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从《肝硬化腹水及相关并发症的诊疗指南》探讨顽固性腹水诊治“路线图”
Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications
文章发布日期:2017年12月09日  来源:  作者:丁惠国  点击次数:1031次  下载次数:220次

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【摘要】:《肝硬化腹水及相关并发症的诊疗指南》提出了肝硬化顽固性腹水(RA)诊治的新标准,其中自发性细菌性腹膜炎为肝硬化RA常见原因。50%~89%肝硬化RA患者对特利加压素(2~8 mg/d)、盐酸米多君(22.5 mg/d)、托伐普坦(7.5~15 mg/d)有显著的应答反应。静脉补充白蛋白(8 g/1000 ml腹水)与特利加压素(3 mg)预防大量放腹水后循环功能障碍的效果相似。药物治疗应答差或需要频繁进行大量放腹水(>3次/周)或频繁住院 (>3次/月)的肝硬化RA患者,应该早期评估肝移植或经颈静脉肝内门体静脉分流术。α晶型利福昔明能够影响肠道-微生物-肝脏轴,是预防肝硬化相关并发症的新策略。因此,探讨适合中国临床实践的肝硬化RA诊治“路线图”具有较重要的意义。
【Abstract】:Guidelines for the diagnosis and treatment of cirrhotic ascites and related complications put forward the new criteria for the diagnosis and treatment of intractable cirrhotic ascites, and spontaneous bacterial peritonitis is a common cause of intractable cirrhotic ascites. About 50%-89% of patients with intractable cirrhotic ascites have a significant response to terlipressin (2-8 mg/d), midodrine hydrochloride (22.5 mg/d), and tolvaptan (7.5-15 mg/d). Intravenous albumin supplementation (8 g/1000 ml ascites) has a similar therapeutic effect as terlipressin (3 mg) in preventing posterior circulation dysfunction after large-volume paracentesis. Patients with a poor response to medication or those who need frequent large-volume paracentesis (more than three times per week) or frequent hospitalization (more than three times per month) should be evaluated for liver transplantation or transjugular intrahepatic portosystemic shunt. α-Crystal rifaximin may become a new strategy for preventing complications of liver cirrhosis by regulating the intestine-microbe-liver axis. Therefore, it is of great significance to explore the “road map” of the diagnosis and treatment of intractable cirrhotic ascites that is suitable for the clinical practice in China.
【关键字】:肝硬化;腹水;腹膜炎;诊断;治疗
【Key words】:liver cirrhosis; ascites; peritonitis; diagnosis; therapy
【引证本文】:DING HG. Road map of the diagnosis and treatment of intractable ascites based on guidelines for the diagnosis and treatment of cirrhotic ascites and related complications[J]. J Clin Hepatol, 2018, 34(1): 31-34. (in Chinese)
丁惠国. 从《肝硬化腹水及相关并发症的诊疗指南》探讨顽固性腹水诊治“路线图”[J]. 临床肝胆病杂志, 2018, 34(1): 31-34.

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