肝硬化腹水的处理

Management of Cirrhotic Ascites

腹水的形成是肝硬化进入失代偿期的重要标志之一,往往提示预后不良,易导致多种其他并发症,如低钠血症、肝肾综合征、自发性细菌性腹膜炎(SBP)等。目前已就限盐、利尿、穿刺放腹水、补充白蛋白、抗感染等方面的治疗达成共识。近年来肝硬化腹水治疗在很多方面取得了新的进展,如利水剂和收缩血管活性药物的应用、利福昔明用于预防SBP、腹腔α-引流泵、干细胞移植等,但仍有众多问题亟待研究解决。本文结合国内外指南和最新研究证据,重点讨论肝硬化腹水的处理以及相关争议问题。

Ascites formation represents a hallmark of decompensation of liver cirrhosis and predicts a poor prognosis.Patients with cirrhotic ascites are at high risk of some complications,such as hyponatremia,hepatorenal syndrome and spontaneous bacterial peritonitis(SBP).Currently,there are consensuses on treatment with sodium intake restriction,diuresis,paracentesis,albumin supplement,anti-infection and etc.In recent years,some advancements have been achieved,such as aquaretics,vasoactive drugs,prevention of SBP with rifaximin,alfapump,stem cell transplantation and etc.,and yet there are still many issues deserved to be researched.This article focused on the management of cirrhotic ascites and related controversies with reference to current international and local guidelines and latest evidences.