Samonakis D N, Triantos C K, Thalheimer U, Patch D W, Burroughs A K
Liver Transplant and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Postgrad Med J. 2004 Nov;80(949):634-41. doi: 10.1136/pgmj.2004.020446.
Treatment of portal hypertension is evolving based on randomised controlled trials. In acute variceal bleeding, prophylactic antibiotics are mandatory, reducing mortality as well as preventing infections. Terlipressin or somatostatin combined with endoscopic ligation or sclerotherapy is the best strategy for control of bleeding but there is no added effect of vasoactive drugs on mortality. Non-selective beta-blockers are the first choice therapy for both secondary and primary prevention; if contraindications or intolerance to beta-blockers are present then band ligation should be used. Novel therapies target the increased intrahepatic resistance caused by microcirculatory intrahepatic deficiency of nitric oxide and contraction of activated intrahepatic stellate cells.
基于随机对照试验，门静脉高压的治疗正在不断发展。在急性静脉曲张出血时，预防性使用抗生素是必需的，可降低死亡率并预防感染。特利加压素或生长抑素联合内镜套扎术或硬化疗法是控制出血的最佳策略，但血管活性药物对死亡率并无额外影响。非选择性β受体阻滞剂是二级和一级预防的首选治疗方法；如果存在β受体阻滞剂的禁忌症或不耐受情况，则应采用套扎术。新疗法针对的是由于肝内微循环一氧化氮缺乏和活化的肝内星状细胞收缩导致的肝内阻力增加。
