tailieunhanh - Báo cáo khoa học: "wards goal-directed therapy of hepatorenal syndrome: we have the tools but we need the trials"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Critical Care giúp cho các bạn có thêm kiến thức về ngành y học đề tài: owards goal-directed therapy of hepatorenal syndrome: we have the tools but we need the trials. | Available online http content 12 2 119 Commentary Towards goal-directed therapy of hepatorenal syndrome we have the tools but we need the trials Rajeshwar P Mookerjee and Rajiv Jalan Liver Failure Group Institute of Hepatology 69-75 Chenies Mews London WC1E 6HX UK Corresponding author Rajiv Jalan Published 19 March 2008 This article is online at http content 12 2 119 2008 BioMed Central Ltd Critical Care 2008 12 119 doi cc6804 See related research by Umgelter et al. http content 12 1 R4 Abstract Patients with cirrhosis who develop tense ascites and hepatorenal syndrome have a very high mortality and present a management challenge. Current debate stems from a lack of studies evaluating changes in effective arterial blood volume following paracentesis or targeting fluid replacement with appropriate vascular physiological measures to ensure no paracentesis-related circulatory dysfunction. The study by Umgelter and colleagues addresses a goal-directed approach to fluid management in hepatorenal syndrome and raises several mechanistic questions the answers to which are likely to improve our understanding of the pathophysiology in hepatorenal syndrome and to guide future management. Decompensated cirrhosis is characterized by severe circulatory derangements including progressive splanchnic vasodilatation and portal hypertension. These derangements result in several of the complications of advanced cirrhosis such as increasing ascites and hepatorenal syndrome HRS . The splanchnic vasodilatation in turn results in relative arterial underfilling 1 with consequent activation of the neurohumoral system leading to vasoconstriction of numerous vascular beds including the liver the kidney and the brain 2 . The more advanced the disease the greater the activation of these neurohumoral factors most maximal in the state of HRS 3 . Management of tense ascites in the context of evolving HRS has been debated with the .