{"id":35155,"date":"2024-05-28T00:01:03","date_gmt":"2024-05-28T00:01:03","guid":{"rendered":"https:\/\/zydq.1006ss.com\/?p=35155"},"modified":"2024-05-28T00:01:03","modified_gmt":"2024-05-28T00:01:03","slug":"%e6%8c%87%e5%8d%97%e4%b8%8e%e5%85%b1%e8%af%86-%e8%82%9d%e7%a1%ac%e5%8c%96%e8%85%b9%e6%b0%b4%e8%af%8a%e7%96%97%e6%8c%87%e5%8d%97%ef%bc%882023%e5%b9%b4%e7%89%88%ef%bc%89","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=35155","title":{"rendered":"\u6307\u5357\u4e0e\u5171\u8bc6 | \u809d\u786c\u5316\u8179\u6c34\u8bca\u7597\u6307\u5357\uff082023\u5e74\u7248\uff09"},"content":{"rendered":"<\/p>\n

\u5f15\u7528\u672c\u6587<\/p>\n

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\uff5c\u6458  \u8981\uff5c<\/p>\n

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\u4efb\u4f55\u75c5\u7406\u72b6\u6001\u4e0b\u5bfc\u81f4\u8179\u8154\u5185\u6db2\u4f53\u91cf\u589e\u52a0\u8d85\u8fc7 200 ml \u65f6\uff0c\u79f0\u4e3a\u8179\u6c34\u3002\u8179\u6c34\u662f\u591a\u79cd\u75be\u75c5\u7684\u8868\u73b0\uff0c\u6839\u636e\u5f15\u8d77\u8179\u6c34\u7684\u539f\u56e0\u53ef\u5206\u4e3a\u809d\u6e90\u6027\u3001\u764c\u6027\u3001\u5fc3\u6e90\u6027\u3001\u8840\u7ba1\u6e90\u6027\uff08\u9759\u8109\u963b\u585e\u6216\u72ed\u7a84\uff09\u3001\u80be\u6e90\u6027\u3001\u8425\u517b\u4e0d\u826f\u6027\u548c\u7ed3\u6838\u6027\u7b49 [4] \u3002\u672c\u6307\u5357\u4e3b\u8981\u4ecb\u7ecd\u809d\u6e90\u6027\u8179\u6c34\u4e2d\u7531\u809d\u786c\u5316\u5f15\u8d77\u7684\u8179\u6c34\u3002<\/p>\n

\uff5c\u4e8c\u3001\u809d\u786c\u5316\u8179\u6c34\uff5c<\/p>\n

\uff08\u4e00\uff09\u53d1\u75c5\u673a\u5236<\/p>\n

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1. \u8179\u6c34\u7684\u8bca\u65ad<\/p>\n

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2. \u8179\u6c34\u7684\u8bc4\u4f30<\/p>\n

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\uff081\uff09\u8179\u6c34\u7684\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u548c\u5206\u6790 \uff1a\u8179\u6c34\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u5185\u5bb9\u89c1\u8868 2\u3002<\/p>\n

\u8179\u6c34\u5916\u89c2\u53ef\u65e0\u8272\u900f\u660e\u3001\u6d51\u6d4a\u3001\u8113\u6027\u3001\u8840\u6027\u3001\u4e73\u7cdc\u6837\u7b49\u3002\u8179\u6c34\u5b9e\u9a8c\u5ba4\u5e38\u89c4\u68c0\u67e5\u5305\u62ec\u7ec6\u80de\u8ba1\u6570\u3001\u5206\u7c7b\u3001\u767d\u86cb\u767d\u3001\u603b\u86cb\u767d\u5b9a\u91cf\u7b49\u3002\u8179\u6c34\u7ec6\u80de\u8ba1\u6570\u53ca\u5206\u7c7b\u662f\u8179\u6c34\u68c0\u6d4b\u7684\u9996\u8981\u6307\u6807\u3002<\/p>\n

\u8179\u6c34\u7ec6\u83cc\u57f9\u517b\u9633\u6027\u7387\u8f83\u4f4e\uff0c\u4e00\u822c\u5728 20% \uff5e 40%\u3002\u4e3a\u4e86\u63d0\u9ad8\u9633\u6027\u7387\uff0c\u5e94\u4ee5\u8840\u57f9\u517b\u74f6\u5728\u5e8a\u65c1\u53d6\u5f97\u8179\u6c34\u7acb\u5373\u6ce8\u5165 10 \uff5e 20 ml \u884c\u8179\u6c34\u9700\u6c27\u83cc\u3001\u538c\u6c27\u83cc\u6216\u771f\u83cc\u57f9\u517b\uff0c\u5e94\u5728\u4f7f\u7528\u6297\u83cc\u836f\u7269\u4e4b\u524d\u7559\u53d6\u6807\u672c\uff0c\u7acb\u523b\u9001\u68c0\uff0c\u4e25\u683c\u65e0\u83cc\u64cd\u4f5c\uff0c\u4ee5\u514d\u6c61\u67d3\u3002\u4e0d\u53ef\u5148\u6c89\u6dc0\u8179\u6c34\uff0c\u4ee5\u6c89\u6dc0\u7269\u57f9\u517b\uff0c\u8fd9\u4f1a\u589e\u52a0\u591a\u5f62\u6838\u767d\u7ec6\u80de\uff08polymorphonuclear leukocyte\uff0cPMN\uff09\u541e\u566c\u7ec6\u83cc\u7684\u673a\u4f1a\uff0c\u53cd\u800c\u4e0d\u6613\u5f97\u5230\u9633\u6027\u7ed3\u679c\u3002<\/p>\n

\uff082\uff09\u8179\u6c34\u7684\u75c5\u56e0 \uff1a\u809d\u786c\u5316\u662f\u5f15\u8d77\u8179\u6c34\u7684\u6700\u4e3b\u8981\u539f\u56e0\uff0c\u5176\u4ed6\u809d\u5916\u75be\u75c5\u7ea6\u5360 15%\uff0c\u5305\u62ec\u6076\u6027\u80bf\u7624\u3001\u7ed3\u6838\u6027\u8179\u819c\u708e\u3001\u6162\u6027\u5fc3\u529b\u8870\u7aed\u6216\u80be\u75c5\u7efc\u5408\u5f81\u7b49[4] \u3002\u90e8\u5206\u8179\u6c34\u60a3\u8005\u6709 2 \u4e2a\u6216\u4ee5\u4e0a\u7684\u75c5\u56e0\u3002\u809d\u786c\u5316\u5f15\u8d77\u7684\u8179\u6c34\u5e38\u901a\u8fc7\u8179\u6c34\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u5224\u65ad\u6f0f\u51fa\u6db2\u6216\u6e17\u51fa\u6db2\uff0c\u4ee5\u53ca\u8840\u6e05 – \u8179\u6c34\u767d\u86cb\u767d\u68af\u5ea6\uff08serum – ascites albumin gradient\uff0cSAAG\uff09\u5224\u65ad\u662f\u95e8\u9759\u8109\u9ad8\u538b\u6027\u6216\u975e\u95e8\u9759\u8109\u9ad8\u538b\u6027\u8179\u6c34\u3002<\/p>\n

SAAG \u5373\u8840\u6e05\u767d\u86cb\u767d\u4e0e\u540c\u65e5\u5185\u6d4b\u5f97\u7684\u8179\u6c34\u767d\u86cb\u767d\u4e4b\u95f4\u7684\u5dee\u503c\uff08SAAG = \u8840\u6e05\u767d\u86cb\u767d – \u8179\u6c34\u767d\u86cb\u767d\uff09\u3002\u8179\u6c34\u4e2d\u7684\u767d\u86cb\u767d\u542b\u91cf\u53ef\u4f53\u73b0\u8179\u6c34\u7684\u6e17\u900f\u538b\uff0c\u5176\u4e0e\u8840\u6e05\u767d\u86cb\u767d\u542b\u91cf\u4e4b\u5dee\u53ef\u95f4\u63a5\u53cd\u6620\u8840\u6e05\u4e0e\u8179\u6c34\u7684\u6e17\u900f\u538b\u5dee[9] \u3002<\/p>\n

SAAG \u4e0e\u95e8\u9759\u8109\u538b\u529b\u5448\u6b63\u76f8\u5173\uff0cSAAG \u8d8a\u9ad8\uff0c\u95e8\u9759\u8109\u538b\u5c31\u8d8a\u9ad8[10] \u3002SAAG \u2265 11 g\/L \u7684\u8179\u6c34\u4e3a\u95e8\u9759\u8109\u9ad8\u538b\u6027\uff0c\u5e38\u89c1\u4e8e\u5404\u79cd\u539f\u56e0\u5bfc\u81f4\u7684\u95e8\u9759\u8109\u9ad8\u538b\u6027\u8179\u6c34[11] \u3002SAAG < 11 g\/L \u7684\u8179\u6c34\u591a\u4e3a\u975e\u95e8\u9759\u8109\u9ad8\u538b\u6027\uff0c\u4e3b\u8981\u5305\u62ec\u8179\u8154\u6076\u6027\u80bf\u7624\u3001\u7ed3\u6838\u6027\u8179\u819c\u708e\u3001\u80f0\u6e90\u6027\u8179\u6c34\u53ca SBP \u7b49\uff08\u8868 3\uff09 [12] \u3002<\/p>\n

3. \u8179\u6c34\u7684\u5206\u7ea7\u4e0e\u5206\u578b<\/p>\n

\u4e34\u5e8a\u4e0a\u6839\u636e\u8179\u6c34\u7684\u91cf\u53ef\u5206\u4e3a 1 \u7ea7\uff08\u5c11\u91cf\uff09\uff0c2 \u7ea7\uff08\u4e2d\u91cf\uff09\uff0c3 \u7ea7\uff08\u5927\u91cf\uff09\u30021 \u7ea7\u6216\u5c11\u91cf\u8179\u6c34 \uff1a\u53ea\u6709\u901a\u8fc7\u8d85\u58f0\u68c0\u67e5\u624d\u80fd\u53d1\u73b0\u7684\u8179\u6c34\uff0c\u60a3\u8005\u4e00\u822c\u65e0\u8179\u80c0\u7684\u8868\u73b0\uff0c\u79fb\u52a8\u6027\u6d4a\u97f3\u9634\u6027 \uff1b\u8d85\u58f0\u8179\u6c34\u6df1\u5ea6 < 3 cm\u30022 \u7ea7\u6216\u4e2d\u91cf\u8179\u6c34 \uff1a\u60a3\u8005\u5e38\u6709\u4e2d\u5ea6\u8179\u80c0\u548c\u5bf9\u79f0\u6027\u8179\u90e8\u9686\u8d77\uff0c\u79fb\u52a8\u6027\u6d4a\u97f3\u9634\/\u9633\u6027\uff1b\u8d85\u58f0\u8179\u6c34\u6df1\u5ea63\uff5e10 cm\u30023 \u7ea7\u6216\u5927\u91cf\u8179\u6c34 \uff1a\u60a3\u8005\u8179\u80c0\u660e\u663e\uff0c\u79fb\u52a8\u6027\u6d4a\u97f3\u9633\u6027\uff0c\u53ef\u6709\u8179\u90e8\u81a8\u9686\u751a\u81f3\u8110\u759d\u5f62\u6210 \uff1b\u8d85\u58f0\u8179\u6c34\u6df1\u5ea6 > 10 cm\u3002<\/p>\n

\u809d\u786c\u5316\u8179\u6c34\u5206\u4e3a\uff1a\u666e\u901a\u578b\/\u6027\u3001\u987d\u56fa\u578b\/\u6027\uff08\u96be\u6cbb\u578b\/\u6027\uff09\u548c\u590d\u53d1\u578b \/ \u6027\u8179\u6c34\u3002<\/p>\n

2021 \u5e74\u7f8e\u56fd\u809d\u75c5\u5b66\u4f1a\uff08AASLD\uff09\u63a8\u8350\u7684\u987d\u56fa\u578b\u8179\u6c34\u8bca\u65ad\u6807\u51c6[13]\uff1a\u2460\u9650\u76d0\uff084 \uff5e 6 g\/d\uff09\u53ca\u5229\u5c3f\u836f\u7269\uff08\u87ba\u5185\u916f 400 mg\/d\u3001\u544b\u585e\u7c73 160 mg\/d\uff09\u6cbb\u7597\u81f3\u5c11 1 \u5468\u6216\u6cbb\u7597\u6027\u653e\u8179\u6c34\uff08\u6bcf\u6b21 > 5 000 ml\uff09\uff0c\u8179\u6c34\u65e0\u6cbb\u7597\u5e94\u7b54\u53cd\u5e94\uff084 d \u5185\u4f53\u8d28\u91cf\u5e73\u5747\u4e0b\u964d < 0.8 kg\/d\uff0c\u5c3f\u94a0\u6392\u6cc4\u5c11\u4e8e 50 mEq\/d \uff1b\u6216\u5df2\u7ecf\u63a7\u5236\u7684\u8179\u6c34 4 \u5468\u5185\u590d\u53d1\uff0c\u8179\u6c34\u589e\u52a0\u81f3\u5c11 1 \u7ea7\uff09\u3002\u2461\u51fa\u73b0\u96be\u63a7\u5236\u7684\u5229\u5c3f\u836f\u7269\u76f8\u5173\u5e76\u53d1\u75c7\u6216\u4e0d\u826f\u53cd\u5e94 \uff1a\u5982\u6025\u6162\u6027\u80be\u635f\u4f24\u3001\u96be\u63a7\u5236\u7684\u7535\u89e3\u8d28\u7d0a\u4e71\u3001\u7537\u6027\u4e73\u623f\u80bf\u5927\u80c0\u75db\u7b49\u3002<\/p>\n

\u6211\u56fd\u987d\u56fa\u578b\u8179\u6c34\u7684\u8bca\u65ad\u6807\u51c6[3]\uff1a\u2460\u5229\u5c3f\u836f\u7269\uff08\u87ba\u5185\u916f160 mg\/d\u3001\u544b\u585e\u7c73 80 mg\/d\uff09\u6cbb\u7597 > 1 \u5468\u6216\u6cbb\u7597\u6027\u95f4\u65ad\u653e\u8179\u6c34\uff084 000 \uff5e 5 000 ml\/ \u6b21\uff09\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\uff0820 \uff5e 40 g\u00b7\u6b21-1<\/sup> \u00b7d -1<\/sup> \uff09\u6cbb\u7597 2 \u5468\uff0c\u8179\u6c34\u65e0\u6cbb\u7597\u5e94\u7b54\u53cd\u5e94 \uff1b\u2461\u51fa\u73b0\u96be\u4ee5\u63a7\u5236\u7684\u5229\u5c3f\u836f\u7269\u76f8\u5173\u5e76\u53d1\u75c7\u6216\u4e0d\u826f\u53cd\u5e94 \uff1b\u2462\u6392\u9664\u6076\u6027\u8179\u6c34\u53ca\u7aa6\u524d\u6027\u95e8\u9759\u8109\u9ad8\u538b\u75c7\u5f15\u8d77\u7684\u8179\u6c34\u3002<\/p>\n

\u590d\u53d1\u578b\u8179\u6c34[13]\uff1a\u5728\u9650\u76d0\u53ca\u5e94\u7528\u5229\u5c3f\u836f\u7269\u7684\u60c5\u51b5\u4e0b\uff0c1 \u5e74\u5185\u8179\u6c34\u590d\u53d1\u2265 3 \u6b21\u3002<\/p>\n

4. \u809d\u786c\u5316\u8179\u6c34\u7684\u7279\u6b8a\u7c7b\u578b<\/p>\n

\uff081\uff09\u4e73\u7cdc\u6027\u8179\u6c34 \uff1a\u5916\u89c2\u5448\u4e73\u767d\u8272\u6216\u8179\u6c34\u7518\u6cb9\u4e09\u916f\u8d85\u8fc7200 mg\/dl\uff0811.11 mmol\/L\uff09\u652f\u6301\u8bca\u65ad\uff0c\u5c0f\u4e8e 50 mg\/dl \u5219\u53ef\u6392\u9664\u8bca\u65ad\u3002\u5e94\u6392\u9664\u6076\u6027\u80bf\u7624\u3001\u8179\u90e8\u624b\u672f\u3001\u786c\u5316\u6cbb\u7597\u76f8\u5173\u7684\u80f8\u5bfc\u7ba1\u635f\u4f24\u3001\u611f\u67d3\uff08\u7279\u522b\u662f\u7ed3\u6838\u3001\u4e1d\u866b\u75c5\uff09\u548c\u5148\u5929\u5f02\u5e38\u7b49\u56e0\u7d20\u6240\u81f4\u7684\u4e73\u7cdc\u6027\u8179\u6c34[14 – 17] \u3002<\/p>\n

\uff082\uff09\u8840\u6027\u8179\u6c34 \uff1a\u5916\u89c2\u4e3a\u8840\u6027\u6216\u8179\u6c34\u7ea2\u7ec6\u80de\u8ba1\u6570 > 10 000\/mm 3<\/sup>[18] \u3002\u809d\u786c\u5316\u60a3\u8005\u51fa\u73b0\u8840\u6027\u8179\u6c34\uff0c\u9996\u5148\u5e94\u6392\u9664\u80bf\u7624\u3002\u5176\u4ed6\u539f\u56e0\u5982\u5408\u5e76\u4e25\u91cd\u611f\u67d3\uff08\u5305\u62ec\u7ed3\u6838\u6027\u8179\u819c\u708e\uff09\u3001\u51dd\u8840\u529f\u80fd\u969c\u788d\u3001\u8179\u819c\u9759\u8109\u66f2\u5f20\u7834\u88c2\u65f6\u4ea6\u53ef\u6709\u8840\u6027\u8179\u6c34\uff0c\u5916\u89c2\u4ece\u6d17\u8089\u6c34\u6837\u5230\u9759\u8109\u8840\u6837\u3002<\/p>\n

