联合超常规剂量NaCl治疗ACLF伴腹水和SBP临床研究:1例报道  

Clinical study on the combination of unconventional dose of NaCl in the treatment of ACLF with ascites and SBP:one case report

作　　者：刘建军[1] 王梦梦 何国堂 吕广波 LIU Jianjun;WANG Mengmeng;HE Guotang;LYU Guangbo(Department of Gastroenterology,the Second Hospital of Handan,Handan 056001,China)

机构地区：[1][HT6K]邯郸市第二医院消化内科,河北邯郸056001

出　　处：《胃肠病学和肝病学杂志》2025年第4期574-576,共3页Chinese Journal of Gastroenterology and Hepatology

摘　　要：本文报道1例重症酒精性肝炎(alcoholic hepatitis,AH)伴慢加急性肝衰竭(chronic acute liver failure,ACLF)、失代偿性腹水、自发性腹膜炎(spontaneous peritonitis,SBP)、低蛋白血症、电解质紊乱患者联合使用超常规剂量氯化钠(sodium chloride,NaCl)治疗转归。患者除应用人血白蛋白、血浆、糖皮质激素、抗生素、乳果糖、袢利尿剂和螺内酯等治疗外,嘱正常摄入钠盐(6~9 g/d)。另静脉补充平均浓度为2.69%(2.4%~3.5%)和0.9%的NaCl溶液310 mL/d和518.9 mL/d,住院37 d共分别补充11470 mL和19200 mL。收到了纠正低钠血症、增加尿量(2600~4200 mL/d),腹水消失,SBP全愈,改善肝功能与凝血功能,并避免了利尿剂抵抗(diuretic resistance,DR)和血管活性物质抵抗(vasoactive substance resistance,VSR)等,治疗效果显著。This article reported the outcomes of a patient with severe alcoholic hepatitis(AH)accompanied by chronic acute liver failure(ACLF),decompensated ascites,spontaneous peritonitis(SBP),hypoalbuminemia,and electrolyte imbalance treated with unconventional doses of sodium chloride(NaCl).In addition to treatment with human serum albumin,plasma,glucocorticoids,antibiotics,lactulose,loop diuretics,and spironolactone,patients were advised to consume sodium salts normally(6-9 g/d).In addition,intravenous supplementation with an average concentration of 2.69%(2.4%-3.5%)and 0.9%NaCl solution at doses of 310 mL/d and 518.9 mL/d was administered,with a total of 11470 mL and 19200 mL respectively after 37 days of hospitalization.Received significant effects such as correcting hyponatremia,increasing urine output(2600-4200 mL/d),disappearance of ascites,complete recovery of SBP,improvement of liver function and coagulation function,and avoidance of diuretic resistance(DR)and vasoactive substance resistance(VSR).

关 键 词：慢加急性肝衰竭 失代偿性腹水 自发性腹膜炎 氯化钠 补钠治疗 

分 类 号：R57[医药卫生—消化系统]