【摘要】 腹水是肝硬化预后不良的重要指标。近年来尽管出台了很多有关肝硬化腹水的指南和共识,但其处理中仍存在一些争议。回顾了目前肝硬化腹水处置中的难点及争议问题,如补钠和限钠的时机、利尿剂的选择、利水剂的应用价值、大量放腹水后补充白蛋白的方案、经颈静脉肝内门体分流术的指征和疗效等;并指出运用循证医学手段解决上述争议性问题,有助于提高肝硬化腹水的诊疗水平,改善患者预后。更多还原

【Abstract】 Ascites is an important indicator of poor prognosis of liver cirrhosis. Although several guidelines and consensus statements on the management of ascites have been published in the past years,there are still a lot of controversial problems in this regard. The current controversial problems and difficulties in the management of ascites,such as the timing of sodium supplementation or sodium restriction,the selection of diuretics,the application value of aquaretics,the strategy of albumin administration after large- volume paracentesis,and the indications and efficacy of transjugular intrahepatic portosystemic shunt,are reviewed. It is pointed out that further studies on these problems with evidence- based medicine means will enhance the diagnosis and treatment of cirrhotic ascites and improve patients’ prognosis.更多还原