Review article: volume expansion in patients with cirrhosis

被引:33
作者
Henriksen, JH
Kiszka-Kanowitz, M
Bendtsen, F
Moller, S
机构
[1] Univ Copenhagen, Hvidovre Hosp, Dept Clin Physiol 239, Copenhagen, Denmark
[2] Univ Copenhagen, Hvidovre Hosp, Dept Gastroenterol 439, Copenhagen, Denmark
关键词
D O I
10.1046/j.1365-2036.16.s5.3.x
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Adequate size and distribution of the circulating medium are important for cardiovascular function, tissue oxygenation, and fluid homoeostasis. Patients with cirrhosis have cardiovascular dysfunction with a hyperkinetic systemic circulation, abnormal distribution of the blood volume, vasodilation with low systemic vascular resistance, increased whole-body vascular compliance, and increased arterial compliance. The effectiveness and temporal relations of plasma blood volume expansion depend highly on the type of load (water, saline, oncotic material, red blood cells). Patients with cirrhosis respond in some aspects differently from healthy subjects, owing to their disturbed circulatory function and neurohormonal activation. Thus the increase in cardiac output and suppression of the renin-angiotensin-aldosterone system and sympathetic nervous system during volume expansion may be somewhat blunted, and in advanced cirrhosis, especially the non-central parts of the circulation, including the splanchnic blood volume, are expanded by a volume load. Infusion of oncotic material (preferably albumin) is important in the prevention of post-paracentesis circulatory dysfunction. In conclusion, volume expansion in advanced cirrhosis is qualitatively and quantitatively different from that of healthy subjects, and in those with early cirrhosis. Timely handling is essential, but difficult as it is a balance between the risks of excess extravascular volume loading and further circulatory dysfunction in these patients with a hyperdynamic, but hyporeactive, circulation.
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页码:12 / 23
页数:12
相关论文
共 100 条
[1]  
Abraham WT, 1999, ASCITES AND RENAL DYSFUNCTION IN LIVER DISEASE, P129
[2]  
ADAM R, 1991, TRANSPLANT P, V23, P2374
[3]   Randomized comparative multicenter study of hydroxyethyl starch versus albumin as a plasma expander in cirrhotic patients with tense ascites treated with paracentesis [J].
Altman, C ;
Bernard, B ;
Roulot, D ;
Vitte, RL ;
Ink, O .
EUROPEAN JOURNAL OF GASTROENTEROLOGY & HEPATOLOGY, 1998, 10 (01) :5-10
[4]   Total effective vascular compliance in patients with cirrhosis.: Effects of propranolol [J].
Andreu, V ;
Perello, A ;
Moitinho, E ;
Escorsell, A ;
García-Pagán, JC ;
Bosch, J ;
Rodés, J .
JOURNAL OF HEPATOLOGY, 2002, 36 (03) :356-361
[5]  
[Anonymous], 1984, HDB PHYSL CARDIOVASC
[6]   Complications of cirrhosis.: II.: Renal and circulatory dysfunction.: Lights and shadows in an important clinical problem [J].
Arroyo, V ;
Jiménez, W .
JOURNAL OF HEPATOLOGY, 2000, 32 :157-170
[7]   RENIN, ALDOSTERONE AND RENAL HEMODYNAMICS IN CIRRHOSIS WITH ASCITES [J].
ARROYO, V ;
BOSCH, J ;
MAURI, M ;
VIVER, J ;
MAS, A ;
RIVERA, F ;
RODES, J .
EUROPEAN JOURNAL OF CLINICAL INVESTIGATION, 1979, 9 (01) :69-73
[8]  
Arroyo V, 1999, ASCITES AND RENAL DYSFUNCTION IN LIVER DISEASE, P463
[9]  
BENGMARK S, 1989, PERITONEUM PERITONEA, P1
[10]   POTENTIAL ROLE OF INCREASED SYMPATHETIC ACTIVITY IN IMPAIRED SODIUM AND WATER-EXCRETION IN CIRRHOSIS [J].
BICHET, DG ;
VANPUTTEN, VJ ;
SCHRIER, RW .
NEW ENGLAND JOURNAL OF MEDICINE, 1982, 307 (25) :1552-1557