肝硬化合并脓毒症的临床应对策略

Management of sepsis in liver cirrhosis

肝硬化患者由于免疫力低下很容易发生细菌感染、脓毒症和脓毒症所致器官功能衰竭。脓毒症是细菌感染触发机体免疫产生的过度炎症、凝血及削弱的纤溶反应的一种临床过程，通常按病情进展可分为三个阶段：脓毒症、严重脓毒症和脓毒性休克。脓毒症已成为肝硬化住院患者最主要的死亡原因，应引起临床医生的重视。此文对肝硬化患者细菌感染的流行病学、临床特征、诊断治疗、相关并发症的处理以及预防策略作了综述。

Patients with cirrhosis are prone to develop bacterial infections, sepsis and sepsis-induced organ failure. Infection induces a systemic host respo^lse with three stages of severity called sepsis, severe sepsis（when an acute organ failure occurs）, and septic shock（when hypotension does not respond to adequate fluid resuscitation）. Because of the wefl-defined, effective prophylactic treatment for variceal bleeding, sepsis has become a major cause of death in patients with advanced cirrhosis. In this ＇article, the prevalenee, the clinical features and management of the common infections in cirrhosis and nmnagement of these complications are reviewed.