第3章：肝肾综合征治疗进展.doc

肝肾综合征治疗进展 : 2008-11-17 16:26 ?? [摘要]? 肝肾综合征(HRS) 是严重肝病常见并发症，病死率极高。其发病机制尚不十分明确，最近有学者提出“二次打击”学说：肝功能障碍、肝窦性门静脉高压导致内脏血管扩张是肝肾综合征的基础，即“第一次打击”，各种导致有效动脉内血容量降低或肾血管收缩的因素能够促使肝肾综合征的发生，即“第二次打击”。临床表现为功能性肾衰竭，对其正确诊断以及鉴别诊断非常重要。治疗主要是针对循环动力学改变及肾灌注不足等环节，选择具有较强的全身血管收缩作用，而对肾动脉无影响的血管活性药，加上血管扩张剂，以逆转高动力循环状态，抑制RAAS和交感神经系统的兴奋，改善肾功能；针对门静脉高压环节给予经颈静脉肝内门-体分流(TIPS) 治疗；最佳治疗是肝移植。HRS 应采取积极预防措施。[关键词]? 肝肾综合征；肾小球滤过率；血管收缩药；肝移植 [Abstract]?? Hepatorenal sundrome(HRS) is a common complication of serious liver disease with a very high mortality.Its pathogenesis is? not? very? clear. Recently, some? scholar? put? forward? the? theory? oftwice? attack. The vasodilation of visceral? blood? vessels? caused? by? failure? of? hepatic? function? and? portal hypertension is the basis? of HRS. It is the first attack, Factors causing decrease of? effective? arteries? blood capacity or contraction of renal blood vessels? bring? out? HRS. That is the second attack. Clinical? symptom? is? the? fuctional? renal? failure, correct diagnosis and distinguishing diagnosis are very important. Treatment is mainly aimed at the changes of circulation and the insufficient of renal blood capacity. We can choose vasocontractive? drugs,that? are? highly? selective? to? systemic? vaso-contraction? with? a? minimal? effect? on? renal? blood? flow ,should? be? used? incombination? with? the? plasma? expansion,in order to correct the hyperdynamic cir-culation, to inhibit the stimulation of? RAAS? and? the? sympathetic? nerve ,and? to improve? the? renal? function;Transjugular? intrahepatic? portosystemic? shunt(TIPS)? should? be? used? to? reduce? portal? hypertension ;and? Liver? transplantation should? be? the? best? treatment? for? HRS.Prevention? of? HRS is the? best? way? for? progressing? to? HRS.[Key Words]?? Hepatorenal? syndrome;?? Gomerular? filtration? rate; Vasocontrictor? agents;? Liver? transplantation 肝肾综合征(HRS)是严重肝病患者，在无肾脏原发病变的情况下，发生的进行性、功能性肾衰竭。常见于肝硬化晚期、重型肝炎等慢性肝病终末期。临床以少尿或无尿、肌酐清除率降低及稀释性低血钠等为主要表现。HRS在肝硬化腹腔积液住院病人中的发生率为10%左