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腹水临床上并非鲜见,其病因和发病机制甚为复杂。对可疑腹水病人,可首先应用物理检查和超声,确定是否有腹水存在,然后籍助于常规实验室试验区别漏出液和渗出液。前者常为心衰、门脉高压、低蛋白血症的后果;后者系由炎症(细菌性、过敏性、化学性)和癌肿所致。自发性细菌性腹膜炎是一种死亡率很高的疾患,肝硬化腹水患者出现腹痛、腹部压痛、发热等时,应及时检查腹水白细胞并作细菌培养,以明确诊断;胰性腹水是一种由于胰液直接漏入腹腔所引致的腹腔内大量液体贮留状态。常为慢性良性胰疾患的后果。癌性腹水的诊断在于寻找原发病变,癌细胞检查有确定诊断意义,惜敏感性有待提高。测定腹水乳酸脱氢酶、纤维连接蛋白、胆固醇、癌胚抗原以及染色体核型分析有助于与炎症性腹水相鉴别。腹水的治疗依病因而异。对门脉高压所致的腹水,除限制钠水摄入外,正确使用利尿剂为治疗的关键。肝硬化“顽固性”腹水的治疗十分棘手,腹水浓缩回输为一较有效的方法。对此种腹水,一般认为应严格限制钠摄入量;但有学者在应用利尿剂的同时,参考患者血钠钾浓度,给患者口服或静脉输注足量钠盐或钾盐,谓能增强利尿效果。对此,有待进一步研究。本刊聘请国内有关专家对腹水的诊治撰写了专稿,以飨读者。
Ascites clinical is not uncommon, its etiology and pathogenesis is very complicated. Suspected patients with ascites, the first physical examination and ultrasound can be used to determine the presence of ascites, and then help by conventional laboratory tests to distinguish between leakage and exudate. The former often heart failure, portal hypertension, the consequences of hypoproteinemia; the latter by the inflammation (bacterial, allergic, chemical) and cancer caused. Spontaneous bacterial peritonitis is a high mortality disease, cirrhosis patients with abdominal pain, abdominal tenderness, fever, etc., should be promptly examined ascites white blood cells and bacterial culture to confirm the diagnosis; pancreatic ascites is a result of Pancreatic juice directly into the abdominal cavity caused by a large number of intra-abdominal fluid storage state. Often chronic benign pancreatic disease consequences. The diagnosis of cancerous ascites is to look for the primary lesion, the diagnosis of cancer cells has a definite diagnostic significance, but the sensitivity needs to be improved. Determination of ascites lactate dehydrogenase, fibronectin, cholesterol, carcinoembryonic antigen and karyotype analysis contribute to the identification of inflammatory ascites. The treatment of ascites varies depending on the cause. Ascites caused by portal hypertension, in addition to limiting sodium intake, the correct use of diuretics is the key to treatment. Cirrhosis of the “refractory” ascites treatment is very tricky, ascites concentration and reinfusion as a more effective method. Of such ascites, the general view that sodium intake should be strictly limited; but some scholars in the use of diuretics at the same time, refer to the patient’s serum sodium-potassium concentration, oral or intravenous infusion of adequate sodium or potassium salt, that can be enhanced Diuretic effect. In this regard, pending further study. This journal hired domestic experts on the diagnosis and treatment of ascites Zhuangao wrote to readers.