文档介绍：肝硬化腹水的治疗 【 The Guidelines of 2006 】
06级全科住院医师韩静
流行病学调查 No1. About cirrhosis
4% general population abnormal liver function or liver disease
(non-alcoholic fatty liver disease, alcoholic liver disease, and chronic hepatitis)
10–20% develop cirrhosis over a period of 10–20 years
%~%
发病高峰年龄 35~48岁
男女比例 ~8:1
流行病学调查 No2. About ascites
The majority (75%) of patients with ascites have underlying cirrhosis,the remainder being due to malignancy(10%), heart failure (3%), tuberculosis(2%), Pancreatitis(1%), and other rare causes
50% of cirrhosis patients over 10 years of follow up
50% mortality over two years-the need to consider liver transplantation as a therapeutic
机制:门脉高压、低蛋白血症、淋巴液生成过多,、继醛、抗利尿激素等
诊断:病史,查体,X线,B超,CT。
关于腹水的检查:蛋白定量、中性粒细胞计数、腹水培养、SAAG;淀粉酶;细胞学
血清腹水白蛋白浓度梯度(SAAG)
Serum ascites-albumin gradient(SA-AG)
SA-AG >11 g/l
SA-AG <11 g/l
Cirrhosis
Cardiac failure
Nephrotic syndrome
Malignancy
Pancreatitis
Tuberculosis
The initial ascitic fluid analysis should include serum ascites-albumin gradient in preference to ascitic protein.
(Level of evidence: 2b; mendation: B.)
Ascitic amylase should be measured when there is clinical suspicion of pancreatic disease. (Level of evidence: 4; mendation: C.)
Ascitic fluid should be inoculated into blood culture bottles at the bedside and examined by microscopy for a neutrophil count.
(Level of evidence: 2a; mendation:B.)
肝硬化腹水的治疗
1. Bed rest 卧床休息
2. Dietary salt restriction 限盐
3. Role of water restriction 限水
4. Management of hyponatraemia
治疗低钠血症
5. Therapeutic paracentesis治疗性穿刺
6. TIPS 经颈静脉肝内门体分流术
7. SBP 自发性细菌性腹膜炎