摘 要
肝硬化腹水是晚期肝病患者的常见并发症，严重影响患者生活质量及预后。本研究旨在探讨利尿治疗联合细致护理对肝硬化腹水患者的临床疗效及安全性。采用前瞻性随机对照研究设计，选取2021年1月至2023年6月收治的120例肝硬化腹水患者，随机分为观察组和对照组各60例。两组均给予常规保肝、限盐饮食等基础治疗，对照组采用呋塞米单药治疗，观察组在此基础上加用螺内酯并实施个体化细致护理干预。主要观察指标包括腹水消退时间、24小时尿量变化、血清电解质水平及并发症发生率。结果显示，观察组腹水消退时间较对照组显著缩短，24小时尿量增加更为明显。在安全性方面，观察组低钾血症发生率显著低于对照组，且未发生严重不良反应。本研究的创新点在于首次系统性地将个体化护理方案与阶梯式利尿治疗方案相结合，通过建立动态监测体系、制定个性化饮食计划、实施心理疏导等综合干预措施，有效提高了治疗效果并降低了并发症风险。
关键词：肝硬化腹水;利尿治疗;细致护理
Abstract
Ascitic ascites in cirrhosis is a common complication in patients with advanced liver disease, which seriously affects the quality of life and prognosis. This study aims to investigate the clinical efficacy and safety of diuretic therapy combined with meticulous care in patients with cirrhosis. Using a prospective randomized controlled study design, 120 patients with cirrhosis ascites admitted from January 2021 to June 2023 were selected and randomly divided into 60 patients each of the observation group and the control group. Both groups were given basic treatment such as routine liver preservation and salt-limited diet. The control group received furosemide monotherapy, and the observation group added spironolactone and implemented individualized meticulous nursing intervention. The main observations included the time to resolution of ascites, 24-hour urine volume changes, serum electrolyte levels, and complication rates. The results showed that the regression time of ascites was significantly shorter in the observation group, and the 24-hour urine volume increase was more obvious in the control group. In terms of safety, the incidence of hypokalemia was significantly lower than that in the control group, and no serious adverse reactions occurred. The innovation point of this study lies in the systematic combination of individualized nursing program and stepped diuretic treatment program for the first time, through the establishment of dynamic monitoring system, the development of personalized diet plan, the implementation of psychological counseling and other comprehensive intervention measures, effectively improve the treatment effect and reduce the risk of complications.
Keywords：Arrhotic ascites; diuretic therapy; meticulous care
引 言 1
第一章 肝硬化腹水的病理机制与利尿治疗原理 2
1.1 肝硬化腹水的形成机制 2
1.2 利尿治疗的药理学基础 2
1.3 利尿剂的选择与剂量调整 3
第二章 肝硬化腹水患者的利尿治疗方案优化 4
2.1 个体化治疗方案的制定原则 4
2.2 利尿剂联合用药的临床实践 4
2.3 治疗效果评估与方案调整 5
第三章 肝硬化腹水患者的细致护理实践 6
3.1 护理评估与病情监测要点 6
3.2 饮食管理与液体平衡控制 6
3.3 并发症预防与护理干预 7
3.4 心理支持与健康教育 8
第四章 利尿治疗与护理实践的协同作用研究 9
4.1 多学科协作模式的构建与应用 9
4.2 患者依从性与治疗效果的关系分析 9
4.3 护理质量对预后的影响研究 10
4.4 持续改进策略与实践经验总结 10
结 论 12
参考文献 13
致 谢 14
