Habeeb K S, Herrera J L
University of Vermont College of Medicine, Burlington, USA.
Postgrad Med. 1997 Jan;101(1):191-2, 195-200. doi: 10.3810/pgm.1997.01.149.
All patients with new-onset ascites or with known ascites and any change in their condition, such as the appearance of fever, abdominal pain, renal insufficiency, or encephalopathy, should undergo diagnostic paracentesis to characterize the ascitic fluid, detect infection, and aid differential diagnosis. A serum-ascites albumin gradient greater than 1.1 g/dL indicates portal hypertension. Spontaneous bacterial peritonitis is a common and serious complication of ascites and is best diagnosed by the number of neutrophils in the ascitic fluid. Patients with the condition should be treated with parenteral antibiotics, and response to therapy should be assessed with repeated paracentesis. Hospitalized patients with low-protein ascites should receive antibiotic prophylaxis. Sodium restriction and diuretics are the cornerstones of therapy for ascites. In refractory cases, alternative forms of therapy, such as large-volume paracentesis, peritoneovenous shunting, or transjugular intrahepatic portosystemic shunting, may be of benefit. Patients with refractory ascites should be considered for liver transplantation.
所有新发腹水患者或已知腹水且病情有任何变化（如出现发热、腹痛、肾功能不全或脑病）的患者，均应接受诊断性腹腔穿刺术，以明确腹水特征、检测感染并辅助鉴别诊断。血清-腹水白蛋白梯度大于1.1 g/dL提示门静脉高压。自发性细菌性腹膜炎是腹水常见且严重的并发症，最好通过腹水中性粒细胞计数来诊断。患有该疾病的患者应接受肠外抗生素治疗，并通过重复腹腔穿刺术评估治疗反应。住院的低蛋白腹水患者应接受抗生素预防。限钠和利尿剂是腹水治疗的基石。在难治性病例中，其他治疗方式，如大量腹腔穿刺放液、腹腔静脉分流术或经颈静脉肝内门体分流术，可能有益。难治性腹水患者应考虑肝移植。
