gastro-jРоссийский журнал гастроэнтерологии, гепатологии, колопроктологииRussian Journal of Gastroenterology, Hepatology, Coloproctology1382-43762658-6673«Gastro» LLC10.22416/1382-4376-2017-27-5-48-56gastro-j-180Research ArticleГЕПАТОЛОГИЯHEPATOLOGYПринципы диуретической терапии при лечении больных циррозом печениPrinciples of diuretic therapy at liver cirrhosisДядыкА. И.DyadykA. I.noemail@neicon.ruКуглерТ. Е.KuglerT. Ye.kugler2@mail.ruМаловичкоИ. С.MalovichkoI. S.noemail@neicon.ruЯроваяН. Ф.YarovayaN. F.noemail@neicon.ruРакитскаяИ. В.RakitskayaI. V.noemail@neicon.ruФИПО «Донецкий национальный медицинский университет им. Максима Горького»Russian Federation2017120820182754856Copyright © Дядык А.И., Куглер Т.Е., Маловичко И.С., Яровая Н.Ф., Ракитская И.В., 20182018Дядык А.И., Куглер Т.Е., Маловичко И.С., Яровая Н.Ф., Ракитская И.В.Dyadyk A.I., Kugler T.Y., Malovichko I.S., Yarovaya N.F., Rakitskaya I.V.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.gastro-j.ru/jour/article/view/180

Цель обзора. Представить основные положения лечебной тактики, используемой при отечном синдроме (асцит, гидроторакс, периферические отеки) у больных циррозом печени (ЦП). Основные положения. ЦП в большинстве случаев диагностируют на стадии декомпенсации, когда ведущим синдромом является портальная гипертензия. Отечный синдром - наиболее частое проявление портальной гипертензии, ассоциирующееся с заметным ухудшением качества жизни, риском развития спонтанных бактериальных инфекций, гепаторенального синдрома и неблагоприятным прогнозом. Важное место среди мероприятий, направленных на устранение отечного синдрома и профилактику его рецидивов, занимает диуретическая терапия. Необходимо ориентироваться в спектре осложнений, обусловленных диуретиками (нарушение гемодинамики, электролитного баланса и кислотно-основного состояния), что позволит прогнозировать возможность их развития, своевременно диагностировать и устранить, а следовательно, повысить эффективность лечения. Заключение. Лечебная тактика при развитии отечного синдрома у больных ЦП должна базироваться на ряде фундаментальных подходов, включающих: понимание патофизиологии отечного синдрома; полноценное обследование больных; оценку тяжести отечного синдрома (в частности, асцита) и наличия осложнений; учет фармакологических характеристик диуретиков, их взаимодействия и побочных эффектов; применение альбумина или плазмозаменителей, вазоконстрикторов, проведение при необходимости трансъюгулярного внутрипеченочного портосистемного шунтирования и трансплантации печени.

Aim of review. To present the key points of medical approach for treatment of edema syndrome (ascites, hydrothorax, dependent edema) at liver cirrhosis (LC). Key points. Most commonly LC is diagnosed at decompensated stage when portal hypertension becomes the leading syndrome. Generalized edema is the most common manifestation of portal hypertension which is associated with significant decrease in life quality, high risk of spontaneous bacterial complications, hepatorenal syndrome and poor prognosis. Diuretics play important role in the treatment of edema and prevention of relapses. The doctor should be aware of diuretic-related complications spectrum (hemodynamic, electrolytic, acid-base metabolism disorders) that will provide timely diagnostics and elimination and consequently, increase in treatment efficacy. Conclusion. Therapeutic approach for edema syndrome at LC should be based on series of fundamental steps: edema pathophysiology understanding; comprehensive investigation of patients; assessment of edema severity and presence of complications; awareness of pharmacological features of diuretic drugs, their interaction and side effects; albumin or plasma substitutes administration, use of vasoconstrictors, transjugular intrahepatic portosystemic shunting and liver transplantation when required.

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The authors declare that there are no conflicts of interest present.