\uff083\uff09\u80f8\u6c34 \uff1a\u9700\u6392\u9664\u7ed3\u6838\u7b49\u5176\u4ed6\u539f\u56e0\u3002\u809d\u786c\u5316\u60a3\u8005\u5408\u5e76\u80f8\u8154\u79ef\u6db2\u591a\u89c1\u4e8e\u53f3\u4fa7\uff0c\u56e0\u5438\u6c14\u5f15\u8d77\u80f8\u8154\u8d1f\u538b\uff0c\u8179\u6c34\u901a\u8fc7\u8188\u808c\u7f3a\u635f\u8fdb\u5165\u80f8\u8154\u3002\u4e25\u91cd\u8005\u53ef\u6709\u53cc\u4fa7\u80f8\u8154\u79ef\u6db2\uff0c\u5c11\u6570\u60a3\u8005\u5355\u72ec\u5408\u5e76\u5de6\u4fa7\u80f8\u8154\u79ef\u6db2\uff0c\u80f8\u90e8\u8d85\u58f0\u6216 X \u7ebf\u53ef\u786e\u8bca\u3002\u80f8\u6c34\u5408\u5e76\u81ea\u53d1\u6027\u7ec6\u83cc\u611f\u67d3\uff0c\u9884\u540e\u4e0d\u4f73\uff0c\u4e2d\u4f4d\u751f\u5b58\u671f\u4e3a 8 \uff5e 12 \u4e2a\u6708[19 – 20] \uff0c\u8bca\u65ad\u6027\u80f8\u8154\u7a7f\u523a\u53ef\u660e\u786e\u80f8\u6c34\u6027\u8d28\u548c\u75c5\u539f\uff0c\u6307\u5bfc\u6297\u83cc\u836f\u7269\u5e94\u7528\u3002\u5e94\u6ce8\u610f\u4e0d\u4f34\u6709\u8179\u6c34\u5355\u72ec\u80f8\u6c34\u7684\u5931\u4ee3\u507f\u671f\u809d\u786c\u5316\u3002<\/p>\n

\uff08\u4e09\uff09\u8179\u6c34\u7684\u6cbb\u7597<\/p>\n

\u6839\u636e\u8179\u6c34\u91cf\u3001\u662f\u5426\u6709\u76f8\u5173\u5e76\u53d1\u75c7\u53ca\u4f34\u968f\u75be\u75c5\uff0c\u786e\u5b9a\u60a3\u8005\u662f\u5426\u9700\u8981\u4f4f\u9662\u6cbb\u7597\uff08\u56fe 1\uff09\u30021 \u7ea7\u8179\u6c34 \uff1a\u591a\u6570\u60a3\u8005\u65e0\u75c7\u72b6\uff0c\u809d\u810f\u50a8\u5907\u529f\u80fd\u591a\u4e3a Child – Pugh A \u7ea7\uff0c\u5bf9\u5229\u5c3f\u836f\u7269\u6cbb\u7597\u654f\u611f\uff0c\u53ef\u95e8\u8bca\u6cbb\u7597\uff0c\u5e76\u7763\u4fc3\u60a3\u8005\u5b9a\u671f\u968f\u8bbf\u30022 \u7ea7\u8179\u6c34 \uff1a\u5927\u591a\u6570\u60a3\u8005\u6709\u75c7\u72b6\uff0c\u9700\u8981\u4f4f\u9662\u6cbb\u7597\u30023 \u7ea7\u8179\u6c34 \uff1a\u6709\u660e\u663e\u75c7\u72b6\uff0c\u5e38\u4f34\u8179\u6c34\u76f8\u5173\u5e76\u53d1\u75c7\uff0c\u8868\u73b0\u4e3a\u987d\u56fa\u6027\u8179\u6c34\u6216\u590d\u53d1\u6027\u8179\u6c34\uff0c\u5fc5\u987b\u4f4f\u9662\u6cbb\u7597\u3002<\/p>\n

1. \u809d\u786c\u5316\u8179\u6c34\u6cbb\u7597\u7684\u539f\u5219<\/p>\n

\uff081\uff09\u6cbb\u7597\u76ee\u6807 \uff1a\u8179\u6c34\u6d88\u9664\u6216\u57fa\u672c\u63a7\u5236\uff0c\u6539\u5584\u4e34\u5e8a\u75c7\u72b6\u548c\u751f\u6d3b\u8d28\u91cf\uff0c\u5ef6\u957f\u751f\u5b58\u65f6\u95f4\u3002<\/p>\n

\uff082\uff09\u4e00\u7ebf\u6cbb\u7597\uff1a\u2460\u75c5\u56e0\u6cbb\u7597\uff1b\u2461\u5408\u7406\u9650\u76d0\uff08\u6444\u5165\u91cf 4 \uff5e 6g\/d\uff09\u53ca\u5e94\u7528\u4f20\u7edf\u5229\u5c3f\u836f\u7269\uff08\u87ba\u5185\u916f\u548c \/ \u6216\u544b\u585e\u7c73\uff09\uff1b\u2462\u907f\u514d\u5e94\u7528\u80be\u6bd2\u6027\u836f\u7269\u3002<\/p>\n

\uff083\uff09\u4e8c\u7ebf\u6cbb\u7597 \uff1a\u2460\u5408\u7406\u5e94\u7528\u7f29\u8840\u7ba1\u6d3b\u6027\u7b49\u836f\u7269\uff0c\u5982\u7279\u5229\u52a0\u538b\u7d20\u3001\u76d0\u9178\u7c73\u591a\u541b\u53ca\u6258\u4f10\u666e\u5766 \uff1b\u2461\u8179\u8154\u7a7f\u523a\u5927\u91cf\u653e\u8179\u6c34\u53ca\u4eba\u8840\u767d\u86cb\u767d\uff1b\u2462\u7ecf\u9888\u9759\u8109\u809d\u5185\u95e8\u4f53\u9759\u8109\u5206\u6d41\u672f\uff08transjugular intrahepatic potorsystemic shunt\uff0cTIPS\uff09\u3002<\/p>\n

\uff084\uff09\u4e09\u7ebf\u6cbb\u7597 \uff1a\u2460\u809d\u79fb\u690d \uff1b\u2461\u59d1\u606f\u6027\u6cbb\u7597 \uff1a\u8179\u6c34\u5f15\u6d41\u6cf5\u6216\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u7b49\u3002<\/p>\n

2. \u5229\u5c3f\u836f\u7269<\/p>\n

\u5229\u5c3f\u836f\u7269\u662f\u6cbb\u7597\u809d\u786c\u5316\u8179\u6c34\u7684\u4e3b\u8981\u65b9\u6cd5\uff0c\u6839\u636e\u5229\u5c3f\u836f\u7269\u7684\u4f5c\u7528\u673a\u5236\u5206\u4e3a\u919b\u56fa\u916e\u62ee\u6297\u5242\uff08\u87ba\u5185\u916f\uff09\u3001\u6291\u5236\u9ad3\u88a2\u94a0 – \u94be\u6cf5\uff08\u544b\u585e\u7c73\uff09\u53ca\u9009\u62e9\u6027\u8840\u7ba1\u52a0\u538b\u7d20V2\u53d7\u4f53\u62ee\u6297\u5242\uff08\u6258\u4f10\u666e\u5766\uff09\u3002\u5229\u5c3f\u836f\u7269\u53ca\u5176\u5242\u91cf\u7684\u9009\u62e9\u9700\u8981\u8003\u8651\u8179\u6c34\u91cf\u3001\u4f34\u968f\u75be\u75c5\u6216\u5e76\u53d1\u75c7\uff0c\u6700\u5e38\u7528\u65b9\u6848\u662f\u87ba\u5185\u916f\u8054\u5408\u544b\u585e\u7c73\u3002<\/p>\n

\uff081\uff09\u4f20\u7edf\u5229\u5c3f\u836f\u7269\u7684\u5e94\u7528 \uff1a\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u87ba\u5185\u916f\u3001\u544b\u585e\u7c73\u7684\u5e94\u7528\u5242\u91cf\u53ca\u7597\u7a0b\u5747\u7f3a\u4e4f\u968f\u673a\u5bf9\u7167\u7814\u7a76[21] \uff0c\u5e94\u7528\u7684\u8d77\u59cb\u5242\u91cf\u4ecd\u4ee5\u7ecf\u9a8c\u4e3a\u4e3b\u3002<\/p>\n

1 \u7ea7\u8179\u6c34\u6216\u521d\u53d1\u8179\u6c34\u53ef\u5355\u72ec\u7ed9\u4e88\u87ba\u5185\u916f\uff0c\u63a8\u8350\u8d77\u59cb\u5242\u91cf40 mg\/d\uff0c1 \uff5e 2 \u6b21 \/d \u53e3\u670d\uff0c\u82e5\u7597\u6548\u4e0d\u4f73\u65f6\uff0c3 \uff5e 5 d \u9012\u589e40 mg \u6216\u8054\u5408\u544b\u585e\u7c73\u3002\u87ba\u5185\u916f\u5e38\u89c4\u5242\u91cf\u4e0a\u9650\u4e3a 100 mg\/d\uff0c\u53ef\u6700\u5927\u5242\u91cf400 mg\/d\u3002\u544b\u585e\u7c73\u63a8\u8350\u8d77\u59cb\u5242\u91cf20\uff5e40 mg\/d\uff0c3 \uff5e 5 d \u9012\u589e 20 \uff5e 40 mg\uff0c\u544b\u585e\u7c73\u5e38\u89c4\u5242\u91cf\u4e0a\u9650\u4e3a 80 mg\/d\uff0c\u53ef\u6700\u5927\u5242\u91cf 160 mg\/d\u3002<\/p>\n

2\/3 \u7ea7\u8179\u6c34\u6216\u590d\u53d1\u6027\u8179\u6c34\u8d77\u59cb\u87ba\u5185\u916f\u8054\u5408\u544b\u585e\u7c73\u7597\u6548\u660e\u663e\u4f18\u4e8e\u87ba\u5185\u916f\u5242\u91cf\u9012\u589e\u6216\u5e8f\u8d2f\u8054\u5408\u544b\u585e\u7c73\uff0c\u4e14\u4f4e\u94be\u8840\u75c7\u53d1\u751f\u7387\u663e\u8457\u964d\u4f4e[22] \u3002\u521d\u59cb\u5242\u91cf\u87ba\u5185\u916f 40 \uff5e 80 mg\/d\uff0c\u544b\u585e\u7c73 40 mg\/d\uff0c3 \uff5e 5 d \u53ef\u9012\u589e\u87ba\u5185\u916f\u4e0e\u544b\u585e\u7c73\u7684\u5242\u91cf\uff0c\u81f3\u8fbe\u5e38\u89c4\u5242\u91cf\u4e0a\u9650\u3002<\/p>\n

\uff082\uff09\u6258\u4f10\u666e\u5766 \uff1a\u5bf9\u4e8e 1 \u7ea7\u8179\u6c34\u60a3\u8005\u4e0d\u63a8\u8350\u6258\u4f10\u666e\u5766\uff0c\u5bf9\u4e8e 2\/3 \u7ea7\u8179\u6c34\u3001\u590d\u53d1\u6027\u8179\u6c34\u60a3\u8005\uff0c\u5f53\u4f20\u7edf\u5229\u5c3f\u836f\u7269\u6cbb\u7597\u5e94\u7b54\u5dee\u8005\uff0c\u53ef\u5e94\u7528\u6258\u4f10\u666e\u5766[23] \u3002\u7814\u7a76\u53d1\u73b0\uff0c\u6258\u4f10\u666e\u5766\u8054\u5408\u4f20\u7edf\u5229\u5c3f\u836f\u7269\uff0c\u53ef\u4ee5\u51cf\u5c11\u544b\u585e\u7c73\u5242\u91cf\uff0c\u6539\u5584\u80be\u529f\u80fd\u6216\u907f\u514d\u5927\u5242\u91cf\u544b\u585e\u7c73\u7b49\u6240\u81f4\u7684\u6025\u6027\u80be\u635f\u4f24\uff08acute kidney injury\uff0cAKI\uff09\u548c\u7535\u89e3\u8d28\u7d0a\u4e71[24] \uff1b\u5bf9\u987d\u56fa\u6027\u6216\u590d\u53d1\u6027\u8179\u6c34\u7279\u522b\u662f\u4f34\u4f4e\u94a0\u8840\u75c7\u6709\u8f83\u597d\u7684\u6548\u679c\u53ca\u5b89\u5168\u6027[25] \u3002\u6258\u4f10\u666e\u5766\u8d77\u59cb\u5242\u91cf7.5\uff5e15 mg\/d\uff0c\u5efa\u8bae\u5c0f\u5242\u91cf\u5f00\u59cb\uff0c\u6839\u636e\u8840\u94a0\u6d53\u5ea6\u4e0e\u5c3f\u91cf\u8c03\u6574\u5242\u91cf \uff1b\u6700\u5927\u5242\u91cf60 mg\/d\uff0c\u6700\u4f4e\u5242\u91cf 3.75 mg\/d\uff0c\u4e00\u822c\u8fde\u7eed\u5e94\u7528\u4e0d\u8d85\u8fc7 30 d\u3002<\/p>\n

\u5229\u5c3f\u836f\u7269\u7684\u4e0d\u826f\u53cd\u5e94\u5927\u591a\u51fa\u73b0\u5728\u6cbb\u7597 1 \u5468\u5185\uff0c\u56e0\u6b64\u7528\u836f3 d \u5185\u76d1\u6d4b\u80be\u529f\u80fd\u4e0e\u7535\u89e3\u8d28\u3002\u968f\u673a\u68c0\u6d4b\u5c3f\u94a0 \/ \u94be\u6bd4\u503c\uff0c\u53ef\u8bc4\u4f30\u5229\u5c3f\u836f\u7269\u7684\u6cbb\u7597\u5e94\u7b54[26] \uff0c\u5982\u679c\u5c3f\u94a0 \/ \u94be\u6bd4\u503c > 1 \u6216\u5c3f\u94a0\u6392\u6cc4 > 50 mEq\/d\uff0c\u63d0\u793a\u5229\u5c3f\u836f\u7269\u6cbb\u7597\u6709\u5e94\u7b54\u53cd\u5e94\u3002<\/p>\n

3. \u6536\u7f29\u8840\u7ba1\u6d3b\u6027\u836f\u7269<\/p>\n

\u5185\u810f\u8840\u7ba1\u6269\u5f20\u662f\u8179\u6c34\u5f62\u6210\u53ca\u809d\u786c\u5316\u9ad8\u52a8\u529b\u5faa\u73af\u7684\u5173\u952e\u56e0\u7d20\uff0c\u662f\u7f29\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u6cbb\u7597\u809d\u786c\u5316\u8179\u6c34\u7684\u7406\u8bba\u57fa\u7840\u3002<\/p>\n

\uff081\uff09\u7279\u5229\u52a0\u538b\u7d20\uff1a\u5bf9\u4e8e\u4f34\u6216\u4e0d\u4f34 AKI \u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\uff0c\u7279\u5229\u52a0\u538b\u7d20\u5747\u6709\u4e00\u5b9a\u7684\u7597\u6548[27 – 28] \u3002\u5927\u91cf\u8179\u8154\u653e\u6db2\u540e\uff0c\u7279\u5229\u52a0\u538b\u7d20\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\u53ef\u4ee5\u6709\u6548\u9884\u9632\u5927\u91cf\u653e\u8179\u6c34\u540e\u5faa\u73af\u529f\u80fd\u969c\u788d\uff08post – paracentesis induced circulatory dysfunction\uff0cPICD\uff09\u3001AKI \u4e0e HRS [29] \u3002\u5bf9\u987d\u56fa\u6027\u6216\u590d\u53d1\u6027\u8179\u6c34\u60a3\u8005\uff0c\u7279\u5229\u52a0\u538b\u7d20\u4e5f\u6709\u8f83\u597d\u7684\u6548\u679c\u53ca\u5b89\u5168\u6027 [30] \u3002\u7279\u5229\u52a0\u538b\u7d20\u95f4\u6b47\u6027\u6301\u7eed\u9759\u8109\u6ef4\u6ce8\u7ed9\u836f\uff0c\u521d\u59cb\u5242\u91cf\u4e3a\u6bcf 12 h 1 \uff5e 2 mg\uff0c\u5982\u679c48 \uff5e 72 h \u5c3f\u91cf\u65e0\u660e\u663e\u589e\u52a0\u6216\u8840\u808c\u9150\uff08serum creatinine\uff0cScr\uff09\u4e0b\u964d\u4e0d\u5230 30%\uff0c\u5219\u589e\u52a0\u81f3\u6bcf 6 h 2 mg\uff0c\u6216\u8054\u5408\u5e94\u7528\u53bb\u7532\u80be\u4e0a\u817a\u7d20\uff080.5 \uff5e 3 mg\/h\uff09\u6301\u7eed\u9759\u8109\u6ef4\u6ce8\u3002\u5982\u679c\u60a3\u8005\u8179\u6c34\u5b8c\u5168\u7f13\u89e3\u53ef\u505c\u836f\uff0c\u4e00\u822c\u5e94\u7528 5 \uff5e 7 d\u3002<\/p>\n

\uff082\uff09\u76d0\u9178\u7c73\u591a\u541b \uff1a\u53ef\u589e\u52a0\u809d\u786c\u5316\u987d\u56fa\u6027\u8179\u6c34\u60a3\u8005 24 h \u5c3f\u91cf\u548c\u94a0\u6392\u6cc4\uff0c\u5bf9\u975e\u6c2e\u8d28\u8840\u75c7\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u6709\u8f83\u597d\u7684\u7597\u6548[31 – 32] \u3002<\/p>\n

\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u6cbb\u7597\u5e94\u7b54\u6307\u6807[33]\uff1a\u2460\u5b8c\u5168\u5e94\u7b54 \uff1a72 h \u5185Scr \u964d\u4f4e\u81f3\u57fa\u7ebf\u503c\u6216\u4ee5\u4e0b\u6216\u8f83\u7528\u836f\u524d\u4e0b\u964d > 50%\u3002\u2461\u90e8\u5206\u5e94\u7b54 \uff1a72 h \u5185 AKI \u5206\u671f\u4e0b\u964d\u53ca Scr \u8f83\u7528\u836f\u524d\u4e0b\u964d > 25%\u3002\u2462\u65e0\u5e94\u7b54 \uff1aScr \u5347\u9ad8\u6216\u65e0\u660e\u663e\u4e0b\u964d\u3002<\/p>\n

4. \u8425\u517b\u652f\u6301\u6cbb\u7597\u4e0e\u9650\u76d0<\/p>\n

\u809d\u786c\u5316\u60a3\u8005\u5e94\u91cd\u89c6\u8425\u517b\u4e0d\u826f\u7684\u7b5b\u67e5\u4e0e\u8bca\u65ad\uff0c\u65e9\u671f\u7ea0\u6b63\u8425\u517b\u4e0d\u826f\uff0c\u8425\u517b\u6210\u4efd\u7684\u6444\u5165\u53ef\u53c2\u8003\u76f8\u5173\u6307\u5357[34 – 35] \u3002\u63a8\u8350\u5c11\u98df\u591a\u9910\u3001\u7761\u524d\u52a0\u9910\u4ee5\u53ca\u652f\u94fe\u6c28\u57fa\u9178\u7684\u8865\u5145\u3002<\/p>\n

