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目的探讨可调式腹腔闭式持续引流技术在原发性肾病综合征伴大量腹水、急性肾功能不全(ARI)中的应用。方法对2005年12月至2006年8月南京军区福州总医院肾脏科6例原发性肾病综合征(PNS)伴大量腹水(腹围>95cm、B超示腹水>8.0cm)及ARI患者采用可调式腹腔闭式持续引流技术,联合激素、抗凝、降脂、抗炎、抗氧化治疗、改善肾微循环,并用中药冬虫夏草制剂等治疗,观察其治疗效果。结果经过上述综合治疗[平均治疗(50.1±17.1)d],6例腹水消失或明显减少,其中5例肾功能均恢复正常;PNS3例部分缓解(PR)、无效3例,出院后继续药物治疗并随访3~12个月,PNS完全缓解2例、PR3例,仅3例局部少量渗液。结论可调式腹腔闭式持续引流技术适用于PNS并发大量腹水及ARI且肾脏病变较轻患者,可清除过多水分,减轻肾间质水肿,促进肾功能恢复,也为应用激素、抗凝及降脂等治疗赢得机会。
Objective To investigate the application of adjustable peritoneal closure continuous drainage in patients with idiopathic nephrotic syndrome complicated with massive ascites and acute renal insufficiency (ARI). Methods Six patients with primary nephrotic syndrome (PNS) with massive ascites (abdominal circumference> 95cm, B-ascites> 8.0cm) and ARI in the Department of Nephrology, Fuzhou General Hospital of Nanjing Military Command from December 2005 to August 2006 were enrolled in this study. Adjustable closed peritoneal drainage technology, combined with hormones, anticoagulants, lipid-lowering, anti-inflammatory, anti-oxidation treatment, improve renal microcirculation, and treatment with traditional Chinese medicine Cordyceps sinensis, and observe its therapeutic effect. Results After the above comprehensive treatment (average treatment: 50.1 ± 17.1 days), 6 cases of ascites disappeared or obviously decreased, of which 5 cases recovered to normal renal function; 3 cases of partial remission (PNS) and 3 cases of ineffective PNS were discharged after treatment All cases were followed up for 3 to 12 months. PNS completely relieved in 2 cases, PR3 cases, and only 3 cases of local exudate. Conclusion Adjustable intraperitoneal closed continuous drainage technology is suitable for PNS complicated with large amounts of ascites and ARI and patients with mild renal disease, can clear excess water, reduce renal interstitial edema and promote renal function recovery, but also for the application of hormones, anticoagulation and lowering Lipids and other treatment to win the opportunity.