University of Rochester Medical Center, Department of Anesthesiology, Rochester, New York, USA.
Curr Opin Anaesthesiol. 2010 Apr;23(2):133-8. doi: 10.1097/ACO.0b013e328335f024.
Liver cirrhosis and portal hypertension present with three unique pulmonary complications that are the subject of ongoing clinical research: hepatopulmonary syndrome, portopulmonary hypertension (POPH), and hepatic hydrothorax. The present article is based on a review of the current literature on how to manage these disorders, which are highly important to both anesthesiologists and intensive care physicians.
Hepatopulmonary syndrome leads to progressive hypoxemia through diffuse vasodilatation of the pulmonary microcirculation. Liver transplantation, although associated with increased mortality, is the only viable treatment. POPH occurs when vascular remodeling triggers an increase in pulmonary artery pressure and resistance. The role of liver transplantation in POPH is controversial given the excessive mortality in patients with moderate to severe POPH. Medical treatment is able to decrease pulmonary artery pressures, though multicenter randomized controlled trials showing improved outcome are lacking to date. Ultrasound plays an increasingly important role in the diagnosis of all three conditions.
Patients with end-stage liver disease are at risk for respiratory failure and hypoxemia and need to be screened for hepatopulmonary syndrome, POPH, and hepatic hydrothorax. Failure to timely recognize and adequately treat these complications of cirrhosis may have severe consequences.
肝硬化和门静脉高压症表现出三种独特的肺部并发症，这些并发症是正在进行的临床研究的主题：肝肺综合征、门脉高压性肺高血压（POPH）和肝性胸水。本文基于对这些疾病管理的当前文献的回顾，这些疾病对麻醉师和重症监护医师都非常重要。
肝肺综合征通过肺微循环的弥漫性血管扩张导致进行性低氧血症。肝移植虽然与死亡率增加有关，但却是唯一可行的治疗方法。POPH 发生在血管重构触发肺动脉压力和阻力增加时。鉴于中度至重度 POPH 患者的死亡率过高，肝移植在 POPH 中的作用存在争议。尽管目前缺乏显示改善结果的多中心随机对照试验，但药物治疗能够降低肺动脉压。超声在这三种疾病的诊断中发挥着越来越重要的作用。
终末期肝病患者有发生呼吸衰竭和低氧血症的风险，需要筛查肝肺综合征、POPH 和肝性胸水。未能及时认识和充分治疗这些肝硬化并发症可能会产生严重后果。
