肝硬化腹水的治疗进展及药学监护  

Focus on Pharmaceutical Care and Progress in Management of Patients with Liver Cirrhosis and Ascites

作　　者：刘金永[1,2] 卞晓洁[1] 葛卫红[1] 周长江[1] 

机构地区：[1]南京大学医学院附属鼓楼医院,南京210008 [2]中国药科大学临床药学教研室,南京210009

出　　处：《药学与临床研究》2015年第4期370-375,共6页Pharmaceutical and Clinical Research

摘　　要：腹水是肝硬化最常见的并发症之一,其出现往往提示预后不良。腹水的一线治疗包括限钠饮食和规范使用利尿剂,如口服螺内酯和呋塞米。难治性腹水患者需要系列的大量穿刺放腹水(LVP)或经颈静脉肝内门-体分流术(TIPS)治疗,并评估是否适合肝移植。尽管大量穿刺放腹水、使用白蛋白预防循环功能障碍仍有争议,但临床以大量穿刺放腹水(>5 L)并输注白蛋白预防循环功能障碍多见。治疗腹水新方法包括使用血管加压素V2受体拮抗剂和血管收缩剂,有可能改善腹水的治疗。临床药师可协同临床医师优化治疗方案,实施药学监护,以促进临床合理用药。Ascites is one of the most common complications of liver cirrhosis associated with a poor prognosis. The first line treatment of ascites requires dietary sodium restriction and the judicious use of diuretics, such as spironolactone and furosemide. Patients with refractory ascites require second-line treatments of repeat large-volume paracentesis(LVP) or the insertion of a transjugular intrahepatic portosystemic shunt(TIPS), and assessment for liver transplantation. The use of albumin as a volume expander is recommended for LVP of >5 L to prevent the development of circulatory dysfunction, although the clinical significance of post-paracentesis circulatory dysfunction is still debated. Potential new treatment options for ascites include the use of vasopressin V2 receptor antagonists and vasoconstrictors, which could possibly improve the management of ascites. Clinical pharmacists can optimize treatment plans with doctors and implement pharmaceutical care for patients to promote rational use of drugs.

关 键 词：肝硬化 腹水 治疗 药学监护 

分 类 号：R575[医药卫生—消化系统]