Herrera Jorge L
Division of Gastroenterology, University of South Alabama College of Medicine, Gastroenterology Academic Offices, 6000 University Commons, 75 University Boulevard S., Mobile, AL 36688-0002, USA.
Clin Liver Dis. 2014 May;18(2):347-57. doi: 10.1016/j.cld.2014.01.001. Epub 2014 Feb 25.
Acute variceal bleeding (AVB) is the most common cause of upper gastrointestinal hemorrhage in patients with cirrhosis. Advances in the management of AVB have resulted in decreased mortality. To minimize mortality, a multidisciplinary approach addressing airway safety, prompt judicious volume resuscitation, vasoactive and antimicrobial pharmacotherapy, and early endoscopy to obliterate varices is necessary. Placement of a transjugular intrahepatic portosystemic shunt (TIPS) has been used as rescue therapy for patients failing initial attempts at hemostasis. Patients who have a high likelihood of failing initial attempts at hemostasis may benefit from a more aggressive approach using TIPS earlier in their management.
急性静脉曲张出血（AVB）是肝硬化患者上消化道出血最常见的原因。AVB管理方面的进展已使死亡率降低。为使死亡率降至最低，采用多学科方法处理气道安全、迅速合理的容量复苏、血管活性和抗菌药物治疗以及早期内镜下消除静脉曲张是必要的。经颈静脉肝内门体分流术（TIPS）已被用作初次止血尝试失败患者的挽救治疗。初次止血尝试很可能失败的患者可能会从在治疗早期采用更积极的TIPS方法中获益。
