急性静脉曲张出血管理的最新进展
Recent Advances in the Management of Acute Variceal Hemorrhage.
作者信息
Zanetto Alberto, Shalaby Sarah, Feltracco Paolo, Gambato Martina, Germani Giacomo, Russo Francesco Paolo, Burra Patrizia, Senzolo Marco
机构信息
Gastroenterology and Multivisceral Transplant Unit, Department of Surgery, Oncology, and Gastroenterology, Padova University Hospital, Via Giustiniani 2, 35128 Padova, Italy.
Anesthesiology and Intensive Care Unit, Department of Medicine, Padova University Hospital, 35128 Padova, Italy.
出版信息
J Clin Med. 2021 Aug 25;10(17):3818. doi: 10.3390/jcm10173818.
Abstract
Gastrointestinal bleeding is one of the most relevant causes of death in patients with cirrhosis and clinically significant portal hypertension, with gastroesophageal varices being the most frequent source of hemorrhage. Despite survival has improved thanks to the standardization on medical treatment aiming to decrease portal hypertension and prevent infections, mortality remains significant. In this review, our goal is to discuss the most recent advances in the management of variceal hemorrhage in cirrhosis with specific attention to the treatment algorithms involving the use of indirect measurement of portal pressure (HVPG) and transjugular intrahepatic portosystemic shunt (TIPS), which aim to further reduce mortality in high-risk patients after acute variceal hemorrhage and in the setting of secondary prophylaxis.
摘要
胃肠道出血是肝硬化和具有临床意义的门静脉高压患者最主要的死亡原因之一，食管胃静脉曲张是最常见的出血来源。尽管通过旨在降低门静脉高压和预防感染的标准化医疗治疗，生存率有所提高，但死亡率仍然很高。在本综述中，我们的目标是讨论肝硬化静脉曲张出血管理的最新进展，特别关注涉及使用门静脉压力间接测量（肝静脉压力梯度，HVPG）和经颈静脉肝内门体分流术（TIPS）的治疗算法，这些算法旨在进一步降低急性静脉曲张出血后高危患者以及二级预防情况下的死亡率。
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本文引用的文献
1
Portal Hypertension and Ascites: Patient-and Population-centered Clinical Practice Guidelines by the Italian Association for the Study of the Liver (AISF).门静脉高压和腹水：意大利肝病研究学会（AISF）制定的以患者和人群为中心的临床实践指南。
Dig Liver Dis. 2021 Sep;53(9):1089-1104. doi: 10.1016/j.dld.2021.06.021. Epub 2021 Jul 26.
2
Fresh frozen plasma in treating acute variceal bleeding: Not effective and likely harmful.
Liver Int. 2021 Aug;41(8):1710-1712. doi: 10.1111/liv.14988.
3
Coagulopathy is not predictive of bleeding in patients with acute decompensation of cirrhosis and acute-on-chronic liver failure.肝硬变急性失代偿和慢加急性肝衰竭患者的凝血障碍并不预示出血。
Liver Int. 2021 Oct;41(10):2455-2466. doi: 10.1111/liv.15001. Epub 2021 Jul 16.
4
Management of the major complications of cirrhosis: Beyond guidelines.肝硬化主要并发症的管理：超越指南。
J Hepatol. 2021 Jul;75 Suppl 1:S135-S146. doi: 10.1016/j.jhep.2021.01.027.
5
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Hepatology. 2021 Oct;74(4):2085-2101. doi: 10.1002/hep.31913. Epub 2021 Jul 19.
6
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Liver Int. 2021 Aug;41(8):1901-1908. doi: 10.1111/liv.14936. Epub 2021 May 24.
7
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J Hepatol. 2021 Jun;74(6):1362-1372. doi: 10.1016/j.jhep.2021.01.023. Epub 2021 Jan 26.
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Clin Gastroenterol Hepatol. 2021 Jun;19(6):1098-1107.e1. doi: 10.1016/j.cgh.2021.01.027. Epub 2021 Jan 22.
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