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1、肝肾综合症患者的临床特征分析江宏峰，吴金明，金颖，刘扬，吴利敏,温州医学院附属第一医院消化内科浙江省温州市325000［摘要］目的：探讨在肝硬化腹水基础上发生肝肾综合征(HRS)患者的临床特点，指导临床对HRS进行有效的预防和治疗。方法：冋顾性分析83例HRS患者及92例肝换化腹水而未发牛HRS患者(non-HRS)的临床资料，对两组患者的常见诱因、肝功能分级、交感神经张力、一般情况、死亡率及预后等进行比较分析。结果：(1)大量腹水及继发感染多见于HRS患者，而消化道出血则多见于non-HRS患者，在HRS患者中大量腹
2、水多见于II型HRS,而诱因不明者多见于I型HRSo(2)I型HRS患者肝功能最差,II型居中,non-HRS最好。⑶HRS患者交感神经张力明显高于non-HRS患者。⑷一般情况比鮫中HRS患者血肌ff(Scr)明显高于non-HRS患者，而血钠(Na+).24h尿量及平均动脉压均较后者低。(5)I型HRS的死亡率最窩，II型次之，non-HRS患者最低。HRS患者的生存时I'可明显低于non-HRS患者。结论：(l)HRS常见诱因有大暈腹水、感染、消化道出血、大量放腹水、水少电解质紊乱等，应尽量避免，一旦发现，应积极
3、采取措施，及时治疗。(2)HRS患者交感神经张力明显高于非HRS患者，此可为临床诊治提供参考依据。(3)较之non-HRS患者,HRS患者的病情非常严重,死亡率极髙，预后极差，尤以I型为其。【关键词］I肝破化肝肾综合征临床特点诱因预防对策AnalysisontheclinicalfeaturesofpatientswithhepatorenalsyndromeHong-FengJiang,Jin-MingWu,YinJin,YangLiu,Li-MinWu,DepartmentofGastroenterology,Th
4、eFirstAffiliatedHospitalofWenzhouMedicalCollege,Wenzhou325000,Zhejiang,ChinaCorrespondenceto：Jin-MingWu,Email：phdwu0003@yahoo.com.cn［AbstractJObjective:Investigatetheclinicalfeaturesofhepatorenalsyndrome(HRS)basedoncin-hosiswithascites,toimprovethepreventionandt
5、reatmentofthisdisease.Method:83casesofHRSand92casesofnon-HRSwereincludeinthisstudy.Thefollowingfactorsbetweenthetwogroupssuchaspredisposingfactor>liverfunction、sympathetictone>generalconditions^mortalityandsoonwereanalysedwithacase-controlstudy.Results:(1)Refact
6、oryascitesandinfectionaremorecommoninpatientswithHRS,butRefactoryascitesistheprevalentpredisposingfactorintypeIIHRS,andunknownfactorsaremorecommonintypeIHRS.(2)TheliverfunctioninpatientswithtypeIistheworst,thentype11,andnon-HRSisthebest.(3)Sympathetictonecompari
7、sontestsshowthatpatientswithHRSismoresensitivethannon-HRS.(4)TheNa*、UPDof24hoursandaveragebloodpressuresignificantlydecreasedwhenHRSappeared,andtheserumcreatinineissignificantlyhigherthanthepatientswithnon-HRS.(5)ThemortalityoftypeIHRSisthehighest,followedbytype
8、II,andthenon-HRSisthelowest.ThesurvivaltimeofpatientswithHRSwassignificantlyshorterthanpatientswithnon-HRS・Conclusions：®ThccommonpredisposingfactorofHRSincludingmassi
