Solà Elsa, Solé Cristina, Ginès Pere
Liver Unit, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Instituto Reina Sofía de Investigación Nefrológica (IRSIN).
Liver Int. 2016 Jan;36 Suppl 1:109-15. doi: 10.1111/liv.13015.
Ascites is the most frequent complication of patients with cirrhosis. Ascites is related to increased renal sodium retention as a result of increased activity of the renin-angiotensin-aldosterone system in response to marked vasodilation of the splanchnic circulation. Management of uncomplicated ascites is based on a low-sodium diet and diuretics. However, approximately 10% of patients develop refractory ascites during follow-up, which is associated with a poor prognosis. The treatment of choice in patients with refractory ascites is large-volume paracentesis associated with intravenous albumin. Moreover, patients who develop refractory ascites should be considered as candidates for liver transplantation. Patients with ascites are all at risk of developing spontaneous bacterial peritonitis (SBP). SBP is a common infection in patients with cirrhosis with a risk of mortality of 20%. Empirical antibiotics are the treatment of choice in patients with SBP but differ depending on the acquisition site of infection, because nosocomial infections have a higher risk of being caused by multiresistant bacteria. In addition to antibiotic treatment, all patients with SBP should also receive intravenous albumin. This review summarizes the management of uninfected ascites and SBP in cirrhosis.
腹水是肝硬化患者最常见的并发症。由于肾素 - 血管紧张素 - 醛固酮系统活性增加以应对内脏循环的明显血管舒张，腹水与肾钠潴留增加有关。单纯性腹水的管理基于低钠饮食和利尿剂。然而，约10%的患者在随访期间会出现顽固性腹水，这与预后不良相关。顽固性腹水患者的首选治疗方法是大量腹腔穿刺放液并静脉输注白蛋白。此外，出现顽固性腹水的患者应被视为肝移植的候选者。腹水患者均有发生自发性细菌性腹膜炎（SBP）的风险。SBP是肝硬化患者常见的感染，死亡率为20%。经验性抗生素治疗是SBP患者的首选治疗方法，但因感染获得部位而异，因为医院感染由多重耐药菌引起的风险更高。除抗生素治疗外，所有SBP患者还应接受静脉输注白蛋白。本综述总结了肝硬化未感染性腹水和SBP的管理。
