Beta adrenergic blockade and decompensated cirrhosis
Beta adrenergic blockade and decompensated cirrhosis
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DOI：
10.1016/j.jhep.2016.11.001
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发表时间：
2017-04-01
影响因子：
25.7
通讯作者：
Mandorfer, Mattias
中科院分区：
文献类型：
--
作者：
Reiberger, Thomas;Mandorfer, Mattias
非选择性β受体阻滞剂（NSBB）仍然是门静脉高压症药物治疗的基石。其预防静脉曲张出血的有效性证据来自前瞻性试验，这些试验在很大程度上排除了难治性腹水和肾衰竭患者。随着对门脉高压引起的全身血流动力学、心脏功能和肾脏灌注变化的认识不断增加，新的研究引起了对NSBB有害影响的关注。临床医生正面临着一个持续的争议使用NSBB在晚期肝硬化患者。一方面，NSBB可有效预防静脉曲张出血，也可能具有有益的非血流动力学效应，然而，它们也可能诱导低血压并限制心脏储备。针对肝硬化特定病理生理阶段的个体化NSBB方案可能会优化患者管理。本文旨在对失代偿期肝硬化患者使用NSBB提供实用建议。(C)2016年欧洲肝脏研究协会。Elsevier B.V.出版，保留所有权利。
Non-selective betablockers (NSBBs) remain the cornerstone of medical treatment of portal hypertension. The evidence for their efficacy to prevent variceal bleeding is derived from prospective trials, which largely excluded patients with refractory ascites and renal failure. In parallel to the increasing knowledge on portal hypertension-induced changes in systemic hemodynamics, cardiac function, and renal perfusion, emerging studies have raised concerns about harmful effects of NSBBs. Clinicians are facing an ongoing controversy on the use of NSBBs in patients with advanced cirrhosis. On the one hand, NSBBs are effective in preventing variceal bleeding and might also have beneficial non-hemodynamic effects, however, they also potentially induce hypotension and limit the cardiac reserve. An individualized NSBB regimen tailored to the specific pathophysiological stage of cirrhosis might optimize patient management at this point. This article aims to give practical recommendations on the use of NSBBs in patients with decompensated cirrhosis. (C) 2016 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.