肝衰竭患者出血和侵入性操作期间凝血功能障碍的管理
Management of Coagulopathy during Bleeding and Invasive Procedures in Patients with Liver Failure.
作者信息
Drolz Andreas, Ferlitsch Arnulf, Fuhrmann Valentin
机构信息
Department of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Division of Gastroenterology and Hepatology, Department of Internal Medicine III, Medical University of Vienna, Vienna, Austria.
出版信息
Visc Med. 2018 Aug;34(4):254-258. doi: 10.1159/000491106. Epub 2018 Jul 16.
Abstract
Alterations in hemostasis are a characteristic feature of advanced liver disease. Patients with coagulopathy of advanced liver disease are prone to bleedings and also thromboembolic events. Under stable conditions, cirrhosis patients show alterations in both pro- and anticoagulatory pathways, frequently resulting in a rebalanced hemostasis. This review summarizes current recommendations of management during bleeding and prior to invasive procedures in patients with cirrhosis.
摘要
止血功能的改变是晚期肝病的一个特征性表现。晚期肝病合并凝血功能障碍的患者容易发生出血以及血栓栓塞事件。在病情稳定的情况下，肝硬化患者的促凝和抗凝途径均出现改变，常导致止血功能重新平衡。本文综述了肝硬化患者出血时及侵入性操作前的当前管理建议。
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本文引用的文献
1
[S2k Guideline Gastrointestinal Bleeding - Guideline of the German Society of Gastroenterology DGVS].[S2k 胃肠道出血指南 - 德国胃肠病学会（DGVS）指南]
Z Gastroenterol. 2017 Sep;55(9):883-936. doi: 10.1055/s-0043-116856. Epub 2017 Sep 12.
2
Declining mortality in critically ill patients with cirrhosis in Australia and New Zealand between 2000 and 2015.2000 年至 2015 年期间澳大利亚和新西兰肝硬化重症患者死亡率下降。
J Hepatol. 2017 Dec;67(6):1185-1193. doi: 10.1016/j.jhep.2017.07.024. Epub 2017 Aug 9.
3
Portal hypertensive bleeding in cirrhosis: Risk stratification, diagnosis, and management: 2016 practice guidance by the American Association for the study of liver diseases.肝硬化门静脉高压出血：风险分层、诊断及管理：美国肝病研究协会2016年实践指南
Hepatology. 2017 Jan;65(1):310-335. doi: 10.1002/hep.28906. Epub 2016 Dec 1.
4
Monitoring and Treatment of Coagulation Disorders in End-Stage Liver Disease.终末期肝病凝血障碍的监测与治疗
Visc Med. 2016 Aug;32(4):241-248. doi: 10.1159/000446304. Epub 2016 Aug 4.
5
Treatment of Patients with Cirrhosis.肝硬化患者的治疗
N Engl J Med. 2016 Aug 25;375(8):767-77. doi: 10.1056/NEJMra1504367.
6
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J Hepatol. 2015 Sep;63(3):743-52. doi: 10.1016/j.jhep.2015.05.022. Epub 2015 Jun 3.
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