Abstract：
Third-spacing of fluid is a common complication in hospitalized patients with decompensated cirrhosis. In addition to ascites, patients with advanced cirrhosis may develop significant peripheral edema, which may limit mobility and exacerbate debility and muscle wasting. Concomitant kidney failure and cardiac dysfunction may lead to worsening hypervolemia, which may ultimately result in pulmonary edema and respiratory compromise. Diuretic use in such patients may be limited by kidney dysfunction and electrolyte abnormalities, including hyponatremia and hypokalemia. A slow, continuous form of ultrafiltration known as aquapheresis is a method of extracorporeal fluid removal whereby a pump generates a transmembrane pressure that forces an isotonic ultrafiltrate across a semipermeable membrane. This leads to removal of an ultrafiltrate that is isotonic to blood without the need for dialysate or replacement fluid as is necessary in other forms of continuous kidney replacement therapy. This technique has been utilized in other conditions including acute decompensated heart failure, with trials showing mixed, but generally favorable results. Herein, we present a series of our own experience using aquapheresis among patients with cirrhosis, review the literature regarding its use in other hypervolemic states, and discuss how we may apply lessons learned from use of aquapheresis in heart failure to patients with end-stage liver disease.
摘要：
第三间隔液体是失代偿期肝硬化住院患者的常见并发症。除了腹水,晚期肝硬化患者可能会出现明显的外周水肿，这可能会限制活动性，加剧虚弱和肌肉萎缩。合并的肾功能衰竭和心功能不全可能导致恶化的高血容量，最终可能导致肺水肿和呼吸受损。在这些患者中使用利尿剂可能受到肾功能障碍和电解质异常的限制，包括低钠血症和低钾血症。一个缓慢的，称为水分离的连续形式的超滤是一种体外流体去除方法，其中泵产生跨膜压力，迫使等渗超滤液穿过半透膜。这导致去除与血液等渗的超滤液,而不需要透析液或置换液,如在其他形式的连续肾脏替代疗法中所需的。该技术已用于其他疾病，包括急性失代偿性心力衰竭，试验显示混合，但总体上是有利的结果。在这里，我们提出了一系列我们自己的经验，在肝硬化患者中使用水分离术，回顾有关其在其他高血容量状态中使用的文献，并讨论我们如何将从使用水分离疗法治疗心力衰竭的经验教训应用于终末期肝病患者。
