Recent status and prospect of ascites treatment in cirrhosis patients
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摘要: 腹水是肝硬化最常见的并发症,并与发生感染、稀释性低钠血症、肾功能衰竭和病死率增加密切相关。无并发症的少量腹水患者早期处理原则是,休息加上低钠饮食。中等量腹水患者,一般选择低剂量利尿剂就能达到利尿效果。大量腹水患者,可大量放腹水+静点白蛋白(8g/每放腹水1000ml)。顽固性腹水患者,可用重复多次大量放腹水+血浆扩容治疗或用经颈静脉肝内门体分流术(TIPS)治疗。新药(如V2受拮抗剂和血管收缩剂等)对肝硬化腹水的治疗可能带来希望。Abstract: Ascites is the most common complication in cirrhosis, and is closely related to the increased mortality due to infection, diluted hyponatremia and renal failure.Rest and sodium restriction are the components of the managements of uncomplicated mild ascites.Low dose diuretics are effective in patients with moderate ascites.Furthermore, the large-volume paracentesis (LVP) with albumin administration (8 g/L of ascites removed) are the treatment of choice for the management of patients with large ascites.As to the refractory ascites, methods for treatment include repeated LVP with plasma expander or transjugular intrahepatic portosystemic shunt (TIPS) .New medicines such as vasoconstrictors and V2-receptors of vasopressin maybe beneficial in patients with ascites in liver cirrhosis.
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Key words:
- liver cirrhosis /
- ascites
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[1]Planas R, Montoliu S, Balleste'B, et al.Natural history of patients hospitalized for management of cirrhotic ascites[J].Clin Gastroenterol Hepatol, 2006, 4 (11) ∶1385-1394. [2]Gine`s P.Vaptans:a promising therapy in the management of advanced cirrhosis[J].J Hepatol, 2007, 46 (6) ∶1150-1152. [3]Moore KP, Wong F, Gine`s P, et al.The management of ascites in cirrhosis:report on the consensus conference of the International Ascites Club[J].Hepatology, 2003, 38 (1) ∶258-266. [4]Santos J, Planas R, Pardo A, et al.Spironolactone alone or in combination with furosemide in the treatment of moderate ascites in nonazotemic cirrhosis:a randomized comparative study of efficacy and safety[J].J Hepatol, 2003, 39 (2) ∶187-192. [5]Li CP, Lee FY, Hwang SJ, et al.Treatment of mastalgia with tamoxifen in male patients with liver cirrhosis:a randomized crossover study[J].Am J Gastroenterol, 2000, 95 (4) ∶1051-1055. [6]Lee FY, Lee SD, Tsai YT, et al.A randomized controlled trial of quinidine in the treatment of cirrhotic patients with muscle cramps[J].J Hepatol, 1991, 12 (2) ∶236-240. [7]Angeli P, Albino G, Carraro P, et al.Cirrhosis and muscle cramps:evidence of a causal relationship[J].Hepatology, 1996, 23 (2) ∶264-273. [8]Ruiz-del-Arbol L, Monescillo A, Jimeénez W, et al.Paracentesis-induced circulatory dysfunction:mechanism and effect on hepatic hemodynamics in cirrhosis[J].Gastroenterology, 1997, 113 (2) ∶579-586. [9]Runyon BA.Management of adult patients with ascites due to cirrhosis[J].Hepatology, 2004, 39 (3) ∶841-856. [10]Sakai H, Sheer TA, Mendler MH, et al.Choosing the location for non-image guided abdominal paracentesis[J].Liver Int, 2005, 25 (5) ∶984-986. [11]Moore KP, Aithal GP.Guidelines on the management of ascites in cirrhosis[J].Gut, 2006, 55 (Suppl6) ∶vi1-vi12. [12]Moore KP, Wong F, Gine`s P, et al.The management of ascites in cirrhosis:report on the consensus conference of the International Ascites Club[J].Hepatology, 2003, 38 (1) ∶258-266. [13]Boyer TD, Haskal Z.The role of transjugular intrahepatic portosystemic shunt in the management of portal hypertension[J].Hepatology, 2005, 41 (2) ∶386-400. [14]Gine`s P, Uriz J, Calahorra B, et al.Transjugular intrahepatic portosystemic shunting versus paracentesis plus albumin for refractory ascites in cirrhosis[J].Gastroenterology, 2002, 123 (6) ∶18391847. [15]Salerno F, Camma C, Enea M, et al.Transjugular intrahepatic portosystemic shunt for refractory ascites:a meta-analysis of individual patient data[J].Gastroenterology, 2007, 133 (3) ∶825834. [16]Fernandez-Varo G, Ros J, Cejudo-Martin P, et al.Effect of the V1a/V2-AVP receptor antagonist, conivaptan, on renal water metabolism and systemic hemodynamics in rats with cirrhosis and ascites[J].J Hepatol, 2003, 38 (6) ∶755-761. [17]Wong F, Gine`s P, Watson HR, et al.Effects of a selective vasopressin V2receptor antagonist, satavaptan (SR121463B) , on recurrence of ascites after large volume paracentesis[J].Hepatology, 2006, 44 (2) ∶s270. [18]Kalambokis G, Fotopoulos A, Economou M, et al.Effects of a7day treatment with midodrine in non-azotemic cirrhotic patients with and without ascites[J].J Hepatol, 2007, 46 (2) ∶213-221. [19]Lenaerts A, Codden T, Meunier JC, et al.Effects of clonidine on diuretic response in ascitic patients with cirrhosis and activation of sympathetic nervous system[J].Hepatology, 2006, 44 (4) ∶844849.
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