摘要
肝硬化腹水患者限钠、利尿治疗中忽视补充丢失NaCl常导致低钠血症及精氨酸加压素(arginine vasopressin,AVP)合成与分泌增加和水潴留,有人强调给予AVP-V2受体拮抗剂(托伐普坦)治疗,但存在较多争议:(1)AVP升高及水潴留是否与低钠血症有关;(2)补充因应用利尿剂丢失NaCl是否能抑制AVP合成与释放;(3)高渗NaCl纠正低钠血症效果是否优于托伐普坦;(4)应用托伐普坦时如何规避等渗性血容量不足潜在风险因素;(5)从源头防止低钠血症是否能抑制AVP分泌等,本文就上述问题提出商榷。
Patients with cirrhosis,ascites and heart failure treated with sodium restriction and diuresis,ignoring the loss of NaCl,resulting in the decrease of serum sodium,which is called"acquired hyponatremia(AHA)".Multiple arginine vasopressin(AVP)synthesis and secretion increase and water retention were treated with AVP-V2 receptor antagonist(Tolvaptan),but there were many controversies:(1)Whether AVP elevation and water retention were related to AHA;(2)Whether the supplement of sodium chloride(NaCl)lost due to the application of diuretics can inhibit the synthesis and release of AVP;(3)Whether the effect of applying hypertonic NaCl to correct AHA is better than that of Tovaptan;(4)How to prevent Tovaptan related isotonic hypovolemia and potential risk factors;(5)Whether the prevention of AHA from the source is more advantageous than the application of Tovaptan,etc.This paper discussed the above problems.
作者
朱庆华
高成斌
刘建青
刘广林
刘建军
ZHU Qinghua;GAO Chengbin;LIU Jianqing;LIU Guanglin;LIU Jianjun(Department of Gastroenterology,the First Hospital of Handan City,Handan 056002;Handan Liver Disease Research Institute;Department of Gastroenterology,Handan Second Hospital,China)
出处
《胃肠病学和肝病学杂志》
CAS
2023年第12期1419-1422,共4页
Chinese Journal of Gastroenterology and Hepatology
关键词
低钠血症
腹水
限钠
利尿剂
精氨加压素
托伐普坦
Hyponatremia
Ascites
Sodium limit
Diuretic
Arginine vasopressin
Tolvaptan
