关键词:

肝硬化,  , 托伐普坦,  , 腹水,  , 随机对照研究

Abstract:

Objective To investigate the clinical efficacy and safety of tolvaptan in the treatment of the patients with cirrhosis ascites during the perioperative period. Methods 110 cirrhosis patients who were hospitalized and required surgical treatment from October 2018 to May 2020 were enrolled and randomly divided into observa⁃ tion groupand control group. 56 cases in observation group were treated with Tolvaptan and spironolactone，while 54 cases were treated with spironolactone. Surgical operation was performed according to the main diagnosis.During the perioperative period，the changes in ascites degree，abdominal circumference，weight，length of hospital stay， blood electrolytes，and safety were compared between the two groups using the same conventional comprehensive treatment. Results The proportion of patients with massive ascites after operation in the observation group was significantly lower than that in the control group（day 5 after operation：24.53% vs. 57.69%；day 30 after operation： 7.14% vs. 22.22%）；The difference in ultrasound fibro touch to measure liver stiffness between preoperative and 1 month after surgery of the observation group was higher than that of the control group［（0.75 ± 0.20）vs.（0.28 ± 0.19），P < 0.05］；The abdomen circumference difference value and the weight difference value on patient admission day and hospital discharge day of the observation group were higher than those of the control group.［（2.59 ± 0.16）cm vs.（1.66 ± 0.18）cm，P < 0.05］；［（1.20 ± 0.08）kg vs.（0.92 ± 0.07）kg，P < 0.05］；respectively. The urine output and the serum sodium concentration on the day 3 and day 5 after operation of the observation groupwere higherthan those of the control group（P < 0.05）. But the hospital stays in the observation group was less than that in the control group［（6.40 ± 0.12）d vs.（7.33 ± 0.12）d，P < 0.05］；There was no significant difference in the serum potassium concentration between the two groups during the perioperative period（P > 0.05）. Conclusions In perioperative patients with cirrhosis，tolvaptan therapy can effectively control ascites，promote increased urine volume，facilitate rapid recovery，and improve hyponatremia without affecting blood potassium concentration，which is highly safe.

Key words:  , liver cirrhosis,  , tolvaptan,  , ascites,  , randomized controlled trial（RCT）