Drolz Andreas
I. Medizinische Klinik und Poliklinik, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
Med Klin Intensivmed Notfmed. 2024 Sep;119(6):458-464. doi: 10.1007/s00063-024-01167-3. Epub 2024 Aug 13.
Bleeding events are feared complications in patients with advanced liver diseases and are associated with morbidity and mortality. In this context, gastrointestinal bleeding, particularly upper gastrointestinal bleeding, has a special clinical importance. In addition to endoscopic measures for hemostasis, reducing portal pressure in particular is a key component of treatment. Although the standard coagulation parameters are often altered in patients with liver diseases, optimizing coagulation plays a secondary role. Typically, a bundle of measures are employed in patients with portal hypertensive bleeding, which nowadays in most cases can halt the bleeding and stabilize the situation. The measures include endoscopy, antibiotic treatment, vasopressor treatment and, if necessary, shunt placement (transjugular intrahepatic portosystemic shunt).
出血事件是晚期肝病患者令人担忧的并发症，与发病率和死亡率相关。在这种情况下，胃肠道出血，尤其是上消化道出血，具有特殊的临床重要性。除了内镜止血措施外，特别是降低门静脉压力是治疗的关键组成部分。尽管肝病患者的标准凝血参数常常改变，但优化凝血起次要作用。通常，门静脉高压出血患者采用一系列措施，如今在大多数情况下这些措施可以止血并稳定病情。这些措施包括内镜检查、抗生素治疗、血管升压药治疗，必要时还包括分流术（经颈静脉肝内门体分流术）。
