Caly Wanda Regina, Abreu Rodrigo Martins, Bitelman Bernardo, Carrilho Flair José, Ono Suzane Kioko
Departamento de Gastroenterologia, Divisão de Gastroenterologia e Hepatologia Clinica, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, SP, BR.
Clinics (Sao Paulo). 2017 Jul;72(7):405-410. doi: 10.6061/clinics/2017(07)03.
: To present the clinical features and outcomes of outpatients who suffer from refractory ascites.
: This prospective observational study consecutively enrolled patients with cirrhotic ascites who submitted to a clinical evaluation, a sodium restriction diet, biochemical blood tests, 24 hour urine tests and an ascitic fluid analysis. All patients received a multidisciplinary evaluation and diuretic treatment. Patients who did not respond to the diuretic treatment were controlled by therapeutic serial paracentesis, and a transjugular intrahepatic portosystemic shunt was indicated for patients who required therapeutic serial paracentesis up to twice a month.
: The most common etiology of cirrhosis in both groups was alcoholism [49 refractory (R) and 11 non-refractory ascites (NR)]. The majority of patients in the refractory group had Child-Pugh class B cirrhosis (p=0.034). The nutritional assessment showed protein-energy malnutrition in 81.6% of the patients in the R group and 35.5% of the patients in the NR group, while hepatic encephalopathy, hernia, spontaneous bacterial peritonitis, upper digestive hemorrhage and type 2 hepatorenal syndrome were present in 51%, 44.9%, 38.8%, 38.8% and 26.5% of the patients in the R group and 9.1%, 18.2%, 0%, 0% and 0% of the patients in the NR group, respectively (p=0.016, p=0.173, p=0.012, p=0.012, and p=0.100, respectively). Mortality occurred in 28.6% of the patients in the R group and in 9.1% of the patients in the NR group (p=0.262).
: Patients with refractory ascites were malnourished, suffered from hernias, had a high prevalence of complications and had a high postoperative death frequency, which was mostly due to infectious processes.
呈现难治性腹水门诊患者的临床特征及预后。
这项前瞻性观察性研究连续纳入肝硬化腹水患者，这些患者接受了临床评估、限钠饮食、血液生化检查、24小时尿液检查及腹水分析。所有患者均接受多学科评估及利尿剂治疗。对利尿剂治疗无反应的患者采用系列治疗性腹腔穿刺术进行控制，对于每月需要进行多达两次系列治疗性腹腔穿刺术的患者，则行颈静脉肝内门体分流术。
两组中肝硬化最常见的病因均为酒精中毒[49例难治性（R）腹水和11例非难治性腹水（NR）]。难治性组中的大多数患者为Child-Pugh B级肝硬化（p = 0.034）。营养评估显示，R组81.6%的患者及NR组35.5%的患者存在蛋白质-能量营养不良，而R组51%、44.9%、38.8%、38.8%和26.5%的患者以及NR组9.1%、18.2%、0%、0%和0%的患者分别出现肝性脑病、疝气、自发性细菌性腹膜炎、上消化道出血和2型肝肾综合征（p分别为0.016、0.173、0.012、0.012和0.100）。R组28.6%的患者及NR组9.1%的患者死亡（p = 0.262）。
难治性腹水患者营养不良，患有疝气，并发症发生率高，术后死亡频率高，这主要归因于感染性疾病。
