Transcription of 간경변성 복수의 치료 - kasl.org
1 80PG 3PG Course 2012 Portal Hypertension Management of Ascites in CirrhosisByung-Ho KimKyung Hee University School of Medicine, Seoul, Korea 10 .1 2/3 ,2 60% .3 . , 6 5 ,4 1 , 1 2 . , , , . , , , , (azotemia).
2 , , , . , 90% .. 2011 ,5 2010 ,6 2009 7 . 1.. 81 . , . , B , .8-10 C , . D-penicillamie 6.
3 , ,11 .2.. , ..12 5 g ( 2 g, 88 mEq) , . , 24 78 mEq .. 125 mEq/L .13 1 L , . (antidiuretic hormone, ADH).
4 - - . , . Postgraduate Course 201282 .3. (24 10 mEq) , . , . , (70%) , 10-25% Na-K-2Cl cotransporter . furosemide . 2-3% . Spironolactone.
5 , .14 , , , .. 1 kg, kg . (15), 125 mEq/L . 121-125 mEq/L . 120 mEq/L .. , , .1) Spironolactone .16 Spironolactone 3-4 3-5.
6 50-100 mg 400 mg , spironolactone . Spironolactone furosemide 83 . , , . amiloride 1/10 . , .2) Sprionolactone furosemide . , . , ..17 .18 , thiazide.
7 Furosemide 20-40 mg 160 mg , .19 furosemide . torasemide furosemide , furosemide 1/4 ,20 .3) 1 . 100:40 , . ,21.
8 22 1 . 24 78 mEq . 24 . (spot urine) N/K , N/K 1 mineralocorticoid Postgraduate Course 201284 78 mEq 95% .23 Na/K 24 78 mEq , , .24 , , .6 .4) 125 mEq/L , 120 mEq/L.
9 Mg/dL . mEq/L , mEq/L , mEq/L ..4. (grade 3) , (24 <10 mEq).. (large volume paracentesis, LVP) .25,26 LVP , .27 LVP , (dilutional hyponatremia) . (postparacentesis circulatory dysfunction) , 1 L 8 g.
10 28 5 L dextran 70, polygelin, hydroxy-ethyl starch 29,30 . 10 L .31 LVP 85 . LVP , LVP .325. 1) 10% , . 1 4 kg 4 (diuretic resistant) , (diuretic intractable).