Pedersen Julie Steen, Bendtsen Flemming, Møller Søren
Centre of Functional Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, and Gastro Unit, Medical Division, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark.
Gastro Unit, Medical Division, Hvidovre Hospital, Faculty of Health Sciences, University of Copenhagen, Denmark.
Ther Adv Chronic Dis. 2015 May;6(3):124-37. doi: 10.1177/2040622315580069.
The most common complication to chronic liver failure is ascites. The formation of ascites in the cirrhotic patient is caused by a complex chain of pathophysiological events involving portal hypertension and progressive vascular dysfunction. Since ascites formation represents a hallmark in the natural history of chronic liver failure it predicts a poor outcome with a 50% mortality rate within 3 years. Patients with ascites are at high risk of developing complications such as spontaneous bacterial peritonitis, hyponatremia and progressive renal impairment. Adequate management of cirrhotic ascites and its complications betters quality of life and increases survival. This paper summarizes the pathophysiology behind cirrhotic ascites and the diagnostic approaches, as well as outlining the current treatment options. Despite improved medical treatment of ascites, liver transplantation remains the ultimate treatment and early referral of the patient to a highly specialized hepatology unit should always be considered.
慢性肝衰竭最常见的并发症是腹水。肝硬化患者腹水的形成是由一系列复杂的病理生理事件引起的，这些事件涉及门静脉高压和进行性血管功能障碍。由于腹水形成是慢性肝衰竭自然病程中的一个标志，它预示着预后不良，3年内死亡率达50%。腹水患者发生自发性细菌性腹膜炎、低钠血症和进行性肾功能损害等并发症的风险很高。对肝硬化腹水及其并发症进行充分管理可改善生活质量并提高生存率。本文总结了肝硬化腹水背后的病理生理学、诊断方法，并概述了当前的治疗选择。尽管腹水的药物治疗有所改善，但肝移植仍然是最终的治疗方法，应始终考虑尽早将患者转诊至高专业化的肝病科。