\uff081\uff09\u5408\u7406\u9650\u76d0 \uff1a\u9002\u5f53\u9650\u76d0\u6709\u5229\u4e8e\u6d88\u9000\u8179\u6c34\uff0c\u51cf\u5c11\u8179\u6c34\u590d\u53d1\u3002\u4f46\u957f\u671f\u9650\u76d0\u4f1a\u5bfc\u81f4\u60a3\u8005\u98df\u6b32\u4e0b\u964d\u53ca\u4f4e\u94a0\u8840\u75c7\uff0c\u52a0\u91cd\u8425\u517b\u4e0d\u826f\u3002<\/p>\n

\uff082\uff09\u4f4e\u94a0\u8840\u75c7 \uff1a\u7edd\u5927\u591a\u6570\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u4e0d\u5fc5\u8981\u9650\u6c34\uff0c\u4f46\u5982\u679c\u8840\u94a0 < 125 mmol\/L \u65f6\u5e94\u8be5\u9002\u5f53\u5730\u9650\u5236\u6c34\u6444\u5165\u3002\u5982\u6709\u91cd\u5ea6\u4f4e\u94a0\u8840\u75c7\uff08\u8840\u94a0 < 110 mmol\/L\uff09\u6216\u51fa\u73b0\u4f4e\u94a0\u6027\u8111\u75c5\uff0c\u53ef\u7d27\u6025\u9002\u5f53\u9759\u8109\u8865\u5145 3% \uff5e 5% \u9ad8\u5f20\u6c2f\u5316\u94a0\u6eb6\u6db2 50 \uff5e 100 ml\uff0c2 \uff5e 3 d\uff0c\u4e00\u822c\u4e0d\u8d85\u8fc7 5 d\uff0c\u4ee5\u514d\u8179\u6c34\u52a0\u91cd\u3002\u6258\u4f10\u666e\u5766\u6cbb\u7597\u809d\u786c\u5316\u8179\u6c34\u4f34\u4f4e\u94a0\u8840\u75c7\uff0c\u5177\u6709\u8f83\u597d\u7684\u7597\u6548\u53ca\u5b89\u5168\u6027\u3002\u5728\u4f7f\u7528\u6258\u4f10\u666e\u5766\u8fc7\u7a0b\u4e2d\uff0c24 h \u8840\u94a0\u4e0a\u5347\u4e0d\u8d85\u8fc7 12 mmol\/L\uff0c\u4ee5\u514d\u5faa\u73af\u8d1f\u8377\u589e\u52a0\u6216\u5bfc\u81f4\u795e\u7ecf\u7cfb\u7edf\u8131\u9ad3\u9798\u635f\u5bb3\u3002<\/p>\n

\uff083\uff09\u4eba\u8840\u767d\u86cb\u767d \uff1a\u4eba\u8840\u767d\u86cb\u767d\u5177\u6709\u5341\u5206\u91cd\u8981\u7684\u751f\u7406\u529f\u80fd[36] \u3002\u8f93\u6ce8\u767d\u86cb\u767d\u4f7f\u809d\u786c\u5316\u8179\u6c34\u8840\u6d46\u4e2d\u4e00\u6c27\u5316\u6c2e\u3001\u80bf\u7624\u574f\u6b7b\u56e0\u5b50 – \u03b1\u3001\u5185\u6bd2\u7d20\u548c\u767d\u7ec6\u80de\u4ecb\u7d20 – 6 \u6c34\u5e73\u964d\u4f4e[37] \u3002\u5728\u5931\u4ee3\u507f\u671f\u809d\u786c\u5316\u60a3\u8005\u4e2d\uff0c\u767d\u86cb\u767d\u4e0d\u4ec5\u4ec5\u7ef4\u6301\u80f6\u4f53\u6e17\u900f\u538b\uff0c\u8fd8\u5177\u6709\u6297\u708e\u3001\u836f\u7269\u8fd0\u8f93\u53ca\u514d\u75ab\u8c03\u8282\u7b49\u975e\u80f6\u4f53\u6e17\u900f\u538b\u4f5c\u7528\u3002\u5728\u809d\u786c\u5316\u8179\u6c34\uff0c\u7279\u522b\u662f\u987d\u56fa\u6027\u8179\u6c34\u3001HRS – AKI\u3001SBP \u60a3\u8005\u7684\u6cbb\u7597\u4e2d\uff0c\u77ed\u671f\u6216\u7d27\u6025\u8865\u5145\u4eba\u8840\u767d\u86cb\u767d\u53ef\u63d0\u9ad8\u5229\u5c3f\u836f\u7269\u3001\u6297\u83cc\u836f\u7269\u7684\u6cbb\u7597\u6548\u679c\uff0c\u6539\u5584\u9884\u540e[38 – 39] \u3002<\/p>\n

\u56fd\u5916\u6307\u5357\u63a8\u8350[4\uff0c13] \uff0c\u6bcf\u653e 1 000 ml \u8179\u6c34\uff0c\u8865\u5145 6 \uff5e 8 g\u767d\u86cb\u767d\uff0c\u53ef\u4ee5\u9632\u6cbb\u5927\u91cf\u653e\u8179\u6c34\u540e PICD\uff0c\u63d0\u9ad8\u751f\u5b58\u7387\u3002\u4e5f\u6709\u7814\u7a76\u53d1\u73b0\uff0c\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u6bcf\u653e 1 000 ml \u8179\u6c34\uff0c\u5bf9\u6bd4\u8865\u51454 g \u4e0e 8 g \u767d\u86cb\u767d\uff0c\u4e34\u5e8a\u6548\u679c\u76f8\u4f3c[40] \u3002ANSWER \u7814\u7a76\u663e\u793a\uff0c\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u957f\u671f\u4f7f\u7528\u767d\u86cb\u767d\uff0c\u524d 2 \u5468 80 g\/ \u5468\uff0c\u4ee5\u540e40 g\/ \u5468\uff0c\u7597\u7a0b 1 \u5e74\uff0c\u53ef\u663e\u8457\u5ef6\u957f\u60a3\u8005\u7684\u751f\u5b58\u65f6\u95f4\u3001\u51cf\u5c11\u4f4f\u9662\u9891\u7387\uff0cSBP \u53ca\u987d\u56fa\u6027\u8179\u6c34\u98ce\u9669\u663e\u8457\u4e0b\u964d\uff0c\u5b89\u5168\u6027\u597d[41] \u3002<\/p>\n

5. \u8179\u8154\u7a7f\u523a\u653e\u6db2<\/p>\n

\u8179\u8154\u7a7f\u523a\u5927\u91cf\u653e\u8179\u6c34\uff08> 5 L\/d\uff09\u4ecd\u662f\u987d\u56fa\u6027\u8179\u6c34\u6216\u590d\u53d1\u6027\u8179\u6c34\u7684\u6709\u6548\u6cbb\u7597\u65b9\u6cd5[42] \uff0c\u5e38\u89c1\u5e76\u53d1\u75c7\u662f\u4f4e\u8840\u5bb9\u91cf\u3001AKI \u53ca\u5927\u91cf\u653e\u8179\u6c34\u540e PICD\u3002\u7814\u7a76\u8bc1\u5b9e\uff0c\u5927\u91cf\u653e\u8179\u6c34\u540c\u65f6\u8865\u5145\u4eba\u8840\u767d\u86cb\u767d\uff081 000 ml \u8179\u6c34\uff0c4 \uff5e 8 g \u767d\u86cb\u767d\uff09\u8f83\u5355\u7528\u5229\u5c3f\u836f\u7269\u66f4\u6709\u6548\uff0c\u5e76\u53d1\u75c7\u66f4\u5c11\u3002\u809d\u786c\u5316\u987d\u56fa\u6027\u8179\u6c34\u60a3\u8005\u65e9\u671f\u5927\u91cf\u653e\u8179\u6c34\u53ef\u663e\u8457\u964d\u4f4e 30 d \u518d\u4f4f\u9662\u7387\u53ca 90 d \u75c5\u6b7b\u7387[43] \u3002<\/p>\n

\u5bf9\u4e8e\u7ec8\u672b\u671f\u809d\u75c5\u60a3\u8005\u5408\u5e76\u987d\u56fa\u6027\u8179\u6c34\u65f6\uff0c\u65e0\u809d\u79fb\u690d\u6216 TIPS \u6761\u4ef6\uff0c\u7559\u7f6e\u8179\u8154\u5f15\u6d41\u7ba1\u6bd4\u53cd\u590d\u7a7f\u523a\u5927\u91cf\u653e\u8179\u6c34\u76f8\u5bf9\u8282\u7701\u8d39\u7528\uff0c\u4f46 SBP\u3001\u8702\u7a9d\u7ec4\u7ec7\u708e\u548c\u8179\u6c34\u6e17\u6f0f\u53d1\u751f\u7387\u66f4\u9ad8[44] \u3002\u6709\u5173\u957f\u671f\u7559\u7f6e\u8179\u8154\u5f15\u6d41\u7ba1\u653e\u8179\u6c34\u7684\u62a5\u9053\uff0c\u5927\u591a\u6570\u4e3a\u764c\u75c7\u76f8\u5173\u8179\u6c34\u3002\u957f\u671f\u653e\u7f6e\u5f15\u6d41\u7ba1\u59d1\u606f\u6027\u6cbb\u7597\u987d\u56fa\u6027\u8179\u6c34\u4e3b\u8981\u9002\u7528\u4eba\u7fa4\u4e3a\u65e0TIPS\u6216\u809d\u79fb\u690d\u6761\u4ef6\u7684\u5c45\u5bb6\u60a3\u8005\uff1b\u9891\u7e41\u653e\u8179\u6c342\uff5e3\u6b21\/\u5468\u3001\u6bcf\u6b21\u5f15\u6d41\u8179\u6c342 000\uff5e5 000 ml\u8005\uff0c\u5426\u5219\u4e0d\u53ef\u7559\u7f6e\u8179\u8154\u5f15\u6d41\u7ba1\u3002<\/p>\n

6. TIPS<\/p>\n

TIPS \u662f\u6cbb\u7597\u809d\u786c\u5316\u987d\u56fa\u6027\u6216\u590d\u53d1\u6027\u8179\u6c34\u7684\u6709\u6548\u65b9\u6cd5\u4e4b\u4e00[43] \uff0c\u9002\u5408\u809d\u9759\u8109\u538b\u529b\u68af\u5ea6\u8d85\u8fc7 20 mmHg \u7684\u60a3\u8005\uff0c\u53ef\u589e\u52a0\u65e0\u809d\u79fb\u690d\u751f\u5b58\u7387\uff0c\u4e3a\u9700\u8981\u9891\u7e41\u8179\u8154\u7a7f\u523a\u653e\u8179\u6c34\u6216\u9891\u7e41\u4f4f\u9662\u60a3\u8005\uff08\u2265 3 \u6b21 \/ \u6708\uff09\u6216\u809d\u79fb\u690d\u7684\u8fc7\u6e21\u6cbb\u7597\u3002\u7814\u7a76\u663e\u793a\uff0cTIPS\u53ef\u964d\u4f4e\u95e8\u9759\u8109\u538b\u529b\uff0c\u7f13\u89e3\u6216\u6d88\u9664\u8179\u6c34\uff0c\u6539\u5584\u5c3f\u94a0\u6392\u6cc4\u548c\u80be\u810f\u529f\u80fd\u3002\u4f46\u4f34\u6709 HRS – AKI \u7684\u987d\u56fa\u6027\u8179\u6c34\u60a3\u8005 TIPS \u7684\u6548\u679c\u53ca\u5b89\u5168\u6027\u4ecd\u65e0\u8bc1\u636e[45] \u3002<\/p>\n

7. \u8840\u6db2\u51c0\u5316\u6cbb\u7597<\/p>\n

\u5e8a\u65c1\u8840\u6db2\u900f\u6790\u6216\u6301\u7eed\u9759\u8109\u8840\u6db2\u6ee4\u8fc7\u7684\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u53ef\u6539\u5584\u809d\u786c\u5316\u987d\u56fa\u6027\u8179\u6c34\u53ca HRS – AKI \u80be\u529f\u80fd[46 – 47] \u3002\u65e0\u7ec6\u80de\u8179\u6c34\u6d53\u7f29\u56de\u8f93\u6cbb\u7597\u65e0\u611f\u67d3\u6027\u987d\u56fa\u6027\u8179\u6c34\u6709\u4e00\u5b9a\u7597\u6548[48] \u3002\u4e5f\u6709\u62a5\u9053\u8179\u8154 \u03b1 – \u5f15\u6d41\u6cf5\u6cbb\u7597\u987d\u56fa\u6027\u8179\u6c34\uff0c\u51cf\u5c11\u4e86\u53cd\u590d\u7a7f\u523a\uff0c\u6539\u5584\u4e86\u60a3\u8005\u7684\u751f\u6d3b\u8d28\u91cf\u548c\u8425\u517b\u72b6\u51b5[49] \u3002<\/p>\n

8. \u809d\u79fb\u690d<\/p>\n

\u5bf9\u4e8e Child – Pugh C \u7ea7\u6216\u809d\u8870\u7aed\u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\uff0c\u5e94\u4f18\u5148\u8003\u8651\u809d\u79fb\u690d[50] \u3002\u809d\u79fb\u690d\u524d\u5c3d\u53ef\u80fd\u63a7\u5236\u6025\u6162\u6027\u80be\u635f\u4f24\u53ca\u611f\u67d3\uff0c\u5728\u7b49\u5f85\u809d\u79fb\u690d\u7684\u60a3\u8005\u4e2d\uff0c\u5bf9\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u6cbb\u7597\u6709\u53cd\u5e94\u8005\uff0c\u6709\u53ef\u80fd\u5ef6\u7f13\u8fdb\u884c\u809d\u79fb\u690d\u7684\u65f6\u95f4[29] \u3002<\/p>\n

9. \u7279\u6b8a\u7c7b\u578b\u8179\u6c34\u7684\u7ba1\u7406<\/p>\n

\uff081\uff09\u8179\u6c34\u4f34\u98df\u7ba1\u80c3\u9759\u8109\u66f2\u5f20\u51fa\u8840 \uff1a\u5bf9\u4e8e 1 \uff5e 2 \u7ea7\u8179\u6c34\u4f34\u98df\u7ba1\u80c3\u9759\u8109\u66f2\u5f20\u51fa\u8840\u60a3\u8005\uff0c\u53ef\u91c7\u7528\u76f8\u5173\u6307\u5357\u7684\u63a8\u8350\u610f\u89c1\u3002\u4e00\u822c\u8ba4\u4e3a\u987d\u56fa\u6027\u6216\u590d\u53d1\u6027\u8179\u6c34\u60a3\u8005\uff0c\u65e0\u8bba\u662f\u4e00\u7ea7\u8fd8\u662f\u4e8c\u7ea7\u9884\u9632\u9759\u8109\u66f2\u5f20\u51fa\u8840\uff0c\u975e\u9009\u62e9\u6027 \u03b2 \u53d7\u4f53\u963b\u6ede\u5242\uff08nonselective beta – blockers\uff0cNSBBs\uff09\u4f3c\u4e4e\u5f0a\u591a\u5229\u5c11\u3002\u4f46\u4e34\u5e8a\u89c2\u5bdf\u53d1\u73b0\u5bf9\u8840\u538b\u3001\u8109\u640f\u6b63\u5e38\u7684\u8179\u6c34\u60a3\u8005\uff0c\u5728\u4e00\u7ea7\u6216\u4e8c\u7ea7\u9884\u9632\u98df\u7ba1\u80c3\u9759\u8109\u66f2\u5f20\u51fa\u8840\u65f6\uff0cNSBBs \u5bf9\u90e8\u5206\u60a3\u8005\u5177\u6709\u4e00\u5b9a\u7684\u7597\u6548\uff0c\u4e34\u5e8a\u53ef\u8c28\u614e\u5e94\u7528\u3002\u4f18\u5148 TIPS \u662f\u9009\u62e9\u7684\u65b9\u6cd5\u4e4b\u4e00[7] \u3002<\/p>\n

\uff082\uff09\u4e73\u7cdc\u6027\u8179\u6c34 \uff1a\u4e0e\u95e8\u9759\u8109\u9ad8\u538b\u5185\u810f\u6dcb\u5df4\u56de\u6d41\u969c\u788d\u6709\u5173\uff0c\u6709\u6761\u4ef6\u5e94\u505a\u6dcb\u5df4\u7ba1\u9020\u5f71\u68c0\u67e5\uff0c\u4ee5\u6392\u9664\u6dcb\u5df4\u7ba1\u963b\u585e\u3002\u4f20\u7edf\u5229\u5c3f\u836f\u7269\u5bf9\u4e73\u7cdc\u6027\u8179\u6c34\u4f5c\u7528\u6709\u9650\u3002\u4e3b\u8981\u6cbb\u7597\u65b9\u6cd5\u4e3a\u91c7\u7528\u4e2d\u94fe\u8102\u80aa\u9178\u3001\u9ad8\u86cb\u767d\u4f4e\u8102\u80aa\u996e\u98df\uff1b\u964d\u4f4e\u95e8\u9759\u8109\u538b\u529b\u836f\u7269\uff0c\u7279\u7acb\u52a0\u538b\u7d20\u3001\u751f\u957f\u6291\u7d20\u7b49\u6709\u4e00\u5b9a\u6548\u679c \uff1b\u5982\u836f\u7269\u6cbb\u7597\u65e0\u6548\uff0c\u53ef\u91c7\u7528 TIPS\u3001\u5927\u91cf\u653e\u8179\u6c34\u7b49[51 – 52] \u3002<\/p>\n

