾前14 mm)、门静脉12 mm;2.肝内多发稍低回声结节19×13 mm;3.门静脉高压、侧枝循环开放;4.胆囊继发改变、胆囊多发结石。2019年5月14日腹部CT:1.肝硬化,脾稍大,腹水,附脐静脉开放;2.胆囊结石,胆囊炎;3.腹腔内钙化灶。中医诊断 鼓胀(气虚血瘀,水湿内停)西医诊断 酒精性肝硬化失代偿期; 腹水(3级);脾大;低蛋白血症;高血压;胆囊炎;胆囊结石干预措施 1.中医治疗:治以益气活血,利水消肿;2.处方:生黄芪40 g、泽兰15 g 、茯苓皮3 0g、猪苓20 g、泽泻15 g、车前子30 g,包煎,、玉米须15 g、大腹皮15 g、白茅根30 g、水红花子10 g、白芍15 g、陈皮10 g,水煎每次200 mL,一日两次温服 2.西医治疗:予口服托拉塞米10 mg,Bid、口服螺内酯40 mg,Bid、间断口服托伐普坦15 mg,Qd利尿治疗。疗效转归 患者经过约17个月中西结合治疗后,乏力、腹胀、纳差、尿量少等症状均有明显好转,腹部膨隆减轻,脐疝消失。肝功能、血凝、血常规等未见异常。腹部超声检查示下腹肠间隙腹水由102降至15 mm,肝前腹水由31降至0 mm,脾前腹水由14降至0 mm。肝脏瞬时弹性成像示肝硬度值E由24.8降至18.4 Kpa。
Summary of case history, The patient seek medical advice for repeated fatigue and abdominal distension for 1 year. In June 2018, there was no obvious cause for fatigue, accompanied by abdominal distension, which could be relieved after rest. In January 2019, the patient had symptoms of fatigue, abdominal distension, lower limb edema. The surface antigen of hepatitis B virus and antibody of hepatitis C virus are negative. Abdominal ultrasound showed cirrhosis, splenomegaly and ascites. The patient has been drinking alcohol for more than 30 years, and the alcohol content is about 80 g/day. The diagnosis was Alcoholic cirrhosis, Peritoneal effusion, Hypoalbuminemia. The symptoms improved after liver protection, diuresis and albumin infusion. Since then, due to repeated abdominal distension, the patients were treated with liver protection, diuresis and ultrafiltration of ascites. The ascites did not improve significantly. Currently, take spironolactone 40mg,twice a day, torasemide 20mg, once a day,intermittently tolvaptan 15mg orally for diuretic therapy. Past: hypertension history of more than 10 years, long-term drinking history of more than 30 years, about 80g / day of alcohol. Physical examination: dark complexion, no yellow stain on skin and sclera, liver palm (+), spider nevus (-). High abdominal swelling, umbilical hernia, positive mobile voiced, mild edema of both lower limbs. The tongue is dark red, the tongue coating is white, and the pulse is deep. Auxiliary examination: May,16, 2019 liver function result are ALT 14 U/L, AST 25 U/L, ALB 31 g/L, GGT 113 U/L, ALP 95 U/L, TBIL 16.6 umol/L, DBIL 7.6 umol/L, CHE 3211 U/L. Blood routine check report shows that RBC 3.97×10,9,/L, HGB 129 g/L, WBC 6.44×10,9,/L, PLT 151×10,9,/L. Hemagglutination: PTA 60.9%. Blood ammonia: 44.8umol/L. Tumor markers: AFP 5.12 ng/ml, CA125 387.2U/ml. No obvious abnormality is found in routine urine test, renal function and ion series. March,16,2019 Abdominal ultrasoundresult are 1. Liver cirrhosis and splenomegaly × 145mm, large amount of ascites 31mm in front of liver, 102mm in the space between lower abdomen and intestine, 14mm in front of spleen, and 12mm in portal vein; 2. Multiple slightly hypoechoic nodules in the liver 19×13 mm; 3. Portal hypertension and collateral circulation opening; 4. Secondary changes of gallbladder and multiple gallstones. May,14,2019 abdominal CT result are 1. Liver cirrhosis, slightly enlarged spleen, ascites, and open accessory umbilical vein; 2. Gallstone and cholecystitis; 3. Intraperitoneal calcification.,TCM diagnosis, Tympanite-Qi deficiency induced blood stasis pattern, water retention pattern,Western medicine diagnosis, Decompensated stage of alcoholic cirrhosis; ascites(Level 3); Splenomegaly; Hypoalbuminemia; Hypertension; Cholecystitis; Gallstone,Therapeutic methods, 1. Traditional Chinese medicine treatment: it is used to replenish qi and activate blood circulation, promote water and reduce swelling. The prescription is as follows: Sheng Huang qi 40 g, Ze lan 15 g, Fu ling pi 30 g, Zhu ling 20 g, Ze xie 15 g, Che qian zi 30 g, Yu mi xu 15 g, Da fu pi 15 g, Bai mao gen 30 g, Shui hong hua zi 10 g, Bai shao 15 g, Chen pi 10 g 200 ml each time, twice a day, warm drinking. 2. Western medicine treatment: torasemide 10 mg po bid, spironolactone 40 mg po bid, tolvaptan 15 mg po qd Occasionally.,Clinical outcomes, After about 17 months of treatment with combination of Chinese and Western medicine, the symptoms of fatigue, abdominal distension, anorexia, and low urine volume were significantly improved, the abdominal distension was reduced, and the umbilical hernia disappeared. No abnormality was found in liver function, hemagglutination and blood routine. Ultrasound examination showed that ascites in the lower abdominal intestinal space changed from 102 to 15 mm, pre hepatic ascites changed from 31 to 0 mm, and pre splenic ascites changed from 14 to 0mm. Liver stiffness value E changed from 24.8 to 18.4 kpa.
酒精性肝硬化失代偿期腹水中西医治疗案例
alcoholic cirrhosisDecompensation periodascitesChinese and Western Medicine TreatmentCase
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