武瑞 刘春涛 傅晓晴

[摘要] 目的 非選择性β-受体阻滞剂（NSBBs）可降低肝硬化患者门脉压和静脉曲张出血的风险。探讨当这些患者发生自发性细菌性腹膜炎（SBP）时，应用NSBBs治疗，对患者循环储备的影响、肝肾综合征（HRS）的发生率及风险研究。且研究NSBBs对伴或不伴有SBP的肝硬化腹水患者的影响。 方法 回顾性分析2012年7月～2016年6月在我科住院的215例肝硬化患者，并将215例患者分为单纯腹水组和SBP两组，研究应用NSBBs对两组患者血流动力学的影响和发生HRS的风险。 结果 ①从血流动力学方面来看，SBP组患者的基础心率（HR）高于单纯腹水组，差异有统计学意义（P<0.01），而SBP组在动脉收缩压（SAP）、平均动脉压（MAP）方面与单纯腹水组比较，差异无统计学意义（P>0.01），但腹膜炎组患者的SAP、MAP普遍低于单纯腹水组。②在诊断SBP后，应用NSBBs组患者的静脉曲张破裂出血的发病率较高。虽然未用NSBBs组与应用NSBBs组在SAP、MAP方面无明显差异（P>0.05），但用NSBBs治疗的患者有较低的SAP和MAP。HRS发生率在应用NSBBs组较高，未用NSBBs组较低。结论 对于肝硬化合并SBP患者，NSBBs可增加血流动力学损害的比例和HRS的风险；肝硬化合并SBP患者不应该接受NSBBs治疗。

[关键词] 肝硬化；β-受体阻滞剂；自发性细菌性腹膜炎；肝肾综合征

[中图分类号] R575.2 [文献标识码] A [文章编号] 1673-9701（2018）25-0005-05

[Abstract] Objective Non-selective β-receptor blockers（NSBBs） can reduce the risk of portal hypertension and variceal bleeding in patients with cirrhosis. To investigate the effect of NSBBs on the circulatory reserve， incidence of hepatorenal syndrome （HRS） and risk when these patients develop spontaneous bacterial peritonitis （SBP）. We investigated the effect of NSBBs on cirrhotic patients with or without SBP. Methods 215 patients with cirrhosis who were retrospectively analyzed in our department from July 2012 to June 2016. 215 patients were divided into two groups： simple ascites group and SBP group. NSBBs were used to study the impact of hydrodynamics of the two groups of patients and the risk of HRS. Results 1. From the hemodynamic point of view， the basal heart rate（HR） in the SBP group was higher than that in the ascites group. The difference between the two groups was statistically significant（P<0.01）， while the SBP group was in the arterial systolic pressure. There was no significant difference in （SAP） and mean arterial pressure （MAP） between the ascites group and the ascites group （P>0.01）. However， SAP and MAP in the peritonitis group were generally lower than those in the ascites group. 2.After the diagnosis of SBP， the incidence of variceal hemorrhage in patients with NSBBs was higher. Although there was no statistically significant difference in SAP and MAP between the non-NSBBs group and the NSBBs group（P>0.05）. However， patients treated with NSBBs had lower SAP and MAP. The incidence of HRS was higher in the NSBBs group than in the non-NSBBs group. Conclusion For patients with cirrhosis combined with SBP， NSBBs increase the proportion of hemodynamic damage and the risk of HRS. Patients with cirrhosis complicated with SBP should not be treated with NSBBs.

[Key words] Liver cirrhosis； β-receptor blockers； Spontaneous bacterial peritonitis； Hepatorenal syndrome

肝硬化是慢性肝炎发展的结果，分为代偿性肝硬化（一般属 child-pugh A级）和失代偿性肝硬化（一般属child-pugh B、C级）。而失代偿期肝硬化患者可出现腹水、肝性脑病及门脉高压症引起的食管、胃底静脉明显曲张或破裂出血，往往预后差、并发症多、死亡率高。非选择性β-受体阻滞剂（Nonselective blockers，NSBBs）已被证明能通过抑制儿茶酚胺与β1和β2受体结合，来降低心输出量和内脏血管收缩，从而降低肝门静脉压力，故其在肝硬化患者中应用最广泛，甚至被称为“肝病中的阿司匹林”，然而，近年来β-受体阻滞剂的作用似乎已经改变[1]。最……