\uff083\uff09\u80f8\u6c34 \uff1a\u809d\u786c\u5316\u80f8\u6c34\u6cbb\u7597\u539f\u5219\u4e0e\u8179\u6c34\u6cbb\u7597\u76f8\u540c\uff0c\u5305\u62ec\u5229\u5c3f\u836f\u7269\u3001\u9650\u76d0\u3001TIPS \u53ca\u6297\u611f\u67d3[53] \u3002\u6709\u660e\u663e\u547c\u5438\u56f0\u96be\u7684\u5927\u91cf\u80f8\u6c34\u60a3\u8005\uff0c\u80f8\u8154\u7a7f\u523a\u5f15\u6d41\u80f8\u6c34\u53ef\u7f13\u89e3\u75c7\u72b6[54] \u3002\u957f\u671f\u53cd\u590d\u53d1\u4f5c\u7684\u5927\u91cf\u80f8\u6c34\u60a3\u8005\u53ef\u8003\u8651 TIPS\uff0c\u80f8\u6c34\u5408\u5e76\u611f\u67d3\uff0c\u5e94\u6309\u75c5\u539f\u5b66\u6307\u5bfc\u6297\u83cc\u836f\u7269\u5e94\u7528\u3002<\/p>\n

\uff084\uff09\u8840\u6027\u8179\u6c34 \uff1a\u8840\u6027\u8179\u6c34\u591a\u53d1\u751f\u5728\u539f\u53d1\u6027\u809d\u764c\u60a3\u8005\uff0c\u4e5f\u53ef\u53d1\u751f\u5728 SBP\u3001\u7ed3\u6838\u6027\u8179\u819c\u708e\u53ca\u5c11\u89c1\u8179\u819c\u9759\u8109\u66f2\u5f20\u51fa\u8840\u60a3\u8005\uff0c\u8179\u8154\u7a7f\u523a\u672f\u53d1\u751f\u8840\u6027\u8179\u6c34\u7f55\u89c1\u3002\u8840\u6027\u8179\u6c34\u4f34\u751f\u547d\u4f53\u5f81\u4e0d\u7a33\u5b9a\u7684\u60a3\u8005\u5e38\u9700\u52a0\u5f3a\u76d1\u62a4[18] \uff0c\u53ef\u5e94\u7528\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u3001\u7279\u5229\u52a0\u538b\u7d20\u53ca\u751f\u957f\u6291\u7d20\u7b49\u3002<\/p>\n

10. \u75c5\u56e0\u6cbb\u7597\u4e0e\u6297\u809d\u7ea4\u7ef4\u5316\u6cbb\u7597<\/p>\n

\u75c5\u56e0\u6cbb\u7597\u53ef\u51cf\u8f7b\u809d\u7ea4\u7ef4\u5316\uff0c\u964d\u4f4e\u95e8\u9759\u8109\u538b\u529b\uff0c\u963b\u6b62\u6216\u9006\u8f6c\u809d\u7ea4\u7ef4\u5316\u3001\u809d\u786c\u5316\u7684\u8fdb\u5c55[8\uff0c55] \u3002<\/p>\n

\u5bf9\u65e0\u6cd5\u8fdb\u884c\u75c5\u56e0\u6cbb\u7597\u7684\u809d\u786c\u5316\u60a3\u8005\uff0c\u6297\u809d\u7ea4\u7ef4\u5316\u3001\u9632\u6cbb\u80a0\u9053\u7ec6\u83cc\u79fb\u4f4d\u3001\u4fdd\u62a4\u8840\u7ba1\u5185\u76ae\u7ec6\u80de\u529f\u80fd\u53ca\u7ea0\u6b63\u51dd\u8840\u529f\u80fd\u5f02\u5e38\u7b49\uff0c\u4e5f\u53ef\u6539\u5584\u809d\u786c\u5316\u95e8\u9759\u8109\u9ad8\u538b\u75c7\u76f8\u5173\u5e76\u53d1\u75c7\u7684\u8fdb\u5c55[56] \u3002<\/p>\n

\u76ee\u524d\u5c1a\u65e0\u6297\u7ea4\u7ef4\u5316\u897f\u836f\u7ecf\u8fc7\u4e34\u5e8a\u6709\u6548\u9a8c\u8bc1\uff0c\u4e2d\u533b\u4e2d\u836f\u53d1\u6325\u4e86\u8f83\u91cd\u8981\u7684\u4f5c\u7528[57 – 60] \u3002\u4e2d\u533b\u5b66\u8ba4\u4e3a\u809d\u7ea4\u7ef4\u5316\u57fa\u672c\u75c5\u673a\u662f\u672c\u865a\u6807\u5b9e\uff0c\u4e3b\u8981\u6cbb\u7597\u539f\u5219\u6709\u6d3b\u8840\u5316\u7600\u3001\u6276\u6b63\u8865\u865a\u548c\u6e05\u70ed\uff08\u89e3\u6bd2\uff09\u5229\u6e7f\u6cd5\u7b49\u3002\u53ef\u4f7f\u7528\u5b89\u7edc\u5316\u7ea4\u4e38\u3001\u6276\u6b63\u5316\u7600\u80f6\u56ca\u548c\u9cd6\u7532\u8f6f\u809d\u7247\u7b49\u4e2d\u6210\u836f\u8fdb\u884c\u6297\u7ea4\u7ef4\u5316\u6cbb\u7597\uff0c\u9006\u8f6c\u809d\u7ea4\u7ef4\u5316\u548c\u809d\u786c\u5316\uff0c\u5bf9\u9884\u9632\u809d\u786c\u5316\u5931\u4ee3\u507f\u53ca\u6539\u5584\u809d\u786c\u5316\u7ed3\u5c40\u8d77\u5230\u8f85\u52a9\u4f5c\u7528\u3002<\/p>\n

11. \u5168\u7a0b\u7ba1\u7406<\/p>\n

\u8179\u6c34\u4e3a\u809d\u786c\u5316\u5931\u4ee3\u507f\u8868\u73b0\uff0c\u5e38\u6709\u660e\u663e\u8bf1\u56e0\uff0c\u5bf9\u5229\u5c3f\u5242\u53cd\u5e94\u8f83\u597d\u3002\u5982\u4e3a\u6162\u52a0\u6025\u6027\u809d\u8870\u7aed\u6240\u81f4\u7684\u8179\u6c34\uff0c\u5e38\u4f34AKI\u6216\u611f\u67d3\uff0c\u9884\u540e\u8f83\u5dee\u3002\u51fa\u73b0 HRS – AKI \u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\uff0c3 \u4e2a\u6708\u75c5\u6b7b\u7387\u4e3a 50% \uff5e 70%\u3002<\/p>\n

\u5404\u671f\u809d\u786c\u5316\u60a3\u8005\u5747\u662f\u809d\u764c\u7684\u6781\u9ad8\u5371\u4eba\u7fa4\uff0c\u5e94\u6bcf 3 \u4e2a\u6708\u590d\u67e5\u751f\u5316\u3001\u8840\u5e38\u89c4\u3001\u51dd\u8840\u529f\u80fd\u3001\u7532\u80ce\u86cb\u767d\u53ca\u5176\u8179\u90e8\u8d85\u58f0\u7b49[61] \u3002\u6bcf 12 \uff5e 24 \u4e2a\u6708\u80c3\u955c\u68c0\u67e5\u4ee5\u4e86\u89e3\u6709\u65e0\u98df\u7ba1\u9759\u8109\u66f2\u5f20\u53ca\u5176\u8fdb\u5c55\u7a0b\u5ea6\u3002\u5bf9\u5931\u4ee3\u507f\u671f\u809d\u786c\u5316\u60a3\u8005\u9700\u5236\u5b9a\u957f\u671f\u3001\u751a\u81f3\u662f\u7ec8\u751f\u7684\u4e34\u5e8a\u7ba1\u7406\u65b9\u6848\u3002<\/p>\n

\u63a8\u8350\u610f\u89c11: \u809d\u786c\u5316\u4e34\u5e8a\u53ef\u5206\u4e3a\u4ee3\u507f\u671f\u3001\u5931\u4ee3\u507f\u671f\u53ca\u518d\u4ee3\u507f\u671f\uff08B\uff0c1\uff09\uff1b\u8179\u6c34\uff08\u6392\u9664\u5176\u4ed6\u539f\u56e0\uff09\u4e3a\u809d\u786c\u5316\u5931\u4ee3\u507f\u7684\u5e38\u89c1\u4e34\u5e8a\u8868\u73b0\u3002<\/p>\n

\u63a8\u8350\u610f\u89c12: \u5bf9\u65b0\u51fa\u73b0\u7684\u8179\u6c34\u548c 2\u30013 \u7ea7\u4ee5\u4e0a\u8179\u6c34\u60a3\u8005\uff0c\u5e94\u884c\u8179\u8154\u7a7f\u523a\u8179\u6c34\u5e38\u89c4\u68c0\u67e5\uff0c\u5305\u62ec\u8179\u6c34\u7ec6\u80de\u8ba1\u6570\u548c\u5206\u7c7b \u3001\u8179\u6c34\u603b\u86cb\u767d\u3001\u767d\u86cb\u767d\u3002\u8179\u8154\u7a7f\u523a\u540c\u65e5\u68c0\u6d4b\u8840\u6e05\u767d\u86cb\u767d\uff0cSAAG \u2265 11 g\/L \u7684\u8179\u6c34\u63d0\u793a\u4e3a\u95e8\u9759\u8109\u9ad8\u538b\u6027\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c13: \u7591\u4f3c\u8179\u8154\u611f\u67d3\u65f6\uff0c\u987b\u5728\u4f7f\u7528\u6297\u83cc\u836f\u7269\u524d\u7559\u53d6\u6807\u672c\uff0c\u4f7f\u7528\u8840\u57f9\u517b\u74f6\u5728\u5e8a\u65c1\u884c\u8179\u6c34\u7ec6\u83cc\u3001\u538c\u6c27\u83cc\u548c \/ \u6216\u771f\u83cc\u57f9\u517b\u3002\u4e25\u683c\u65e0\u83cc\u64cd\u4f5c\uff0c\u5e8a\u65c1\u53d6\u5f97\u8179\u6c34\u7acb\u5373\u6ce8\u5165\u8840\u57f9\u517b\u74f610 \uff5e 20 ml\uff0c\u5e76\u5373\u523b\u9001\u68c0\uff08A\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c14: \u987d\u56fa\u578b\u8179\u6c34\u7684\u8bca\u65ad \uff1a\u2460\u4f20\u7edf\u5229\u5c3f\u836f\u7269\uff08\u87ba\u5185\u916f 160 mg\/d\u3001\u544b\u585e\u7c73 80 mg\/d\uff09\u6cbb\u7597 > 1 \u5468\u6216\u6cbb\u7597\u6027\u95f4\u65ad\u653e\u8179\u6c34\uff084 000 \uff5e 5 000 ml\/ \u6b21\uff09\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\uff0820 \uff5e 40 g \u00b7 \u6b21-1<\/sup>\u00b7 d -1 <\/sup>\uff09\u6cbb\u7597 2 \u5468\uff0c\u8179\u6c34\u65e0\u6cbb\u7597\u5e94\u7b54\u53cd\u5e94 \uff1b\u2461\u51fa\u73b0\u96be\u4ee5\u63a7\u5236\u7684\u5229\u5c3f\u836f\u7269\u76f8\u5173\u5e76\u53d1\u75c7\u6216\u4e0d\u826f\u53cd\u5e94 \uff1b\u2462\u6392\u9664\u6076\u6027\u8179\u6c34\u53ca\u7aa6\u524d\u6027\u95e8\u9759\u8109\u9ad8\u538b\u75c7\u5f15\u8d77\u7684\u8179\u6c34\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c15: \u590d\u53d1\u578b\u8179\u6c34 \uff1a\u5728\u9650\u76d0\u53ca\u5e94\u7528\u5229\u5c3f\u836f\u7269\u7684\u60c5\u51b5\u4e0b\uff0c1 \u5e74\u5185\u8179\u6c34\u590d\u53d1\u2265 3 \u6b21\u3002<\/p>\n

\u63a8\u8350\u610f\u89c16: \u4e73\u7cdc\u6027\u8179\u6c34 \uff1a\u5916\u89c2\u5448\u4e73\u767d\u8272\uff0c\u8179\u6c34\u7684\u7518\u6cb9\u4e09\u916f\u6c34\u5e73 > 200 mg\/dl \uff0811.11 mmol\/L\uff09\uff0c< 50 mg\/dl \u53ef\u6392\u9664\u8bca\u65ad\u3002<\/p>\n

\u63a8\u8350\u610f\u89c17: \u8840\u6027\u8179\u6c34 \uff1a\u8179\u6c34\u5916\u89c2\u8840\u6027\u6216\u8179\u6c34\u7ea2\u7ec6\u80de\u8ba1\u6570 > 10 000 \u4e2a \/mm 3<\/sup> \u3002<\/p>\n

\u63a8\u8350\u610f\u89c18: \u87ba\u5185\u916f\u8d77\u59cb\u5242\u91cf 40 \uff5e 80 mg\/d\uff0c3 \uff5e 5 d \u9012\u589e 40 mg\/d\uff0c\u5e38\u89c4\u5242\u91cf\u4e0a\u9650\u4e3a 100 mg\/d\uff0c\u6700\u5927\u5242\u91cf 400 mg\/d\uff1b\u544b\u567b\u7c73\u8d77\u59cb\u5242\u91cf 20 \uff5e 40 mg\/d\uff0c3 \uff5e 5 d \u9012\u589e 40 mg\/d\uff0c\u5e38\u89c4\u5242\u91cf\u4e0a\u9650 80 mg\/d\uff0c\u6700\u5927\u5242\u91cf 160 mg\/d\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c19: \u6258\u4f10\u666e\u5766\u662f\u6cbb\u7597\u809d\u786c\u5316\u8179\u6c34\uff0c\u7279\u522b\u662f\u4f34\u4f4e\u94a0\u8840\u75c7\u7684\u6709\u6548\u6392\u6c34\u836f\u7269\uff0c\u6839\u636e\u8840\u94a0\u6c34\u5e73\u8c03\u6574\u5242\u91cf\uff0c\u907f\u514d\u8840\u94a0\u5347\u9ad8\u8fc7\u5feb\u3002\u8d77\u59cb\u5242\u91cf 7.5 \uff5e 15 mg\/d\uff0c\u6700\u4f4e\u5242\u91cf 3.75 mg\/d\uff0c\u6700\u5927\u5242\u91cf 60 mg\/d\uff08A\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c110: \u7279\u5229\u52a0\u538b\u7d20\u53ef\u7528\u4e8e\u809d\u786c\u5316\u987d\u56fa\u578b\u8179\u6c34\u7684\u6cbb\u7597\uff0c1 \uff5e 2 mg\uff0c12 h \u4e00\u6b21\u9759\u8109\u7f13\u6162\u63a8\u6ce8\uff08\u81f3\u5c11 15 min\uff09\u6216\u6301\u7eed\u9759\u8109\u6ef4\u6ce8\uff0c\u6709\u5e94\u7b54\u8005\u6301\u7eed\u5e94\u7528 5 \uff5e 7 d\uff1b\u65e0\u5e94\u7b54\u8005\uff0c\u53ef 1 \uff5e2 mg\uff0c6 h \u4e00\u6b21\uff0c\u6216\u8054\u5408\u53bb\u7532\u80be\u4e0a\u817a\u7d20 0.5 \uff5e 3 mg\/h\u3002\u505c\u836f\u540e\u75c5\u60c5\u53cd\u590d\uff0c\u53ef\u518d\u91cd\u590d\u5e94\u7528\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c111: \u987d\u56fa\u578b\u8179\u6c34\u60a3\u8005\u9700\u8981\u8fdb\u884c\u9650\u76d0\u6559\u80b2\uff0c\u94a0\u6444\u5165 4 \uff5e 6 g\/d\uff08B\uff0c1\uff09\uff1b\u8840\u94a0\u4f4e\u4e8e 125 mmol\/L\uff0c\u9700\u9650\u5236\u6c34\u6444\u5165\u91cf\uff0c\u5426\u5219\u4e0d\u9700\u4e25\u683c\u9650\u6c34\uff08C\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c112: \u987d\u56fa\u578b\u8179\u6c34\u6cbb\u7597\u65b9\u6848 \uff1a\u2460\u5229\u5c3f\u836f\u7269\u3001\u4eba\u8840\u767d\u86cb\u767d\u53ca\u8840\u7ba1\u6d3b\u6027\u836f\u7269 \uff1b\u2461\u5927\u91cf\u653e\u8179\u6c34\uff084 000 \uff5e 5 000ml\u00b7\u6b21-1<\/sup> \u00b7d -1<\/sup> \uff09\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\uff081 000 ml \u8179\u6c34 4 g\uff09\uff08B\uff0c1\uff09\uff1b\u2462\u5bf9\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\u3001\u95e8\u9759\u8109\u9ad8\u538b\u8d77\u4e3b\u8981\u4f5c\u7528\u7684\u987d\u56fa\u578b\u8179\u6c34\uff0c\u6709\u6761\u4ef6\u4e14\u65e0\u7981\u5fcc\u8bc1\u65f6\u4f18\u5148 TIPS \u6cbb\u7597\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c113: \u5bf9\u987d\u56fa\u578b\u8179\u6c34\u60a3\u8005\u53ef\u8c28\u614e\u957f\u671f\u8179\u8154\u653e\u7f6e\u5f15\u6d41\u7ba1\u653e\u8179\u6c34\uff08C\uff0c1\uff09\u3002\u809d\u786c\u5316\u987d\u56fa\u578b\u8179\u6c34\u60a3\u8005\u5e94\u5217\u5165\u4f18\u5148\u809d\u79fb\u690d\u7b49\u5f85\u540d\u5355\uff08B\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c114: \u8840\u538b\u3001\u8109\u640f\u6b63\u5e38\u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\uff0c\u7279\u522b\u662f\u987d\u56fa\u578b\u8179\u6c34\u4f34 AKI \u60a3\u8005\uff0c\u5728\u98df\u7ba1\u80c3\u9759\u8109\u66f2\u5f20\u51fa\u8840\u4e00\u7ea7\u6216\u4e8c\u7ea7\u9884\u9632\u65f6\uff0c\u53ef\u8c28\u614e\u4f7f\u7528 NSBBs\uff08D\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c115: \u4e73\u7cdc\u6027\u8179\u6c34\u53ef\u91c7\u7528\u9ad8\u86cb\u767d\u3001\u4f4e\u8102\u80aa\u996e\u98df\uff0c\u7279\u5229\u52a0\u538b\u7d20\u3001\u751f\u957f\u6291\u7d20\u7b49 \uff1b\u5982\u65e0\u6548\u53ef\u91c7\u7528\u5927\u91cf\u653e\u8179\u6c34\u6216TIPS\uff08C\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c116: \u8840\u6027\u8179\u6c34\u4e14\u751f\u547d\u4f53\u5f81\u4e0d\u7a33\u5b9a\u60a3\u8005\u9700 ICU\u76d1\u62a4\uff0c\u53ca\u65f6\u68c0\u67e5\u539f\u56e0 \uff1b\u53ef\u5e94\u7528\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u3001\u7279\u5229\u52a0\u538b\u7d20\u53ca\u751f\u957f\u6291\u7d20\u7b49\uff08C\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c117: \u809d\u786c\u5316\u80f8\u6c34\u6cbb\u7597\u539f\u5219\u540c\u8179\u6c34 \uff1b\u2460\u987d\u56fa\u6027\u80f8\u6c34\u53ef\u8bd5\u7528\u5229\u5c3f\u836f\u7269\u3001\u4eba\u8840\u767d\u86cb\u767d\u53ca\u8840\u7ba1\u6d3b\u6027\u836f\u7269 \uff1b\u2461\u6709\u660e\u663e\u547c\u5438\u56f0\u96be\u60a3\u8005\u53ef\u653e\u80f8\u6c34\u8054\u7528\u4eba\u8840\u767d\u86cb\u767d\uff08B\uff0c1\uff09\uff1b\u2462\u5bf9\u6cbb\u7597\u6548\u679c\u4e0d\u4f73\uff0c\u6709\u6761\u4ef6\u4e14\u65e0\u7981\u5fcc\u8bc1\u65f6\u53ef\u65e9\u671f\u884cTIPS\u6cbb\u7597\u7b49\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c118: \u79ef\u6781\u8fdb\u884c\u75c5\u56e0\u6cbb\u7597\uff0c\u5728\u75c5\u56e0\u6cbb\u7597\u7684\u57fa\u7840\u4e0a\uff0c\u53ef\u4f7f\u7528\u4e2d\u836f\u5b89\u7edc\u5316\u7ea4\u4e38\u3001\u6276\u6b63\u5316\u7600\u80f6\u56ca\u548c\u9cd6\u7532\u8f6f\u809d\u7247\u7b49\u6539\u5584\u809d\u7ea4\u7ef4\u5316\u548c\u809d\u786c\u5316\uff0c\u8fbe\u5230\u809d\u786c\u5316\u75c5\u60c5\u7a33\u5b9a\u6216\u9006\u8f6c\u5931\u4ee3\u507f\u671f\u809d\u786c\u5316\u4e3a\u518d\u4ee3\u507f\u671f\uff08A\uff0c1\uff09\u3002<\/p>\n

