| Objective:To observe the clinical efficacy of tolvaptan in relieving refractory ascites in cirrhosis and correcting electrolyte imbalance,and to provide evidence for the application of new drugs in clinical treatment of refractory ascites in cirrhosis.Methods:Sixty-nine patients with refractory ascites diagnosed as cirrhosis in Department of Hepatobiliary and Pancreatic Medicine,the Second Hospital of Jilin University from January 2016 to December 2018 were collected.All patients met the reference diagnostic criteria for refractory ascites reported by domestic scholars in 2014.According to whether tolvaptan was administered or not,they were divided into conventional therapy group and combined therapy group,of which 38 cases in conventional therapy group were given conventional therapy for liver protection,diuresis,human serum albumin support and so on,while 31 cases in combined therapy group were treated with tolvaptan on the basis of conventional treatment.The changes of urine volume,abdominal perimeter and ions(sodium,chloride,potassium,calcium,magnesium and phosphorus)in the two groups before and after treatment were compared on the Day 1,Day 4 and Day 7 of treatment.On Day 7 of treatment,the changes of renal function(BUN,CR,eGFR),liver function(ALT,AST,TBIL,ALB),blood routine(WBC,RBC,PLT),occurrence of adverse reactions(dry mouth,weakness,constipation,frequent urination)and efficacy of treatment were compared between the two groups before and after treatment.Results:1.Comparison of general clinical data between the two groups According to different treatment methods,there were 38 cases in the conventional treatment group and 31 cases in the combined treatment group.There was no significant difference in gender,age,etiology and Child classification between the two groups(p>0.05).2.Changes in abdominal circumference and urine volume before treatment,on the 1st,4th,and 7th day after treatment There was no significant difference in the abdominal circumference between the two groups before treatment and on the first day of treatment(p>0.05).On the 4th and 7th day of treatment,the abdominal circumference of the combined treatment group was significantly reduced compared with that before treatment,and the reduction was greater than In the conventional treatment group,the difference was statistically significant(p<0.05).There was no significant difference in urine volume between the two groups before treatment(p>0.05).The patients in the combined treatment group were treated for 24 hours on the first,fourth and seventh days of treatment.The urine volume was significantly increased compared with that before treatment,and the increase was higher than that of the conventional treatment group,the difference was statistically significant(p<0.05).3.Changes of ions in the two groups before treatment,on the first day,the fourth day,and the seventh day of treatment There was no significant difference in the levels of ions(blood sodium,blood chlorine,serum potassium,blood calcium,blood magnesium,blood phosphorus)between the two groups before treatment(p>0.05).On the Day 4 of treatment,the blood sodium,blood chloride,serum potassium,blood calcium and blood magnesium in the conventional treatment group were lower than those before treatment,and the difference had statistical significance(p<0.05).On the Day 7 of treatment,the blood sodium,blood chloride and blood calcium in the conventional treatment group were lower than those before treatment,and the difference had statistical significance(p<0.05).The serum sodium in the combination therapy group was significantly higher than that before treatment on the Day 1,Day 4 and Day 7 of treatment,and the difference had statistical significance(p<0.05);In the combination therapy group,the blood chloride level on the Day 4 and Day 7 of treatment was higher than that before treatment,and the difference had statistical significance(p<0.05).On the Day 1,Day 4 and Day 7 of treatment,the increase of serum sodium in the combined treatment group was better than that in the conventional treatment group,and the difference had statistical significance(p< 0.05).On the Day 4 and Day7 of treatment,the increase of blood chloride in the combined treatment group was superior to that in the conventional treatment group,and the difference had statistical significance(p<0.05).4.Changes in renal function,liver function,and blood routine before treatment and on day 7 of treatment in both groups There was no significant difference in renal function(BUN,Scr,eGFR)between the two groups before treatment.The eGFR in the conventional treatment group was lower than that before treatment(p<0.05).In the combination therapy group,eGFR increased on Day 7 of treatment compared with that before treatment,and Scr decreased compared with that before treatment,with statistically significant difference(p<0.05).On Day 7 of treatment,the increase of eGFR in the combination therapy group was superior to that in the conventional therapy group,and the difference had statistical significance(p<0.05).There was no significant change in liver function and blood routine before treatment and on Day 7 of treatment between combination therapy group and conventional therapy group,and there was no significant difference between the two groups(p>0.05).5.The occurrence of adverse reactions before and after treatment in the two groups There were 13 cases of dry mouth,4 cases of weakness,4 cases of urinary frequency,8 cases of constipation,and 10 cases of dry mouth in the conventional treatment group.For example,there were 11 cases of urinary frequency and 5 cases of constipation.There was no significant difference in the incidence of adverse reactions between the two groups(p>0.05).6.Comparison of treatment effectiveness between the two groups The treatment response rate of the two groups was 31.6% in the conventional treatment group and 83.9% in the combined treatment group,and the difference had statistical significance(p<0.05).Conclusion:1.Tolvaptan combined treatment group was superior to conventional treatment group,which could significantly increase urine volume and reduce abdominal circumference.Patients with refractory ascites in cirrhosis with dilutionalhyponatremia can rapidly increase serum sodium to normal for a short period of time without significant effects on other ions.2.Tolvaptan combined treatment group can effectively improve renal function,and has no significant effect on liver function and blood routine changes.3.The common adverse reactions in tolvaptan combined treatment group were basically the same as those in conventional treatment group,without other adverse events,with good safety and certain clinical application value. |
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