内科学肝硬化和肝性脑病(英文).pptVIP

* Slide 302 NORFLOXACIN REDUCES RECURRENCE OF SPONTANEOUS BACTERIAL PERITONITIS (SBP) In a randomized placebo-controlled trial involving 80 cirrhotic patients who had recovered from an episode of SBP, the one-year probability of developing recurrent SBP was significantly lower in patients randomized to oral norfloxacin (400 mg/day) than in patients randomized to placebo (20% vs. 70%) (left panel). As shown in the right panel, recurrent SBP caused by gram-negative bacteria did not occur in any of the patients randomized to norfloxacin. Therefore, the use of long-term antibiotic prophylaxis is recommended in this setting. Gines P, et al. Hepatology 1990; 12: 716 * Slide 307 INDICATIONS FOR PROPHYLACTIC ANTIBIOTICS TO PREVENT SPONTANEOUS BACTERIAL PERITONITIS (SBP) There are only two groups of cirrhotic patients in whom the benefits of antibiotic prophylaxis outweigh the risks of developing quinolone-resistant organisms. These are cirrhotic patients hospitalized with gastrointestinal hemorrhage (short-term prophylaxis) and in patients who have recovered from a prior episode of SBP (long-term prophylaxis). In the setting of GI hemorrhage, the recommended regimen is oral norfloxacin at a dose of 400 mg twice a day for 7 days. If unable to take PO, IV quinolones are also acceptable. For secondary prophylaxis of SBP, the recommended regimen is oral norfloxacin at a dose of 400 mg a day. Weekly quinolones are not recommended because of a lower efficacy and a higher rate of quinolone-resistance. * Slide 203 ASCITES AND HEPATORENAL SYNDROME The most common complication of cirrhosis that results from portal hypertension and the consequent vasodilatation is the development of ascites and, in its extreme, the development of hepatorenal syndrome. The next section will deal with the pathogenesis and management of these complications. * Slide 310 CHARACTERISTICS OF HEPATORENAL SYNDROME (HRS) The hepatorenal syndrome (HRS) occurs in patients with advanced cirrhosis. It is a