\uff5c\u4e09\u3001\u81ea\u53d1\u6027\u8179\u819c\u708e\uff5c<\/p>\n

\u809d\u786c\u5316\u60a3\u8005\u7ec6\u83cc\u611f\u67d3\u53d1\u751f\u7387\u6bd4\u666e\u901a\u4eba\u7fa4\u9ad8\u7ea6 5 \u500d\uff0c\u5e38\u89c1\u7684\u611f\u67d3\u7c7b\u578b\u4e3a SBP\u3002\u5728\u81ea\u53d1\u6027\u8179\u819c\u708e\u60a3\u8005\u4e2d\uff0c5% \uff5e 10%\u4e3a\u81ea\u53d1\u6027\u771f\u83cc\u6027\u8179\u819c\u708e\uff08spontaneous fungal peritonitis\uff0cSFP\uff09\u3002SBP \u662f\u6307\u65e0\u660e\u786e\u8179\u8154\u5185\u75c5\u53d8\u6765\u6e90\uff08\u5982\u80a0\u7a7f\u5b54\u3001\u80a0\u8113\u80bf\uff09\u7684\u60c5\u51b5\u4e0b\u53d1\u751f\u7684\u8179\u819c\u708e\uff0c\u662f\u75c5\u539f\u5fae\u751f\u7269\u4fb5\u5165\u8179\u8154\uff0c\u9020\u6210\u660e\u663e\u635f\u5bb3\u5f15\u8d77\u7684\u611f\u67d3\u6027\u75be\u75c5\uff0c\u662f\u809d\u786c\u5316\u7b49\u7ec8\u672b\u671f\u809d\u75c5\u60a3\u8005\u5e38\u89c1\u5e76\u53d1\u75c7\u3002\u6709 SBP \u75c5\u53f2\u7684\u809d\u786c\u5316\u60a3\u8005 12 \u4e2a\u6708\u5185\u7684 SBP \u590d\u53d1\u7387\u9ad8\u8fbe 40% \uff5e 70%\u3002SBP \u53ef\u8fc5\u901f\u53d1\u5c55\u4e3a\u809d\u80be\u529f\u80fd\u8870\u7aed\uff0c\u81f4\u4f7f\u75c5\u60c5\u8fdb\u4e00\u6b65\u6076\u5316\uff0c\u662f\u809d\u786c\u5316\u7b49\u7ec8\u672b\u671f\u809d\u75c5\u60a3\u8005\u6b7b\u4ea1\u7684\u4e3b\u8981\u539f\u56e0\u3002<\/p>\n

\uff08\u4e00\uff09\u4e34\u5e8a\u8868\u73b0<\/p>\n

\u809d\u786c\u5316 SBP \u60a3\u8005\u591a\u6570\u8d77\u75c5\u9690\u533f\uff0c\u4e34\u5e8a\u8868\u73b0\u591a\u79cd\u591a\u6837\uff0c\u5bb9\u6613\u6f0f\u8bca\u3002\u7ea6 1\/3 \u60a3\u8005\u5177\u6709\u5178\u578b\u8179\u819c\u708e\u7684\u75c7\u72b6\u4e0e\u4f53\u5f81\uff0c\u53ef\u8868\u73b0\u4e3a\u53d1\u70ed\u3001\u5bd2\u6218\u3001\u8179\u75db\u6216\u8179\u6cfb\uff0c\u8179\u90e8\u538b\u75db\u548c \/ \u6216\u53cd\u8df3\u75db\u3002\u672a\u51fa\u73b0\u53d1\u70ed\uff0c\u4e5f\u4e0d\u80fd\u6392\u9664 SBP \u7684\u53ef\u80fd\uff0c\u9700\u5bc6\u5207\u89c2\u5bdf\u3002\u5927\u90e8\u5206\u60a3\u8005\u65e0\u5178\u578b\u7684\u8179\u819c\u708e\u75c7\u72b6\u4e0e\u4f53\u5f81\uff0c\u53ef\u8868\u73b0\u4e3a\u987d\u56fa\u6027\u8179\u6c34\u3001\u4f11\u514b\u3001\u65b0\u53d1\u6216\u6076\u5316\u7684 HE \u53ca AKI \u7b49\u3002<\/p>\n

SBP \u9ad8\u5371\u4eba\u7fa4\u5305\u62ec\u66fe\u53d1\u751f SBP\uff0c\u8001\u5e74\u4eba\uff08> 65 \u5c81\uff09\uff0c\u4f34\u7cd6\u5c3f\u75c5\uff0c\u809d\u764c\u6216\u5176\u4ed6\u80bf\u7624\uff0c\u4f7f\u7528\u514d\u75ab\u6291\u5236\u5242\uff0c\u4e25\u91cd\u809d\u529f\u80fd\u53d7\u635f\uff08Child – Pugh B\/C \u7ea7\uff09\u53ca EVB \u8005\u3002\u5bf9\u53ef\u7591\u7ec6\u83cc\u611f\u67d3\u7ecf\u6297\u83cc\u6cbb\u7597\u65e0\u6548\u7684\u53d1\u70ed\uff0c\u6216\u539f\u56e0\u4e0d\u660e\u7684\u809d\u529f\u80fd\u8870\u7aed\u3001\u8113\u6bd2\u8840\u75c7\u957f\u65f6\u95f4\u4f4e\u8840\u538b\uff08\u6536\u7f29\u538b < 80 mmHg\uff0c\u4e14 > 2 h\uff09\u4e14\u5bf9\u6269\u5bb9\u590d\u82cf\u65e0\u53cd\u5e94\u7684\u8179\u6c34\u60a3\u8005\uff0c\u8981\u8b66\u60d5\u8010\u6297\u83cc\u836f\u7269 SBP \u6216 SFP\u3002<\/p>\n

\uff08\u4e8c\uff09SBP \u7684\u8bca\u65ad<\/p>\n

SBP \u4e34\u5e8a\u8868\u73b0\u7f3a\u4e4f\u7279\u5f02\u6027\uff0c\u5e94\u79ef\u6781\u4e3b\u52a8\u5bfb\u627e SBP \u7684\u8bc1\u636e\u3002\u76ee\u524d\u65e9\u671f\u8bca\u65ad\u57fa\u4e8e\u4ee5\u4e0b\u51e0\u4e2a\u65b9\u9762 \uff1a<\/p>\n

1. \u6709\u4ee5\u4e0b\u75c7\u72b6\u6216\u4f53\u5f81\u4e4b\u4e00<\/p>\n

\uff081\uff09\u6025\u6027\u8179\u819c\u708e \uff1a\u8179\u75db\u3001\u8179\u90e8\u538b\u75db\u6216\u53cd\u8df3\u75db\uff0c\u8179\u808c\u5f20\u529b\u589e\u5927\uff0c\u5455\u5410\u3001\u8179\u6cfb\u6216\u80a0\u6897\u963b \uff1b\uff082\uff09\u5168\u8eab\u708e\u75c7\u53cd\u5e94\u7efc\u5408\u5f81\u7684\u8868\u73b0 \uff1a\u53d1\u70ed\u6216\u4f53\u6e29\u4e0d\u5347\u3001\u5bd2\u6218\u3001\u5fc3\u52a8\u8fc7\u901f\u3001\u547c\u5438\u6025\u4fc3 \uff1b\uff083\uff09\u65e0\u660e\u663e\u8bf1\u56e0\u809d\u529f\u80fd\u6076\u5316 \uff1b\uff084\uff09\u809d\u6027\u8111\u75c5 \uff1b\uff085\uff09\u4f11\u514b \uff1b\uff086\uff09\u987d\u56fa\u578b\u8179\u6c34\u6216\u5bf9\u5229\u5c3f\u836f\u7269\u7a81\u53d1\u65e0\u53cd\u5e94\u6216\u80be\u529f\u80fd\u8870\u7aed \uff1b\uff087\uff09\u6025\u6027\u80c3\u80a0\u9053\u51fa\u8840\u3002<\/p>\n

2. \u6709\u4ee5\u4e0b\u5b9e\u9a8c\u68c0\u67e5\u5f02\u5e38\u4e4b\u4e00<\/p>\n

\uff081\uff09\u8179\u6c34 PMN \u8ba1\u6570\u2265 0.25\u00d7109<\/sup> \/L \uff1b\uff082\uff09\u8179\u6c34\u7ec6\u83cc\u57f9\u517b\u9633\u6027 \uff1b\uff083\uff09PCT > 0.5 ng\/ml\uff0c\u6392\u9664\u5176\u4ed6\u90e8\u4f4d\u611f\u67d3\u3002\u8179\u6c34\u771f\u83cc\u57f9\u517b\u9633\u6027\u6216\u8840\u6e05\u8461\u805a\u7cd6\u660e\u663e\u5347\u9ad8\u60a3\u8005\uff0c\u8981\u8b66\u60d5 SFP [62-63] \u3002<\/p>\n

SBP \u60a3\u8005\u51fa\u73b0\u4ee5\u4e0b 2 \u6761\u8005\u8ba4\u4e3a\u662f\u91cd\u75c7\u611f\u67d3 \uff1a\u2460\u9ad8\u70ed\u3001\u5bd2\u98a4\uff0c\u4f53\u6e29 > 39.5\u2103 \uff1b\u2461\u611f\u67d3\u6027\u4f11\u514b \uff1b\u2462\u6025\u6027\u547c\u5438\u7a98\u8feb\u7efc\u5408\u5f81\uff1b\u2463\u4e0d\u660e\u539f\u56e0 AKI\uff1b\u2464\u5916\u5468\u8840\u767d\u7ec6\u80de\u8ba1\u6570 > 10\u00d7109<\/sup> \/L\uff1b\u2465 PCT > 2 ng\/ml\u3002<\/p>\n

\u5728\u5f00\u59cb\u6297\u83cc\u836f\u7269\u6cbb\u7597\u524d\uff0c\u5bf9\u7591\u4f3c SBP \u7684\u60a3\u8005\u5e94\u8fdb\u884c\u8179\u6c34\u57f9\u517b\uff0c\u7ea6 40% \u7684 SBP \u60a3\u8005\u7684\u8840\u57f9\u517b\u9633\u6027\u3002<\/p>\n

\uff08\u4e09\uff09SBP \u4e34\u5e8a\u7279\u6b8a\u7c7b\u578b<\/p>\n

1. \u8179\u6c34\u57f9\u517b\u9634\u6027\u7684\u4e2d\u6027\u7c92\u7ec6\u80de\u589e\u591a\u6027\u8179\u6c34\uff08culture negative neutrocyticascites\uff0cCNNA\uff09<\/p>\n

\u5176\u8bca\u65ad\u6807\u51c6\u4e3a : \u2460\u8179\u6c34\u7ec6\u83cc\u57f9\u517b\u9634\u6027 \uff1b\u2461\u8179\u6c34 PMN \u8ba1\u6570\u2265 0.25\u00d7109<\/sup> \/L \uff1b\u2462\u6392\u9664\u7ee7\u53d1\u6027\u8179\u819c\u708e \uff1b\u2463 30 d \u5185\u672a\u4f7f\u7528\u6297\u83cc\u836f\u7269\u6cbb\u7597\u3002CNNA\u4e0e\u57f9\u517b\u9633\u6027\u7684SBP\u6bd4\u8f83\uff0c\u5728\u4e34\u5e8a\u75c7\u72b6\u3001\u4f53\u5f81\u3001\u8179\u6c34\u5206\u6790\u3001\u75c5\u6b7b\u7387\u53ca\u5bf9\u6297\u83cc\u836f\u7269\u6cbb\u7597\u7684\u53cd\u5e94\u6027\u5747\u65e0\u660e\u663e\u5dee\u5f02\uff0c\u56e0\u6b64\u8ba4\u4e3a CNNA \u548c SBP \u662f\u540c\u4e00\u4e2a\u75be\u75c5\u3002<\/p>\n

2. \u4e2d\u6027\u7c92\u7ec6\u80de\u4e0d\u9ad8\u7684\u7ec6\u83cc\u6027\u8179\u6c34\uff08monomicrobial nonneutrocytic bacterascites\uff0cMNB\uff09<\/p>\n

\u6216\u79f0\u7ec6\u83cc\u6027\u8179\u6c34\uff08bacterascite\uff0cBA\uff09\u3002\u5176\u8bca\u65ad\u6807\u51c6\u4e3a \uff1a\u2460\u8179\u6c34\u7ec6\u83cc\u57f9\u517b\u9633\u6027;\u2461\u8179\u6c34PMN \u8ba1\u6570< 0.25\u00d7109<\/sup> \/L;\u2462\u65e0\u660e\u663e\u8179\u8154\u5185\u611f\u67d3\u7076\u3002<\/p>\n

3. \u81ea\u53d1\u6027\u771f\u83cc\u6027\u8179\u819c\u708e<\/p>\n

\u4e34\u5e8a\u8868\u73b0\u4e0e SBP \u76f8\u4f3c[61] \u3002\u835f\u8403\u5206\u6790 [64]\u53d1\u73b0\uff0c\u5728\u81ea\u53d1\u6027\u8179\u819c\u708e\u53d1\u4f5c\u4e2d\uff0c\u771f\u83cc\u5360 4.28%\u3002\u6297\u83cc\u836f\u7269\u6cbb\u7597\u5e94\u7b54\u5dee\u7684\u60a3\u8005\uff0c\u9700\u8003\u8651\u8010\u836f\u548c\u771f\u83cc\u6027\u8179\u819c\u708e\u3002\u5511\u7c7b\u6216\u68d8\u767d\u83cc\u7d20\u662f\u6709\u6548\u3001\u5b89\u5168\u7684\u6297\u771f\u83cc\u836f\u7269\u3002<\/p>\n

\uff08\u56db\uff09SBP \u7684\u6297\u611f\u67d3\u6cbb\u7597<\/p>\n

\u4e0d\u540c\u75c5\u539f\u83cc SBP \u4e34\u5e8a\u7279\u5f81\u3001\u65e9\u671f\u75c5\u539f\u5b66\u8bca\u65ad\u53ca\u65e9\u671f\u7ecf\u9a8c\u6027\u7684\u6297\u611f\u67d3\u6cbb\u7597\u4ecd\u662f\u4e34\u5e8a\u533b\u5e08\u9762\u4e34\u7684\u5de8\u5927\u6311\u6218[65] \uff0c\u9274\u522b\u793e\u533a\u83b7\u5f97 SBP \u4e0e\u9662\u5185\u611f\u67d3 SBP \u5bf9\u4e8e\u6307\u5bfc\u7ecf\u9a8c\u6027\u9009\u62e9\u6297\u83cc\u836f\u7269\u975e\u5e38\u91cd\u8981[66] \u3002\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u4f4f\u9662 48 h \u540e\uff0c\u51fa\u73b0 SBP \u7684\u75c7\u72b6\u4e0e\u4f53\u5f81\u6216\u7b26\u5408 SBP \u5b9e\u9a8c\u5ba4\u8bca\u65ad\u6761\u4ef6\uff0c\u53ef\u8bca\u65ad\u4e3a\u662f\u9662\u5185\u83b7\u5f97 SBP\u3002\u4e34\u5e8a\u5b9e\u8df5\u4e2d\uff0c\u8179\u6c34 PMN \u8ba1\u6570\u2265 0.25\u00d7109<\/sup> \/L \u7684\u60a3\u8005\uff0c\u5e94\u7acb\u5373\u8fdb\u884c\u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597\uff0c\u6839\u636e\u836f\u654f\u8bd5\u9a8c\u7ed3\u679c\u8c03\u6574\u6297\u83cc\u836f\u7269\u3002\u4e00\u822c\u6765\u8bf4\uff0c\u5728\u6297\u83cc\u836f\u7269\u6cbb\u7597 48 h \u540e\uff0c\u8179\u6c34\u4e2d\u7684 PMN \u6570\u91cf\u51cf\u5c11 > 25% \u6216\u8179\u90e8\u75c7\u72b6\u4f53\u5f81\u660e\u663e\u6539\u5584\uff0c\u8ba4\u4e3a\u6cbb\u7597\u6709\u6548\u3002\u5426\u5219\uff0c\u5e94\u8be5\u53ca\u65f6\u8c03\u6574\u6297\u83cc\u836f\u7269\u3002<\/p>\n

