Kuiper J J, van Buuren H R, de Man R A
Department of Gastroenterology and Hepatology, Erasmus MC University Medical Centre, Rotterdam, the Netherlands.
Neth J Med. 2007 Sep;65(8):283-8.
Ascites is the most common manifestation in cirrhotic patients, and is associated with a reduced survival rate. Management of ascites is primarily focused on sodium restriction and diuretic treatment to which most patients respond appropriately. For the small group of patients who do not respond sufficiently, interventions such as large volume paracentesis and transjugular intrahepatic portosystemic shunt placement should be considered. Most important in the management of cirrhotic patients with ascites is prevention of complications. Spontaneous bacterial peritonitis and hepatorenal syndrome are severe complications with a poor prognosis when not detected and treated in an early stage. In all hospitalised patients with ascites, an infection of the ascitic fluid should be ruled out. For those patients at risk of developing spontaneous bacterial peritonitis, in particular patients after a first episode and patients with gastrointestinal bleeding, antibiotic prophylaxis should be given. To prevent the hepatorenal syndrome, substitution with albumin is essential, both in patients who experience an episode of spontaneous bacterial peritonitis and in patients treated with large volume paracentesis. For those patients unresponsive to standard treatment regimens, liver transplantation may be the only suitable treatment option.
腹水是肝硬化患者最常见的表现，且与生存率降低相关。腹水的管理主要集中在限钠和利尿剂治疗上，大多数患者对此反应良好。对于少数反应不佳的患者，应考虑采取如大量腹腔穿刺放液和经颈静脉肝内门体分流术等干预措施。肝硬化腹水患者管理中最重要的是预防并发症。自发性细菌性腹膜炎和肝肾综合征是严重并发症，如未早期发现和治疗，预后较差。在所有住院的腹水患者中，应排除腹水感染。对于有发生自发性细菌性腹膜炎风险的患者，尤其是首次发作后的患者和有胃肠道出血的患者，应给予抗生素预防。为预防肝肾综合征，无论是发生自发性细菌性腹膜炎的患者还是接受大量腹腔穿刺放液治疗的患者，补充白蛋白都是必不可少的。对于那些对标准治疗方案无反应的患者，肝移植可能是唯一合适的治疗选择。
