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目的:评估去甲肾上腺素(NE)治疗肝肾综合征(HRS)的疗效及安全性。方法:50例肝肾综合征患者随机分成3组,15例患者接受去甲肾上腺素[0.1-0.5μg/(kg·min)]加白蛋白(10g/d)治疗,15例患者接受特利加压素(0.5-1mg/4h)加白蛋白(10g/d)治疗,20例患者接受白蛋白(10g/d)治疗。治疗至肾功能逆转,最长疗程为15d。观察患者尿量、心率、平均动脉压、肝肾功能。结果:去甲肾上腺素组15例患者中8例患者肾功能好转(53.3%),特利加压素组15例患者中9例患者肾功能好转(60%),均未出现严重的心肌缺血,单纯白蛋白治疗组患者病情恶化。单变量分析显示,基线CTP(Child Tuecotte Pugh)积分、终末期肝病模型(MELD)、24h尿量、白蛋白、平均动脉压(MAP)与疗效相关。然而,多变量分析显示仅有CTP积分与疗效相关。结论:去甲肾上腺素治疗肝肾综合征具有和特利加压素相同的疗效和安全性,而费用显著降低。
Objective: To evaluate the efficacy and safety of norepinephrine (NE) in the treatment of hepatorenal syndrome (HRS). Methods: Fifty patients with hepatorenal syndrome were randomly divided into three groups, 15 patients received norepinephrine (0.1-0.5μg / (kg · min)] plus albumin (10g / d), and 15 patients received Terrene Vasopressin (0.5-1mg / 4h) plus albumin (10g / d) treatment, 20 patients received albumin (10g / d) treatment. Treatment to renal function reversal, the longest course of treatment for 15d. Observe the urine volume, heart rate, mean arterial pressure, liver and kidney function. RESULTS: Renal function was improved in 8 of 15 patients (n = 53.3%) in the norepinephrine group and in 9 of the 15 patients in the terlipressin group (60%). No severe myocardial deficits occurred Blood, albumin treatment group patients deteriorated. Univariate analysis showed that baseline CTP (Child Tuecotte Pugh) score, end-stage liver disease (MELD), 24h urine output, albumin, and mean arterial pressure (MAP) were related to efficacy. However, multivariate analysis showed that only CTP scores correlated with efficacy. Conclusions: Norepinephrine treatment of hepatorenal syndrome has the same efficacy and safety as terlipressin with a significant reduction in cost.