1. \u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597<\/p>\n

\u5355\u4e00\u5e7f\u8c31\u6297\u83cc\u836f\u7269\u4e5f\u53ef\u4f7f\u8179\u6c34\u7ec6\u83cc\u57f9\u517b\u9634\u6027\u7387\u8fbe 86%\u3002\u7531\u4e8e\u809d\u786c\u5316 SBP \u60a3\u8005\u75c5\u6b7b\u7387\u9ad8\uff0c12 h \u5185\u8179\u8154\u7a7f\u523a\u8179\u6c34\u68c0\u67e5\uff0c\u53ef\u6307\u5bfc\u65e9\u671f\u7ecf\u9a8c\u6027\u5408\u7406\u4f7f\u7528\u6297\u83cc\u836f\u7269\uff0c\u5bf9\u4e8e\u964d\u4f4e\u75c5\u6b7b\u7387\u6709\u610f\u4e49[67] \u3002<\/p>\n

\u5bf9\u4e8e\u793e\u533a\u83b7\u5f97\u6027 SBP\uff0c\u5176\u7ecf\u9a8c\u6cbb\u7597\u4e3b\u8981\u9488\u5bf9\u9769\u5170\u9634\u6027\u80a0\u6746\u83cc\u3002\u521d\u59cb\u6cbb\u7597\u83b7\u5f97\u6ee1\u610f\u4e34\u5e8a\u7597\u6548\u65f6\u4e0d\u9700\u8981\u6539\u53d8\u6cbb\u7597\u65b9\u6848\u3002\u9488\u5bf9\u533b\u9662\u83b7\u5f97\u6027 SBP \u7684\u7ecf\u9a8c\u6027\u6297\u83cc\u836f\u7269\u6cbb\u7597\uff0c\u5e94\u53c2\u8003\u5f53\u5730\u5fae\u751f\u7269\u5b66\u8c03\u67e5\u7ed3\u679c\uff0c\u8986\u76d6\u9769\u5170\u9634\u6027\u80a0\u6746\u83cc\uff0c\u9633\u6027\u7403\u83cc\u6216\u8010\u836f\u7ec6\u83cc\u3002\u6cbb\u7597\u4e25\u91cd\u793e\u533a\u83b7\u5f97\u6027\u611f\u67d3\u548c\u533b\u9662\u83b7\u5f97\u6027\u611f\u67d3\u7684\u836f\u7269\uff0c\u4e0d\u63a8\u8350\u7528\u4e8e\u6cbb\u7597\u8f7b\u5ea6\u793e\u533a\u83b7\u5f97\u7684 SBP\u3002<\/p>\n

\u53ef\u7591\u793e\u533a SBP\uff0c\u9009\u7528\u5934\u5b62\u567b\u809f\u6216\u7c7b\u4f3c\u4e09\u4ee3\u5934\u5b62\u7c7b\u6297\u83cc\u836f\u7269\uff0c\u53ef\u4ee5\u8986\u76d6 95% \u7684\u9769\u5170\u9634\u6027\u80a0\u6746\u83cc\u3002\u9662\u5185\u83b7\u5f97\u6027 SBP\uff0c\u7ecf\u9a8c\u6297\u611f\u67d3\u6cbb\u7597\u5e94\u9996\u9009\u78b3\u9752\u9709\u70ef\u7c7b\u4e3a\u57fa\u7840\u7684\u8054\u5408\u6cbb\u7597\u3002<\/p>\n

2. \u4e09\u4ee3\u5934\u5b62\u7c7b\u6297\u83cc\u836f\u7269\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d<\/p>\n

\u6297\u83cc\u6cbb\u7597\u7684\u6548\u679c\u53d6\u51b3\u4e8e\u611f\u67d3\u90e8\u4f4d\u6297\u83cc\u836f\u7269\u7684\u6d53\u5ea6\u3002\u4f4e\u767d\u86cb\u767d\u8840\u75c7\u589e\u52a0\u4e86\u836f\u7269\u6e05\u9664\u7387\uff0c\u964d\u4f4e\u4e0e\u6297\u83cc\u836f\u7269\u7684\u7ed3\u5408\uff0c\u56e0\u800c\u611f\u67d3\u90e8\u4f4d\u6297\u83cc\u836f\u7269\u6d53\u5ea6\u53ef\u80fd\u4f4e\u4e8e\u6700\u4f4e\u6291\u83cc\u6d53\u5ea6\uff08minimum inhibitory concentration\uff0cMIC\uff09\uff0c\u4ece\u800c\u5bfc\u81f4\u6297\u611f\u67d3\u6cbb\u7597\u65e0\u6548\u3002\u4e3a\u4e86\u5c06\u6e38\u79bb\u836f\u7269\u6c34\u5e73\u7ef4\u6301\u5728 MIC \u4ee5\u4e0a\uff0c\u53ef\u901a\u8fc7\u63d0\u9ad8\u767d\u86cb\u767d\u6c34\u5e73\u3001\u836f\u7269\u8fde\u7eed\u6216\u5ef6\u957f\u8f93\u6ce8\u65f6\u95f4\uff0c\u63d0\u9ad8\u809d\u786c\u5316\u60a3\u8005\u7684 30d \u751f\u5b58\u7387[39] \u3002<\/p>\n

\u7814\u7a76\u53d1\u73b0\uff0cSBP \u60a3\u8005\u4f7f\u7528\u5934\u5b62\u567b\u809f 6 h \u5185\u52a0\u7528\u4eba\u8840\u767d\u86cb\u767d 1.5 g\/kg\u3001\u7b2c 3 \u5929 1.0 g\/kg \u548c\u5355\u7528\u5934\u5b62\u567b\u809f\u8fdb\u884c\u6bd4\u8f83 \uff1a\u75c5\u6b7b\u7387\u660e\u663e\u4e0b\u964d\uff0c\u53ef\u6709\u6548\u63a7\u5236\u809d\u786c\u5316\u5e76\u53d1\u75c7[68] \u3002\u767d\u86cb\u767d\u8054\u5408\u6297\u611f\u67d3\u6cbb\u7597\u53ef\u5c06\u80be\u8870\u7aed\u7684\u98ce\u9669\u660e\u663e\u964d\u4f4e[66] \u3002\u6b64\u5916\uff0c\u7279\u5229\u52a0\u538b\u7d20\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\u3001\u4e09\u4ee3\u5934\u5b62\u7c7b\u6297\u83cc\u836f\u7269\u53ef\u663e\u8457\u63d0\u9ad8\u4f4f\u9662\u751f\u5b58\u7387[69] \u3002<\/p>\n

3. \u8010\u836f\u7ec6\u83cc\u7684\u76ee\u6807\u6cbb\u7597<\/p>\n

\u7531\u4e8e\u6c1f\u55b9\u8bfa\u916e\u7c7b\u6297\u83cc\u836f\u7269\u7684\u5e7f\u6cdb\u4f7f\u7528\u3001\u60a3\u8005\u9891\u7e41\u4f4f\u9662\u4ee5\u53ca\u5e7f\u8c31\u6297\u83cc\u836f\u7269\u7684\u4f7f\u7528\uff0c\u5bfc\u81f4\u8179\u6c34\u611f\u67d3\u83cc\u682a\u53d1\u751f\u53d8\u5316\uff0c\u9769\u5170\u9633\u6027\u83cc\u548c\u4ea7\u8d85\u5e7f\u8c31 \u03b2 – \u5185\u9170\u80fa\u9176\uff08extended – spectrum beta -lactamase\uff0cESBL\uff09\u5927\u80a0\u57c3\u5e0c\u83cc\u7b49\u591a\u91cd\u8010\u836f\u83cc\u682a\u589e\u52a0\uff0c\u4e25\u91cd\u5f71\u54cd\u6297\u611f\u67d3\u6cbb\u7597\u7684\u6548\u679c\u548c\u60a3\u8005\u7684\u9884\u540e[70] \u3002\u4e3a\u51cf\u5c11\u7ec6\u83cc\u8010\u836f\u6027\uff0c\u5e94\u9650\u5236\u9884\u9632\u6027\u5e94\u7528\u6297\u83cc\u836f\u7269\u3002\u4e00\u65e6\u83b7\u5f97\u611f\u67d3\u8bc1\u636e\uff0c\u5e94\u7f29\u77ed\u6297\u83cc\u836f\u7269\u7528\u836f\u65f6\u95f4\uff0c\u6839\u636e\u836f\u654f\u8bd5\u9a8c\u7b49\uff0c\u9009\u62e9\u7a84\u8c31\u6297\u83cc\u836f\u7269\u3002<\/p>\n

\u5bf9\u4e8e\u9ad8\u5ea6\u7591\u4f3c\u8010\u836f\u83cc\u611f\u67d3\u7684 SBP \u60a3\u8005\uff0c\u53ef\u9009\u62e9\u54cc\u62c9\u897f\u6797 \/ \u4ed6\u5511\u5df4\u5766\u3001\u5934\u5b62\u54cc\u916e\u8212\u5df4\u5766\u6216\u78b3\u9752\u9176\u70ef\u7c7b\u6297\u83cc\u836f\u7269\u8054\u5408\u8fbe\u6258\u9709\u7d20\u3001\u4e07\u53e4\u9709\u7d20\u6216\u5229\u5948\u5511\u80fa\u7ecf\u9a8c\u6027\u6cbb\u7597\u7b56\u7565\u3002\u5bf9\u6297\u83cc\u836f\u7269\u6cbb\u7597\u7597\u6548\u6b20\u4f73\u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u5e94\u76d1\u6d4b\u771f\u83cc\u6027\u8179\u819c\u708e\u3002\u6709\u5b66\u8005\u5c1d\u8bd5\u91c7\u7528\u9ad8\u901a\u91cf\u6d4b\u5e8f\u7b49\u65b9\u6cd5\u63d0\u9ad8\u8179\u6c34\u75c5\u539f\u5fae\u751f\u7269\u7684\u68c0\u6d4b\u654f\u611f\u5ea6\u3001\u7279\u5f02\u5ea6\uff0c\u7f29\u77ed\u68c0\u51fa\u65f6\u95f4[71 – 72] \u3002<\/p>\n

4\uff0e\u80a0\u9053\u975e\u5438\u6536\u6297\u83cc\u836f\u7269<\/p>\n

\u5229\u798f\u6614\u660e\uff08rifaximin\uff09\u53ef\u5e7f\u8c31\u3001\u5f3a\u6548\u6291\u5236\u80a0\u9053\u5185\u7ec6\u83cc\u751f\u957f\uff0c\u5177\u6709\u6740\u83cc \/ \u6291\u83cc\uff0c\u514d\u75ab\u8c03\u8282\u548c\u6297\u708e\u6d3b\u6027\uff0c\u5bf9\u809d\u786c\u5316SBP \u53ca\u987d\u56fa\u6027\u8179\u6c34\u7684\u9632\u6cbb\u6709\u8f83\u597d\u7684\u6548\u679c[73] \u3002<\/p>\n

\uff08\u4e94\uff09SBP \u7684\u9884\u9632<\/p>\n

\u9700\u5bf9 SBP \u7684\u9ad8\u5371\u4eba\u7fa4\u8fdb\u884c\u4e00\u7ea7\u9884\u9632\uff08\u65e0 SBP \u75c5\u53f2\u7684\u60a3\u8005\uff09\uff0c\u4e8c\u7ea7\u9884\u9632\uff08\u66fe\u7ecf\u53d1\u751f\u8fc7 SBP \u7684\u60a3\u8005\uff09\u3002<\/p>\n

1\uff0e\u9884\u9632 SBP \u9996\u6b21\u53d1\u751f\uff08\u4e00\u7ea7\u9884\u9632\uff09<\/p>\n

\u539f\u5219\u4e0a\uff0c\u65e2\u5f80\u6ca1\u6709 SBP \u75c5\u53f2\u7684\u60a3\u8005\uff0c\u5e94\u8c28\u614e\u4f7f\u7528\u6297\u83cc\u836f\u7269\u3002\u5bf9\u4e8e\u6d88\u5316\u9053\u51fa\u8840\u60a3\u8005\uff0c\u5728\u51fa\u8840\u671f\u95f4\uff0c\u5e94\u79ef\u6781\u4f7f\u7528\u6297\u83cc\u836f\u7269[74] \u3002\u6709\u5b66\u8005\u5efa\u8bae\uff0c\u5bf9 SBP \u9ad8\u98ce\u9669\u60a3\u8005\uff0c\u5982 Child – Pugh C\u7ea7\u3001\u4f34\u7cd6\u5c3f\u75c5\u6216\u6076\u6027\u80bf\u7624\u3001\u4f4e\u8179\u6c34\u86cb\u767d\u60a3\u8005\uff08\u8179\u6c34\u603b\u86cb\u767d < 1.5g\/L\uff09\uff0c\u53ef\u4f7f\u7528\u5229\u798f\u6614\u660e\u7b49\u8fdb\u884c\u9884\u9632\u6027\u7528\u836f[75] \u3002<\/p>\n

2. \u9884\u9632\u590d\u53d1\uff08\u4e8c\u7ea7\u9884\u9632\uff09<\/p>\n

\u65e2\u5f80\u6709\u8fc7 SBP \u75c5\u53f2\u7684\u60a3\u8005\uff0cSBP \u590d\u53d1\u7684\u98ce\u9669\u8f83\u9ad8\u3002\u7814\u7a76\u663e\u793a\u91c7\u7528\u5229\u798f\u6614\u660e\uff0c6 \u4e2a\u6708\u5185 SBP \u590d\u53d1\u7387\u660e\u663e\u964d\u4f4e[76] \u3002<\/p>\n

\u63a8\u8350\u610f\u89c119 \uff1a\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u5982\u53d1\u70ed\u3001\u8179\u90e8\u75bc\u75db\u6216\u538b\u75db\u7b49\u6216\u611f\u67d3\u76f8\u5173\u5b9e\u9a8c\u5ba4\u68c0\u67e5\u5f02\u5e38\uff0c\u53ef\u4f5c\u4e3a\u65e9\u671f\u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597\u6307\u5f81\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c120 \uff1a\u65e0\u8fd1\u671f\u5e94\u7528 \u03b2- \u5185\u9170\u80fa\u6297\u83cc\u836f\u7269\u7684\u793e\u533a\u83b7\u5f97\u8f7b\u3001\u4e2d\u5ea6 SBP \u60a3\u8005\uff0c\u9996\u9009\u4e09\u4ee3\u5934\u5b62\u7c7b\u6297\u83cc\u836f\u7269\u5355\u836f\u7ecf\u9a8c\u6027\u6cbb\u7597\uff08A\uff0c1\uff09\u3002\u672a\u4f7f\u7528\u8fc7\u6c1f\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\u60a3\u8005\uff0c\u53ef\u5355\u7528\u6c1f\u55b9\u8bfa\u916e\u7c7b\u836f\u7269\uff08B\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c121 \uff1a\u5728\u533b\u9662\u73af\u5883\u548c \/ \u6216\u8fd1\u671f\u5e94\u7528 \u03b2- \u5185\u9170\u80fa\u7c7b\u6297\u83cc\u836f\u7269\u7684 SBP \u60a3\u8005\uff0c\u5e94\u6839\u636e\u836f\u654f\u8bd5\u9a8c\u6216\u9009\u62e9\u4ee5\u78b3\u9752\u9176\u70ef\u7c7b\u4e3a\u57fa\u7840\u7684\u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597\uff08A\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c122 \uff1a\u8179\u6c34 PMN \u8ba1\u6570 < 250\/mm \u00b3 \uff0c\u4f34\u611f\u67d3\u7684\u75c7\u72b6\u6216\u8179\u90e8\u75bc\u75db\u3001\u89e6\u75db\u5e94\u63a5\u53d7\u7ecf\u9a8c\u6027\u6297\u611f\u67d3\u6cbb\u7597\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c123 \uff1a\u91cd\u75c7 SBP \u53ef\u8054\u5408\u4f7f\u7528\u6297\u83cc\u836f\u7269\u3001\u4eba\u8840\u767d\u86cb\u767d\u548c\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u6cbb\u7597\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c124 \uff1a\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u53ef\u4f7f\u7528\u5229\u798f\u6614\u660e\u8fdb\u884cSBP \u4e8c\u7ea7\u9884\u9632\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c125 \uff1a\u6297\u83cc\u836f\u7269\u6cbb\u7597\u5e94\u7b54\u5dee\u7684\u60a3\u8005\uff0c\u9700\u8003\u8651\u8010\u836f\u83cc\u548c \/ \u6216\u771f\u83cc\u6027\u8179\u819c\u708e\uff0c\u771f\u83cc\u6027\u8179\u819c\u708e\u53ef\u9009\u62e9\u5511\u7c7b\u6216\u68d8\u767d\u83cc\u7d20\u7c7b\u7b49\u6297\u771f\u83cc\u836f\u7269\uff08B\uff0c1\uff09\u3002<\/p>\n

\uff5c\u56db\u3001\u6025\u6027\u80be\u635f\u4f24\u4e0e\u809d\u80be\u7efc\u5408\u5f81\uff5c<\/p>\n

\uff08\u4e00\uff09\u5b9a\u4e49<\/p>\n

\u809d\u786c\u5316\u60a3\u8005\u80be\u529f\u80fd\u635f\u4f24\u5305\u62ec AKI\u3001HRS – AKI\u3001\u809d\u80be\u7efc\u5408\u5f81 – \u975e\u6025\u6027\u80be\u635f\u4f24\uff08hepatorenal syndrome – non acute kidney injury\uff0cHRS – NAKI\uff09\u3001\u6162\u6027\u80be\u75c5\uff08chronic kidney diseases\uff0cCKD\uff09\u548c\u6025\u6027\u80be\u75c5\uff08acute kidney diseases\uff0cAKD\uff09 [77] \u3002\u6700\u65b0\u7684\u809d\u786c\u5316\u80be\u635f\u4f24\u5206\u7c7b\u53bb\u9664\u4e86\u4f20\u7edf 1 \u578b\u30012 \u578bHRS [7\uff0c13\uff0c78] \u3002HRS \u662f\u4e25\u91cd\u809d\u75c5\u60a3\u8005\u75c5\u7a0b\u540e\u671f\u51fa\u73b0\u7684\u529f\u80fd\u6027\u80be\u8870\u7aed\uff0c\u80be\u810f\u65e0\u660e\u663e\u5668\u8d28\u6027\u75c5\u53d8\uff0c\u662f\u4ee5\u80be\u529f\u80fd\u635f\u4f24\u3001\u8840\u6d41\u52a8\u529b\u5b66\u6539\u53d8\u548c\u5185\u6e90\u6027\u8840\u7ba1\u6d3b\u6027\u7269\u8d28\u660e\u663e\u5f02\u5e38\u4e3a\u7279\u5f81\u7684\u4e00\u79cd\u7efc\u5408\u5f81\u3002<\/p>\n

