肝肾综合征治疗进展_谢永鹏.pdfVIP

558 J Clini Hepatol, May 2011, Vol.27, No.5 肝肾综合征治疗进展 谢永鹏，侯 玥，臧秀贤，初 喆 (吉林大学第一医院急诊科，长春 130021) 摘要：肝肾综合征(HRS)是严重肝病常见并发症，病死率高。发病机制尚不十分明确，临床表现主要为功能性肾衰竭，对其 正确诊断非常重要。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，并借助血液净化系统改善肾功能；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 （ ） R575 A 1001-5256 2011 05-0558-04 中图分类号： 文献标识码： 文章编号： The development of treatment of hepatorenal syndrome XIE Yong-peng, HOU Yue, ZANG Xiu-xian, et al. (Department of Emergency, the First Hospital of Jilin University, Changchun 13002 1, China) Abstract: Hepatorenal syndrome (HRS) is a common complication of serious liver disease with a very high mortality. Its pathogenesis is not very clear. The main clinical symptom is the functional renal failure, which is crucial for the correct diagnosis of this kind of disease. The treatment is mainly aimed at the changes in circulation and the insuffi ciency of renal blood capacity. We can choose the vasoactive drugs which have strong action on the systemic vaso-contraction but with a minimal effect on renal blood fl ow. In addition, in order to correct the states of hyperdynamic-circulation, it should be used in combination with the plasma expansion. And blood purifi cation system can be used to improve the renal function. Transjugular intrahepatic portosystemic shunt (TIPS) should be used to reduce portal hypertension, and the best treatment for HRS is to implement liver transplantation. Strenuous efforts should be made to prevent the occurrence of HRS. Key words: hepatorenal syndrome 肝肾综合征(HRS)是慢性肝病患者出现进展性肝衰 (下降至 133mmol L)；白蛋白推荐剂量是1g·kg-1·d-1，最