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首页> 外文期刊>Seminars in Gastrointestinal Disease >The critically ill liver patient: the variceal bleeder.
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The critically ill liver patient: the variceal bleeder.

机译：重症肝病患者：静脉曲张出血。

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摘要

Esophageal varices develop in patients with cirrhosis once portal pressure, measured by hepatic venous pressure gradient, and exceeds 10 mm Hg. At a portal pressure of 12 mm Hg, variceal bleeding may develop that is associated with a mortality of 30% to 50% per episode. In addition to an elevated portal pressure, other risk factors for the development of variceal hemorrhage include: variceal size, endoscopic features on the variceal wall (i.e., red wales), and Child-Pugh class. In patients with suspected variceal hemorrhage, the treatment of the acute episode includes intravascular volume expansion, hemostasis through the use of pharmacological agents and endoscopy, and the prevention and treatment of potential complications associated with variceal hemorrhage such as aspiration pneumonia, spontaneous bacterial peritonitis and hepatic encephalopathy. Given a high rate of rebleeding, long-term prevention through secondary prophylaxis should be instituted in all patients who have survived an episode of variceal bleeding. Current prophylactic options include: non-selective beta-blockers alone (first line) or in combination with long-acting nitrates (isosorbide mononitrate) and/or endoscopic variceal obliteration achieved through sclerotherapy or preferably, band ligation.
机译：肝硬化患者一旦通过肝静脉压力梯度测得的门静脉压力超过10 mm Hg，就会出现食管静脉曲张。在12 mm Hg的门脉压力下，可能会发生静脉曲张破裂出血，每次发作的死亡率为30％至50％。除门静脉压力升高外，发生静脉曲张破裂出血的其他危险因素包括：静脉曲张大小，静脉曲张壁上的内窥镜特征（即红色威尔士）和Child-Pugh分级。对于疑似静脉曲张破裂出血的患者，急性发作的治疗包括血管内容量扩大，通过使用药理学和内窥镜检查止血，以及预防和治疗与静脉曲张破裂出血相关的潜在并发症，如吸入性肺炎，自发性细菌性腹膜炎和肝炎脑病。鉴于再出血的发生率高，应对所有因静脉曲张破裂出血而幸存的患者采取长期预防措施，以通过二级预防来进行。当前的预防选择包括：单独使用非选择性β受体阻滞剂（第一线），或与长效硝酸盐（单硝酸异山梨酯）组合使用非选择性β受体阻滞剂和/或通过硬化疗法或优选通过结扎术实现内镜静脉曲张闭塞术。

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