\uff08\u4e8c\uff09\u53d1\u75c5\u673a\u5236<\/p>\n

\u809d\u786c\u5316 HRS \u7684\u53d1\u75c5\u673a\u5236\u4ecd\u4e0d\u5b8c\u5168\u6e05\u695a\uff0c\u76ee\u524d\u4e3b\u8981\u8ba4\u4e3a\u662f\u7531\u4e8e\u4e25\u91cd\u7684\u809d\u529f\u80fd\u969c\u788d\u5bfc\u81f4\u7684\u8840\u6d41\u52a8\u529b\u5b66\u6539\u53d8\uff0c\u80be\u8840\u6d41\u51cf\u5c11\uff0c\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08glomerular filtration rate\uff0cGFR\uff09\u964d\u4f4e\uff0c\u5bfc\u81f4\u5c11\u5c3f\u548c\u6c2e\u8d28\u8840\u75c7[79] \u3002<\/p>\n

\u4efb\u4f55\u52a0\u91cd\u8840\u6d41\u52a8\u529b\u5b66\u5f02\u5e38\u7684\u8bf1\u56e0\uff0c\u5982\u6d88\u5316\u9053\u51fa\u8840\u3001\u8fc7\u5ea6\u5229\u5c3f\u3001SBP\u3001\u5927\u91cf\u62bd\u53d6\u8179\u6c34\u7b49\uff0c\u5373\u201c\u7b2c\u4e8c\u6b21\u6253\u51fb\u201d\uff0c\u53ef\u4fc3\u8fdbHRS – AKI \u7684\u53d1\u751f[80] \u3002<\/p>\n

\uff08\u4e09\uff09\u8bca\u65ad<\/p>\n

AKI \u662f\u5931\u4ee3\u507f\u671f\u809d\u786c\u5316\u60a3\u8005\u4e25\u91cd\u7684\u5e76\u53d1\u75c7\u4e4b\u4e00\u3002\u4f4f\u9662\u809d\u786c\u5316\u60a3\u8005 AKI \u53d1\u751f\u7387\u53ef\u9ad8\u8fbe 20% \uff5e 80% [81-83] \uff0c\u4e14\u66f4\u6613\u8fdb\u5c55\u4e3a\u80be\u8870\u7aed\uff0c\u75c5\u6b7b\u7387\u9ad8\u3002\u56fd\u9645\u8179\u6c34\u4ff1\u4e50\u90e8\uff08ICA\uff09\u4fee\u8ba2\u7684 AKI \u8bca\u65ad\u6807\u51c6\u4e3a[7\uff0c13\uff0c84]\uff1a\u5165\u9662 48 h \u5185 Scr \u8f83\u57fa\u7ebf\u5347\u9ad8\u2265 26.5 \u03bcmol\/L\uff080.3 mg\/dl\uff09\uff0c\u6216 7 d \u5185 Scr \u5347\u9ad8\u8f83\u5df2\u6709\u6216\u63a8\u65ad\u7684\u57fa\u7ebf\u503c\u2265 50%\uff083 \u4e2a\u6708\u5185\u4efb\u4f55\u4e00\u6b21 Scr \u503c\u5747\u53ef\u4f5c\u4e3a\u57fa\u7ebf\uff09\u3002<\/p>\n

1 \u671f \uff1aScr \u5347\u9ad8\u7edd\u5bf9\u503c\u2265 26.5 \u03bcmol\/L\uff080.3 mg\/dl\uff09\uff0c\u6216 Scr \u5347\u9ad8\u81f3\u57fa\u7ebf\u503c\u7684 1.5 \uff5e 2.0 \u500d \uff1b2 \u671f \uff1aScr \u5347\u9ad8\u81f3\u57fa\u7ebf\u503c\u7684 2.0 \uff5e 3.0 \u500d \uff1b3 \u671f \uff1aScr \u5347\u9ad8\uff1e\u57fa\u7ebf\u503c 3.0 \u500d\uff0c\u6216Scr\u2265 353.6 \u03bcmol\/L\u57fa\u7840\u4e0a\u6025\u5267\u5347\u9ad8\u226526.5 \u03bcmol\/L\uff080.3 mg\/dl\uff09\uff0c\u6216\u5f00\u59cb\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\u3002<\/p>\n

HRS – AKI \u7684\u8bca\u65ad\u6807\u51c6 \uff1a\uff081\uff09\u6709\u809d\u786c\u5316\u3001\u8179\u6c34 \uff1b\uff082\uff09\u7b26\u5408 ICA \u5bf9 AKI \u7684\u8bca\u65ad\u6807\u51c6 \uff1b\uff083\uff09\u505c\u7528\u5229\u5c3f\u836f\u7269\u5e76\u6309\u4f53\u8d28\u91cf1 g\/kg \u8865\u5145\u767d\u86cb\u767d\u6269\u5145\u8840\u5bb9\u91cf\u6cbb\u7597 48 h \u65e0\u5e94\u7b54\uff1b\uff084\uff09\u65e0\u4f11\u514b\uff1b\uff085\uff09\u76ee\u524d\u6216\u8fd1\u671f\u6ca1\u6709\u4f7f\u7528\u80be\u6bd2\u6027\u836f\u7269 \uff1b\uff086\uff09\u6ca1\u6709\u80be\u810f\u7ed3\u6784\u6027\u635f\u4f24\u8ff9\u8c61 : \u2460\u65e0\u86cb\u767d\u5c3f\uff08< 500 mg\/d\uff09; \u2461\u65e0\u5fae\u91cf\u8840\u5c3f\uff08\u6bcf\u9ad8\u500d\u89c6\u91ce < 50 \u4e2a\u7ea2\u7ec6\u80de\uff09; \u2462\u80be\u810f\u8d85\u58f0\u68c0\u67e5\u6b63\u5e38\u3002<\/p>\n

\u5c3f\u91cf\u5728\u809d\u786c\u5316\u5408\u5e76\u8179\u6c34\u7684 HRS \u7684\u8bca\u65ad\u610f\u4e49\u5b58\u5728\u4e89\u8bae\uff0c\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u5e38\u5408\u5e76\u5c3f\u5c11\u53ca\u4e25\u91cd\u94a0\u6f74\u7559\u5374\u7ef4\u6301\u76f8\u5bf9\u6b63\u5e38\u7684GFR\uff0c\u6709\u4e9b\u60a3\u8005\u53ef\u80fd\u7531\u4e8e\u4f7f\u7528\u5229\u5c3f\u836f\u7269\u800c\u9020\u6210\u5c3f\u91cf\u589e\u52a0\u3002<\/p>\n

HRS \u4e00\u76f4\u88ab\u8ba4\u4e3a\u662f\u201c\u7ec8\u672b\u671f\u809d\u75c5\u529f\u80fd\u6027\u80be\u529f\u80fd\u8870\u7aed\u201d\u3002\u968f\u7740\u4e34\u5e8a\u7814\u7a76\u6df1\u5165\uff0c\u80be\u810f\u65e0\u5668\u8d28\u6027\u635f\u4f24\u672a\u5f97\u5230\u80be\u810f\u6d3b\u68c0\u8bc1\u5b9e\u3002\u65e0\u663e\u8457\u86cb\u767d\u5c3f\u548c \/ \u6216\u8840\u5c3f\uff0c\u4e5f\u4e0d\u80fd\u6392\u9664\u80be\u810f\u75c5\u53d8\uff0c\u7279\u522b\u662f\u80be\u5c0f\u7ba1\u548c\u80be\u95f4\u8d28\u75c5\u53d8\u3002\u5c3f\u03b11\/\u03b22 – \u5fae\u7403\u86cb\u767d\u3001\u5c3f\u94a0\/\u94be\u6bd4\u503c\u7b49\uff0c\u53ef\u65e9\u671f\u9274\u522b\u6709\u65e0\u5668\u8d28\u6027\u80be\u635f\u4f24[85 – 86] \u3002\u4f20\u7edf 1 \u578b HRS \u76f8\u5f53\u4e8eHRS – AKI\uff0c2 \u578b HRS \u76f8\u5f53\u4e8e HRS – NAKI\u3002<\/p>\n

HRS – NAKI [85] \uff08\u5305\u62ec AKD \u548c CKD\uff09\u662f\u6307\u9664\u4e86 HRS – AKI\u4ee5\u5916\uff0c\u809d\u786c\u5316\u4f34\u6216\u4e0d\u4f34\u8179\u6c34 \uff1b\u4f30\u7b97\u80be\u5c0f\u7403\u6ee4\u8fc7\u7387\uff08eGFR\uff09 <60 ml\u00b7min -1<\/sup> \u00b7\uff081.73 m 2<\/sup> \uff09 -1 <\/sup>\uff0c\u6ca1\u6709\u5176\u4ed6\u5668\u8d28\u6027\u75c5\u53d8 \uff1b\u6216 3 \u4e2a\u6708\u5185 Scr \u7684\u6700\u540e\u503c\u4f5c\u4e3a\u57fa\u7ebf\u503c\uff0cScr < 50\uff05\u7684\u589e\u52a0 \uff1b\u53ef\u6709\u80c6\u6c41\u6027\u80be\u75c5\uff0c\u6d88\u5316\u9053\u51fa\u8840\u3001\u8fc7\u5ea6\u4f7f\u7528\u5229\u5c3f\u836f\u7269\u6216\u5927\u91cf\u653e\u8179\u6c34\u7b49 \uff1b\u6025\u6027\u80be\u5c0f\u7ba1\u635f\u4f24\u3001\u574f\u6b7b\u53ca\u6025\u6027\u95f4\u8d28\u6027\u80be\u708e\u3002\u4e0e HRS – AKI \u76f8\u6bd4\uff0cHRS – NAKI \u60a3\u8005\u7684\u5668\u5b98\u529f\u80fd\u8870\u7aed\u8bc4\u5206\u66f4\u9ad8\uff0c\u767d\u86cb\u767d\u548c\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u7684\u7597\u6548\u4e0d\u5982 HRS – AKI [86] \u3002<\/p>\n

\u809d\u786c\u5316CKD\u5b9a\u4e49\u4e3a\u65e0\u8bba\u80be\u810f\u6709\u65e0\u5668\u8d28\u6027\u635f\u4f24\uff08\u86cb\u767d\u5c3f\/\u8840\u5c3f\/\u8d85\u58f0\u63d0\u793a\u80be\u810f\u5f02\u5e38\uff09\uff0ceGFR < 60 ml\u00b7min -1 <\/sup>\u00b7\uff081.73 m 2<\/sup> \uff09 -1<\/sup><\/p>\n

\u6301\u7eed 3 \u4e2a\u6708\u5373\u53ef\u8bca\u65ad\u3002\u6162\u6027\u809d\u75c5\u5408\u5e76 CKD \u7684\u53d1\u751f\u7387\u9ad8\u4e8e\u6b63\u5e38\u4eba\u7fa4\uff0c\u4e14\u540c\u65f6\u5408\u5e76\u8425\u517b\u4e0d\u826f\u3001\u611f\u67d3\u7b49\u5e76\u53d1\u75c7\u7684\u6982\u7387\u589e\u52a0\u3002\u4e25\u91cd\u6216\u53cd\u590d\u53d1\u4f5c\u7684 AKI \u60a3\u8005\uff0cCKD \u7684\u98ce\u9669\u66f4\u9ad8\u3002\u975e\u9152\u7cbe\u6027\u8102\u80aa\u809d\u3001\u6162\u6027\u4e59\u578b\u3001\u4e19\u578b\u809d\u708e\u6216\u5176\u4ed6\u80be\u5c0f\u7403\u80be\u708e\u6216\u95f4\u8d28\u6027\u80be\u75c5\u60a3\u8005\u66f4\u6613\u53d1\u751f AKI \u6216 CKD\u3002<\/p>\n

\u5f53\u60a3\u8005\u5b58\u5728 EVB\u3001\u7535\u89e3\u8d28\u7d0a\u4e71\u3001SBP\u3001\u5927\u91cf\u653e\u8179\u6c34\u3001\u5927\u91cf\u5229\u5c3f\u3001SCr \u8f7b\u5fae\u5347\u9ad8\u53ca\u4e25\u91cd\u5455\u5410\u3001\u8179\u6cfb\u7b49\u60c5\u51b5\uff0c\u4e14\u80be\u529f\u80fd\u5feb\u901f\u51cf\u9000\uff0c\u8981\u8003\u8651 HRS \uff1a\u2460\u4e86\u89e3\u60a3\u8005\u8fd1\u671f\u7528\u836f\u60c5\u51b5\uff0c\u5c06\u5229\u5c3f\u836f\u7269\u51cf\u91cf\u6216\u505c\u7528\uff0c\u505c\u7528\u5177\u6709\u6f5c\u5728\u80be\u6bd2\u6027\u836f\u7269\u3001\u8840\u7ba1\u6269\u5f20\u836f\u6216\u975e\u753e\u4f53\u7c7b\u6297\u708e\u836f \uff1b\u2461\u5bf9\u53ef\u7591\u4f4e\u8840\u5bb9\u91cf\u60a3\u8005\u8fdb\u884c\u6269\u5bb9\u6cbb\u7597\uff08\u6839\u636e\u75c5\u60c5\u53ef\u91c7\u7528\u4eba\u8840\u767d\u86cb\u767d\u3001\u8840\u5236\u54c1\u6216\u6676\u4f53\u6db2\uff09\uff1b\u2462\u5982\u786e\u8bca\u6216\u9ad8\u5ea6\u6000\u7591\u5408\u5e76\u7ec6\u83cc\u611f\u67d3\uff0c\u5e94\u8fdb\u884c\u7ec6\u83cc\u9274\u5b9a\u5e76\u7ed9\u4e88\u65e9\u671f\u6297\u611f\u67d3\u6cbb\u7597 \uff1b\u2463\u7ecf\u4e0a\u8ff0\u63aa\u65bd\u65e0\u6548\uff0c\u4e14 SCr \u7ee7\u7eed\u5347\u9ad8\uff1e\u57fa\u7ebf\u6c34\u5e7350%\uff0c> 1.5 mg\/dl\uff08133 \u03bcmol\/L\uff09\u53ef\u8bca\u65ad HRS\u3002<\/p>\n

\uff08\u56db\uff09\u6cbb\u7597<\/p>\n

1. \u5e38\u89c4\u6cbb\u7597<\/p>\n

\u5c3d\u65e9\u7ed9\u4e88\u9ad8\u70ed\u91cf\u6613\u6d88\u5316\u996e\u98df\uff0c\u5bc6\u5207\u76d1\u6d4b\u8840\u538b\u3001\u5c3f\u91cf\u3001\u809d\u80be\u529f\u80fd\u3002\u4fdd\u6301\u6db2\u4f53\u5e73\u8861\uff0c\u9632\u6b62\u6db2\u4f53\u8d85\u8d1f\u8377\u548c\u7a00\u91ca\u6027\u4f4e\u94a0\u8840\u75c7\u53d1\u751f\u3002\u79ef\u6781\u63a7\u5236\u611f\u67d3\u3002<\/p>\n

2. \u836f\u7269\u6cbb\u7597<\/p>\n

\u901a\u8fc7\u5e94\u7528\u8840\u7ba1\u6536\u7f29\u836f\u7269\uff0c\u6536\u7f29\u660e\u663e\u6269\u5f20\u7684\u5185\u810f\u8840\u7ba1\u5e8a\u548c\u5347\u9ad8\u52a8\u8109\u538b\uff0c\u6539\u5584\u5faa\u73af\u529f\u80fd\uff0c\u589e\u52a0\u80be\u8840\u6d41\u91cf\u548c GFR\u3002\u4e3b\u8981\u6709\u7279\u5229\u52a0\u538b\u7d20\u3001\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u3001\u7c73\u591a\u541b\u548c\u751f\u957f\u6291\u7d20\u7c7b\u4f3c\u7269\u7b49\u3002<\/p>\n

\uff081\uff09\u7279\u5229\u52a0\u538b\u7d20\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d \uff1a\u7279\u5229\u52a0\u538b\u7d20\u8054\u5408\u767d\u86cb\u767d\u5728\u9006\u8f6c HRS – AKI \u548c HRS – NAKI\u3001\u6539\u5584\u80be\u529f\u80fd\u65b9\u9762\uff0c\u4f18\u4e8e\u5b89\u6170\u5242\u3001\u5355\u7528\u767d\u86cb\u767d\u3001\u5965\u66f2\u80bd\u6216\u7c73\u591a\u541b + \u5965\u66f2\u80bd + \u767d\u86cb\u767d[29\uff0c87 – 92] \u3002\u7279\u5229\u52a0\u538b\u7d20\uff08\u6bcf4\uff5e6 h 1 mg\uff09\u8054\u5408\u767d\u86cb\u767d\uff0820\uff5e40 g\/d\uff09\u6cbb\u7597 3 d\uff0cScr \u4e0b\u964d < 25%\uff0c\u53ef\u9010\u6b65\u589e\u52a0\u81f3\u6bcf 4 h 2 mg\u3002\u82e5\u6709\u6548\uff08Scr \u4e0b\u964d\u81f3 < 133 \u03bcmol\/L\uff0c\u4e14\u52a8\u8109\u538b\u3001\u5c3f\u91cf\u548c\u8840\u94a0\u6d53\u5ea6\u589e\u52a0\uff09\uff0c\u7597\u7a0b 7 \uff5e 14 d \uff1b\u5e94\u7b54\u8005\u505c\u836f\u540e\u4e00\u822c\u590d\u53d1\u8f83\u5c11\u89c1\uff0c\u82e5\u590d\u53d1\uff0c\u53ef\u518d\u4f7f\u7528\u7279\u5229\u52a0\u538b\u7d20\u3002\u82e5\u65e0\u6548\uff0c\u53ef\u8bd5\u7528\u751f\u957f\u6291\u7d20\u7c7b\u4f3c\u7269\u6216\u53bb\u7532\u80be\u4e0a\u817a\u7d20\uff080.5 \uff5e 3.0 mg\/h\uff09\u8054\u5408\u767d\u86cb\u767d\uff0810 \uff5e 20 g\/L\uff09\u3002<\/p>\n

