肝肾综合征治疗进展

The development of treatment of hepatorenal syndrome

肝肾综合征(HRS)是严重肝病常见并发症,病死率高。发病机制尚不十分明确,临床表现主要为功能性肾衰竭,对其正确诊断非常重要。治疗主要是针对循环动力学改变及肾灌注不足等环节,选择具有较强的全身血管收缩作用,而对肾动脉无影响的血管活性药,加上血管扩张剂,以逆转高动力循环状态,并借助血液净化系统改善肾功能;针对门静脉高压环节给予经颈静脉肝内门-体分流(TIPS)治疗;最佳治疗是肝移植。HRS应采取积极预防措施。

Hepatorenal syndrome（HRS） is a common complication of serious liver disease with a very high mortality.Its pathogenesis is not very clear.The main clinical symptom is the functional renal failure,which is crucial for the correct diagnosis of this kind of disease.The treatment is mainly aimed at the changes in circulation and the insufficiency of renal blood capacity.We can choose the vasoactive drugs which have strong action on the systemic vaso-contraction but with a minimal effect on renal blood flow.In addition,in order to correct the states of hyperdynamic-circulation,it should be used in combination with the plasma expansion.And blood purification system can be used to improve the renal function.Transjugular intrahepatic portosystemic shunt（TIPS） should be used to reduce portal hypertension,and the best treatment for HRS is to implement liver transplantation.Strenuous efforts should be made to prevent the occurrence of HRS.