论文部分内容阅读
目的探讨在肝硬化腹水基础上发生肝肾综合征(HRS)患者的临床特点,指导临床对HRS进行有效的预防和治疗。方法回顾性分析2005年1月至2009年1月温州医学院附属第一医院消化内科收治的83例HRS患者及92例肝硬化腹水而未发生HRS患者(non-HRS)的临床资料,对两组患者的常见诱因、肝功能分级、交感神经张力、一般情况、病死率及预后等进行比较分析。结果(1)大量腹水及继发感染多见于HRS患者,而消化道出血则多见于non-HRS患者,在HRS患者中大量腹水多见于Ⅱ型HRS,而诱因不明者多见于Ⅰ型HRS。(2)Ⅰ型HRS患者肝功能最差,Ⅱ型居中,non-HRS最好。(3)HRS患者交感神经张力明显高于non-HRS患者。(4)一般情况比较中HRS患者血肌酐(Scr)明显高于non-HRS患者,而血钠(Na+)、24h尿量及平均动脉压均较后者低。(5)Ⅰ型HRS的病死率最高,Ⅱ型次之,non-HRS患者最低。HRS患者的存活时间明显低于non-HRS患者。结论(1)HRS常见诱因有大量腹水、感染、消化道出血、大量放腹水、水与电解质紊乱等,应尽量避免,一旦发现,应积极采取措施,及时治疗。(2)HRS患者交感神经张力明显高于非HRS患者,此可为临床诊治提供参考依据。(3)较之non-HRS患者,HRS患者的病情非常严重,病死率极高,预后极差,尤以Ⅰ型为甚。
Objective To investigate the clinical features of patients with hepatorenal syndrome (HSS) on the basis of cirrhosis and ascites to guide the effective prevention and treatment of HRS. Methods The clinical data of 83 patients with HRS admitted to Department of Gastroenterology, First Affiliated Hospital of Wenzhou Medical College from January 2005 to January 2009 and 92 patients with ascites without cirrhosis were retrospectively analyzed. Group of patients with common causes, classification of liver function, sympathetic tone, general conditions, mortality and prognosis for comparative analysis. Results (1) A large number of ascites and secondary infection were more common in patients with HRS, while gastrointestinal bleeding was more common in non-HRS patients. In patients with HRS, a large amount of ascites was more common in type II HRS, while those with unidentified causes were more common in type I HRS. (2) Type I HRS patients had the worst liver function, type II center, non-HRS best. (3) Sympathetic tone was significantly higher in HRS patients than in non-HRS patients. (4) In general, the serum creatinine (Scr) of HRS patients was significantly higher than that of non-HRS patients, while the blood sodium (Na +), 24h urine output and mean arterial pressure were lower than the latter. (5) Type I HRS had the highest case fatality rate, followed by type II and the lowest in non-HRS patients. HRS patients had significantly lower survival than non-HRS patients. Conclusions (1) The common causes of HRS are a large number of ascites, infection, gastrointestinal bleeding, a large number of ascites water, water and electrolyte disorders, should be avoided as far as possible, should be actively taken measures to timely treatment. (2) The sympathetic tone of patients with HRS is significantly higher than that of non-HRS patients, which may provide a reference for clinical diagnosis and treatment. (3) Compared with non-HRS patients, HRS patients are in very serious condition with extremely high case fatality rate and very poor prognosis, especially type I.