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慢加急性肝衰竭并发症对预后的影响及其管理
DOI: 10.12449/JCH260804
利益冲突声明：本文不存在任何利益冲突。
作者贡献声明：何敏负责设计论文框架，起草论文，修改论文；白浪负责拟定写作思路，指导撰写文章并最后定稿。
Impact of complications on prognosis in acute-on-chronic liver failure and related management measures
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摘要: 慢加急性肝衰竭（ACLF）是一种病情进展迅速、短期病死率极高的临床综合征，并发症的数量和严重程度是决定其预后不良的核心因素。然而，目前针对ACLF单个及多种并发症对预后影响的系统评价、规范化的并发症管理，尚缺乏系统性梳理。本文就ACLF常见并发症对预后的影响及其管理策略进行系统综述，以期为临床实践提供参考。Abstract: Acute-on-chronic liver failure （ACLF） is a clinical syndrome characterized by rapid disease progression and extremely high short-term mortality， and the number and severity of complications are core factors contributing to poor prognosis. However， there is still a lack of systematic evaluations of the impact of single or multiple complications of ACLF on prognosis， as well as the clinical value of standardized complication management. This article systematically reviews the impact of common complications of ACLF on prognosis and related management strategies， in order to provide a reference for clinical practice.
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Key words:
- Acute-On-Chronic Liver Failure /
- Complications /
- Prognosis /
- Disease Management
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表 1 ACLF常见并发症管理汇总
Table 1. Summary of management of common complications of ACLF
并发症 管理策略 注意事项 肝性脑病 GCS≤8分行气道保护和插管；及时去除诱因；药物首选乳果糖+
利福昔明；人工肝支持；肝移植评估评估意识状态和脑水肿，严格限液、限蛋白 凝血功能异常 静脉血栓：抗凝治疗；急性上消化道出血：血管收缩药+EBL，预防
性使用抗生素维持血流动力学稳定，监测脑、肾功能 HRS 首选白蛋白+特利加压素；早期启动RRT；肝或肝肾移植 特利加压素逐渐增量，减少不良反应 腹水 分级管理：1～2级，限钠+利尿；3级，LVP+白蛋白 监测体重、肌酐和钠，营养支持 ≥2个并发症 同步干预；移植评估；器官支持 非序贯性治疗，主动化解治疗冲突 注：ACLF，慢加急性肝衰竭；GCS，格拉斯哥昏迷量表；EBL，内镜下套扎术；HRS，肝肾综合征；RRT，肾脏替代治疗；LVP，大容量腹腔穿刺。
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