\u57fa\u7ebf\u8840\u80c6\u7ea2\u7d20\uff1c 10 mg\/dl \u548c\u6cbb\u7597 3 d \u540e\u5e73\u5747\u52a8\u8109\u538b\u4e0a\u5347\u2265 5 mmHg \u662f\u4e24\u4e2a\u72ec\u7acb\u7684\u7f29\u8840\u7ba1\u836f\u7269\u6cbb\u7597\u5e94\u7b54\u9884\u6d4b\u56e0\u7d20[93] \u3002<\/p>\n

\uff082\uff09\u751f\u957f\u6291\u7d20\u7c7b\u4f3c\u7269\u3001\u7c73\u591a\u541b\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d \uff1a\u751f\u957f\u6291\u7d20\u7c7b\u4f3c\u7269\u8054\u5408\u7c73\u591a\u541b\u53ca\u4eba\u8840\u767d\u86cb\u767d\u6cbb\u7597 HRS – AKI \u53ef\u4f5c\u4e3a\u7279\u5229\u52a0\u538b\u7d20\u7684\u66ff\u4ee3\u65b9\u6cd5[89] \u3002\u751f\u957f\u6291\u7d20\u7c7b\u4f3c\u7269\u6bcf 8 h 100 \u03bcg\uff0c\u7c73\u591a\u541b\u53e3\u670d\u8d77\u59cb\u5242\u91cf\u6bcf 8 h 2.5 \uff5e 7.5 mg\uff0c\u5982\u80be\u529f\u80fd\u65e0\u6539\u5584\uff0c\u5242\u91cf\u5206\u522b\u589e\u52a0\u81f3\u6bcf 8 h 200 \u03bcg \u548c 12.5 mg\u3002<\/p>\n

\uff083\uff09\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d \uff1a\u53bb\u7532\u80be\u4e0a\u817a\u7d200.5 \uff5e 3 mg\/h\uff0c\u4eba\u8840\u767d\u86cb\u767d 10 \uff5e 20 g\/d\uff0c\u7597\u7a0b 7 \uff5e 14 d\uff0c\u5bf9 HRS \u6709\u7c7b\u4f3c\u4e8e\u7279\u5229\u52a0\u538b\u7d20\u7684\u6548\u679c[87\uff0c94] \u3002<\/p>\n

\uff084\uff09\u6258\u4f10\u666e\u5766 \uff1a\u4f20\u7edf\u5229\u5c3f\u836f\u7269\u5e76\u4e0d\u80fd\u589e\u52a0 HRS \u60a3\u8005\u7684\u5c3f\u91cf\uff0c\u4e14\u544b\u585e\u7c73\u6709\u53ef\u80fd\u52a0\u91cd AKI\u3002\u6258\u4f10\u666e\u5766\u9009\u62e9\u6027\u7ed3\u5408\u975e\u80bd\u7c7b\u8840\u7ba1\u52a0\u538b\u7d20\u53d7\u4f53\uff0c\u6291\u5236\u6297\u5229\u5c3f\u6fc0\u7d20\u4f5c\u7528\u800c\u4e0d\u523a\u6fc0\u4ea4\u611f\u795e\u7ecf\u6216\u919b\u56fa\u916e\u7cfb\u7edf\uff0c\u660e\u663e\u589e\u52a0\u5c3f\u91cf\uff0c\u7ea0\u6b63\u4f4e\u94a0\u8840\u75c7\uff0c\u4e0d\u5f71\u54cd\u80be\u810f\u529f\u80fd\uff0c\u4e0d\u589e\u52a0 HE\u3001EVB \u53ca HRS \u7684\u53d1\u751f[95] \u3002<\/p>\n

\uff085\uff09\u6269\u8840\u7ba1\u836f\u7269 \uff1a\u5916\u5468\u8840\u7ba1\u6269\u5f20\u662f\u809d\u786c\u5316 HRS \u7684\u4e3b\u8981\u53d1\u75c5\u673a\u5236\uff0c\u76ee\u524d\u5bf9 HRS \u5df2\u4e0d\u518d\u63a8\u8350\u4f7f\u7528\u6269\u8840\u7ba1\u836f\u7269\u3002<\/p>\n

3. TIPS<\/p>\n

TIPS\u53ef\u6539\u5584HRS – AKI\u548cHRS – NAKI\u60a3\u8005\u7684\u80be\u529f\u80fd[96] \uff0c\u80fd\u6709\u6548\u63a7\u5236\u8179\u6c34\uff0c\u51cf\u8f7b\u95e8\u9759\u8109\u538b\u529b\uff0c\u5bf9 HRS – NAKI \u60a3\u8005\u7597\u6548\u8f83\u597d[74\uff0c97] \u3002\u51fa\u73b0 HRS – AKI \u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u4e00\u822c\u75c5\u60c5\u8f83\u91cd\uff0c\u591a\u6709 TIPS \u6cbb\u7597\u7981\u5fcc\u8bc1\u3002<\/p>\n

4. \u8840\u6db2\u51c0\u5316\u6cbb\u7597\uff08\u4eba\u5de5\u809d\u3001\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\uff09<\/p>\n

\u53ef\u6539\u5584\u90e8\u5206 HRS – AKI \u60a3\u8005\u80be\u529f\u80fd\u3002\u4e3b\u8981\u7528\u4e8e HRS \u5e76\u53d1\u4e25\u91cd\u9ad8\u94be\u8840\u75c7\u3001\u4ee3\u8c22\u6027\u9178\u4e2d\u6bd2\u3001\u5bb9\u91cf\u8d85\u8d1f\u8377\uff0c\u7ea6 40% \u60a3\u8005\u7684\u80be\u529f\u80fd\u53ef\u5f97\u5230\u660e\u663e\u6539\u5584[98] \u3002<\/p>\n

5. \u809d\u79fb\u690d<\/p>\n

\u809d\u79fb\u690d\u662f HRS – AKI \u548c HRS – NAKI \u7684\u4f18\u5148\u6cbb\u7597\u65b9\u6cd5\u3002<\/p>\n

\uff08\u4e94\uff09HRS \u7684\u9884\u9632<\/p>\n

\u7ec6\u83cc\u611f\u67d3\u3001\u8fc7\u5ea6\u4f7f\u7528\u5229\u5c3f\u5242\u3001\u5927\u91cf\u653e\u8179\u6c34\u3001\u4e0a\u6d88\u5316\u9053\u51fa\u8840\u3001\u80c6\u6c41\u6de4\u79ef\u6027\u9ec4\u75b8\u7b49\u4e8c\u6b21\u6253\u51fb\u90fd\u53ef\u4ee5\u8bf1\u53d1 HRS\u3002<\/p>\n

1. \u9884\u9632\u611f\u67d3<\/p>\n

\u7ea6 30% \u809d\u786c\u5316\u8179\u6c34\u4f34 SBP \u53ef\u4ee5\u8fdb\u5c55\u4e3a HRS\uff0c\u9884\u9632\u6027\u4f7f\u7528\u6297\u83cc\u836f\u7269\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\u53ef\u5c06 HRS \u7684\u53d1\u751f\u7387\u964d\u4e3a 10%\u30022021 \u5e74 AASLD\u30012018 \u5e74\u6b27\u6d32\u809d\u75c5\u5b66\u4f1a\uff08EASL\uff09\u6307\u5357\u5747\u63a8\u8350 SBP \u8f93\u6ce8\u4eba\u8840\u767d\u86cb\u767d\u8054\u5408\u6297\u83cc\u836f\u7269\uff0c\u51cf\u5c11 HRS \u7684\u53d1\u751f[13\uff0c99] \u3002<\/p>\n

2. \u614e\u7528\u5927\u5242\u91cf\u4f20\u7edf\u5229\u5c3f\u836f\u7269\u548c\u5927\u91cf\u653e\u8179\u6c34<\/p>\n

\u5bf9\u8840\u94a0\u964d\u4f4e\u7684\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u5728\u614e\u7528\u5229\u5c3f\u836f\u7269\u7684\u540c\u65f6\uff0c\u4e0d\u9650\u94a0\u996e\u98df \uff1b\u800c\u5bf9\u8840\u94a0\u57fa\u672c\u6b63\u5e38\u8005\u53ef\u5148\u9002\u5f53\u9650\u94a0\u996e\u98df\uff0c\u907f\u514d\u56e0\u4f4e\u94a0\u8840\u75c7\u5f15\u8d77\u7684\u80be\u529f\u80fd\u635f\u5bb3\u3002<\/p>\n

3. \u614e\u7528 NSBBs<\/p>\n

NSBBs \u53ef\u964d\u4f4e\u95e8\u9759\u8109\u538b\u529b\uff0c\u51cf\u5c11\u809d\u786c\u5316\u60a3\u8005\u9759\u8109\u66f2\u5f20\u7834\u88c2\u51fa\u8840\u7684\u98ce\u9669\u3002\u7136\u800c\uff0c\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u5408\u5e76 SBP\u3001\u52a8\u8109\u6536\u7f29\u538b < 90 mmHg\u3001\u8840\u94a0 < 130 mmol\/L \u6216\u80be\u529f\u80fd\u969c\u788d\u65f6\uff0cNSBBs \u7684\u4f7f\u7528\u53ef\u589e\u52a0\u8840\u6d41\u52a8\u529b\u5b66\u7d0a\u4e71\u3002\u56e0\u6b64\uff0c\u5bf9\u4e8e\u6b63\u5728\u4f7f\u7528 NSBBs \u9884\u9632\u98df\u7ba1\u9759\u8109\u66f2\u5f20\u7834\u88c2\u51fa\u8840\u7684\u60a3\u8005\u51fa\u73b0 HRS \u65f6\uff0c\u5e94\u6682\u65f6\u505c\u7528 NSBBs\uff0c\u5f85\u5faa\u73af\u529f\u80fd\u548c\u80be\u529f\u80fd\u6539\u5584\u540e\u6062\u590d\u6b63\u5e38\u5e94\u7528[100] \u3002<\/p>\n

\u63a8\u8350\u610f\u89c126 \uff1a\u5f53\u8840\u808c\u9150 48 h \u5185\u589e\u52a0\u2265 0.3 mg\/dl\uff0c\u6216\u4ece\u57fa\u7ebf\u503c\u589e\u52a0\u2265 50%\uff0c\u5e94\u8bca\u65ad AKI\uff08A\uff0c1\uff09\u3002\u65e0\u8bba\u80be\u810f\u6709\u65e0\u5668\u8d28\u6027\u635f\u4f24\uff08\u86cb\u767d\u5c3f \/ \u8840\u5c3f \/ \u8d85\u58f0\u63d0\u793a\u80be\u810f\u5f02\u5e38\uff09\uff0ceGFR < 60 ml\u00b7min -1<\/sup> \u00b7 \uff081.73 m 2<\/sup> \uff09 -1<\/sup> \u6301\u7eed 3 \u4e2a\u6708\u4ee5\u4e0a\uff0c\u53ef\u8bca\u65ad CKD\uff08B\uff0c2\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c127\uff1aHRS-AKI \u7684\u8bca\u65ad\uff1a\uff081\uff09\u809d\u786c\u5316\u5408\u5e76\u8179\u6c34\uff1b\uff082\uff09\u65e0\u4f11\u514b \uff1b\uff083\uff09\u7b26\u5408 AKI \u7684\u8bca\u65ad\u6807\u51c6 \uff1b\uff084\uff09\u505c\u5229\u5c3f\u836f\u7269\u8865\u5145\u767d\u86cb\u767d\u6269\u5145\u8840\u5bb9\u91cf 48 h \u65e0\u5e94\u7b54 \uff1b\uff085\uff09\u8fd1\u671f\u65e0\u80be\u6bd2\u6027\u836f\u7269\u4f7f\u7528\u53f2 \uff1b\uff086\uff09\u65e0\u80be\u5b9e\u8d28\u6027\u635f\u4f24\uff08A\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c128 \uff1aHRS-NAKI\uff08\u5305\u62ec AKD \u548c CKD\uff09\uff0c\u9664\u5916HRS-AKI\uff0c\u809d\u786c\u5316\u4f34\u6216\u4e0d\u4f34\u8179\u6c34 \uff1beGFR < 60 ml \u00b7 min -1 <\/sup>\u00b7\uff081.73 m 2 <\/sup>\uff09 -1 <\/sup>\uff0c\u6ca1\u6709\u5176\u4ed6\u5668\u8d28\u6027\u75c5\u53d8 \uff1bScr \u5347\u9ad8 < \u57fa\u7ebf\u503c 50\uff05\u3002<\/p>\n

\u63a8\u8350\u610f\u89c129 \uff1aHRS \u53ef\u5e94\u7528\u7279\u5229\u52a0\u538b\u7d20\u8054\u5408\u4eba\u8840\u767d\u86cb\u767d\uff0820 \uff5e 40 g\/d\uff09\uff0c\u8d77\u59cb\u5242\u91cf 1 \uff5e 2 mg\uff0c\u6bcf 12 h \u4e00\u6b21 ; \u53ef\u9010\u6b65\u589e\u52a0\u81f3\u6700\u5927\u5242\u91cf\u6bcf 4 \uff5e 6 h 2 mg\uff0c3 d\u3002\u6709\u6548\uff0c\u53ef\u7ee7\u7eed\u5e94\u7528 7 \uff5e14 d\u3002\u65e0\u6548\u505c\u7528\u7279\u5229\u52a0\u538b\u7d20\u6216\u8054\u5408\u5e94\u7528\u53bb\u7532\u80be\u4e0a\u817a\u7d20\uff080.5 \uff5e 3.0 mg\/h\uff09\u3002\u590d\u53d1\u8005\u53ef\u91cd\u590d\u5e94\u7528\uff08A\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c130 \uff1a\u8840\u7ba1\u6536\u7f29\u836f\u7269\u6cbb\u7597\u65e0\u6548\u4e14\u6ee1\u8db3\u8840\u6db2\u51c0\u5316\u6cbb\u7597\u6807\u51c6\u7684 HRS\uff0c\u53ef\u9009\u62e9\u76f8\u5173\u8840\u6db2\u51c0\u5316\u6cbb\u7597\uff08B\uff0c1\uff09\u3002<\/p>\n

\u63a8\u8350\u610f\u89c131 \uff1a\u5bf9\u8840\u7ba1\u6536\u7f29\u836f\u7269\u6cbb\u7597\u65e0\u5e94\u7b54\u4e14\u4f34\u5927\u91cf\u8179\u6c34\u7684 HRS-NAKI \u53ef\u884c TIPS \u6cbb\u7597\u3002HRS-AKI \u5e94\u7eb3\u5165\u809d\u79fb\u690d\u8ba1\u5212\uff08B\uff0c1\uff09\u3002<\/p>\n

\uff5c\u4e94\u3001\u5f85\u89e3\u51b3\u7684\u95ee\u9898\uff5c<\/p>\n

\uff08\u4e00\uff09\u654f\u611f\u6027\u548c\u7279\u5f02\u6027\u9ad8\u7684\u8179\u6c34\u75c5\u539f\u5fae\u751f\u7269\u5feb\u901f\u68c0\u6d4b\u65b9\u6cd5\u7684\u7814\u7a76 ; \u809d\u786c\u5316\u8179\u6c34\u60a3\u8005 AKI \u65e9\u671f\u8bca\u65ad\u751f\u7269\u6807\u5fd7\u7269\u7684\u7814\u7a76\u3002<\/p>\n

\uff08\u4e8c\uff09\u5927\u91cf\u653e\u8179\u6c34\u4e0e\u4eba\u8840\u767d\u86cb\u767d\u4e0d\u540c\u5242\u91cf\u6216\u7597\u7a0b\u7684\u6709\u6548\u6027\u3001\u5b89\u5168\u6027\u7814\u7a76\u3002<\/p>\n

\uff08\u4e09\uff09\u809d\u786c\u5316\u8179\u6c34 SBP \u4e00\u7ea7\u9884\u9632\u3001\u771f\u83cc\u6027\u8179\u819c\u708e\u65e9\u671f\u8bca\u6cbb\u7684\u4e34\u5e8a\u7814\u7a76\u3002<\/p>\n

\uff08\u56db\uff09 \u87ba\u5185\u916f\u3001\u544b\u585e\u7c73\u4e0e\u6258\u4f10\u666e\u5766\u7684\u4f18\u5316\u914d\u4f0d\u65b0\u65b9\u6848\u7814\u7a76\u3002<\/p>\n

\uff08\u4e94\uff09\u76ca\u751f\u83cc\u3001\u8840\u7ba1\u6d3b\u6027\u836f\u7269\u3001\u5e72\u7ec6\u80de\u7b49\u975e\u809d\u786c\u5316\u75c5\u56e0\u6cbb\u7597\u65b9\u6848\u53ca\u6548\u679c\u7814\u7a76\u3002<\/p>\n

\uff08\u516d\uff09\u5229\u7528\u4e92\u8054\u7f51\u533b\u9662\u7b49\u4fe1\u606f\u5316\u6280\u672f\u5bf9\u809d\u786c\u5316\u8179\u6c34\u60a3\u8005\u8fdb\u884c\u957f\u671f\u968f\u8bbf\u3001\u4e13\u4e1a\u62a4\u7406\u53ca\u5065\u5eb7\u6307\u5bfc\u7684\u7814\u7a76\u3002<\/p>\n","protected":false},"excerpt":{"rendered":"

\u5f15\u7528\u672c\u6587 \u4e2d\u534e\u533b\u5b66\u4f1a\u809d\u75c5\u5b66\u5206\u4f1a. \u809d\u786c\u5316\u8179\u6c34\u8bca\u7597\u6307\u5357[J]. \u4e2d\u534e\u809d\u810f\u75c5\u6742\u5fd7, … \u7ee7\u7eed\u9605\u8bfb →<\/span><\/a><\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[70],"tags":[],"class_list":["post-35155","post","type-post","status-publish","format-standard","hentry","category-70"],"_links":{"self":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/35155","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=35155"}],"version-history":[{"count":0,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=\/wp\/v2\/posts\/35155\/revisions"}],"wp:attachment":[{"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=35155"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=35155"},{"taxonomy":"post_tag","embeddable":true,"href":"http:\/\/zydq.1006ss.com\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=35155"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}