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Abstract：
In cirrhotic patients, non-selective b-blockers (NSBBs) constitute the reference treatment of choice as monotherapy or combined with band ligation for the prevention of first variceal bleeding and rebleeding, respectively. Furthermore, the last Baveno VII guidelines recommended carvedilol, a b-blocker with additional anti-a1 receptor activity, in all compensated cirrhotics with clinically significant portal hypertension, to prevent liver decompensation. Interestingly enough, NSBBs have been reported to have a potentially positive impact on the short-term mortality of patients with acute-on-chronic liver failure. However, concerns remain about the use of b-blockers in the presence of severe complications, such as refractory ascites, hepatorenal syndrome, spontaneous bacterial peritonitis, or established cirrhotic cardiomyopathy. In addition, it has not been verified yet whether carvedilol supersedes all the other NSBBs in every stage of liver disease, even when severe complications have developed. Therefore, this review aims to illustrate recent data regarding the potential role of b-blockers across all stages of liver disease, beyond the primary and secondary prophylaxis of variceal bleeding, and address the authors\' proposals on the use of NSBBs concerning the severity of liver disease and the patient\'s performance status.
摘要：
在肝硬化患者中，非选择性b受体阻滞剂（NSBBs）作为单药治疗或联合绑扎预防首次静脉曲张破裂出血和再出血的参考治疗选择，分别。此外，最后的BavenoVII指南推荐卡维地洛，一种具有额外抗a1受体活性的b受体阻滞剂，在所有代偿性肝硬化与临床上显著的门静脉高压症，防止肝脏失代偿。有趣的是，据报道，NSBB对慢性急性肝衰竭患者的短期死亡率具有潜在的积极影响。然而,在存在严重并发症的情况下使用b受体阻滞剂仍然令人担忧，如难治性腹水，肝肾综合征,自发性细菌性腹膜炎,或已确诊的肝硬化心肌病.此外,它还没有得到证实，卡维地洛是否取代所有其他NSBB在肝病的每个阶段，即使出现了严重的并发症。因此,这篇综述旨在说明有关b受体阻滞剂在肝病所有阶段的潜在作用的最新数据，除了静脉曲张出血的一级和二级预防，并解决了作者关于使用NSBB有关肝脏疾病严重程度和患者表现状况的建议。
