The activation of renin-angiotensin-aldosterone-vasopressin system is a key factor in the formation of ascites due to splanchnic vasodilation in cirrhosis. In theory, aldosterone antagonists, contraction of blood vessels, vasopressin V2 receptor, and angiotensin receptor antagonists are important targets for the prevention and treatment of cirrhotic ascites. The 15%-20% of patients with cirrhotic ascites that show no response to at least one week's treatment with potent diuretics (spironolactone 160 mg/d combined with furosemide 80 mg/d) are considered to have refractory ascites. At present, effective treatments for refractory ascites include tolvaptan, large-volume paracentesis (4000-6000 ml/time/day) combined with albumin (4 g/L ascites), ascites ultrafiltration and reinfusion, transjugular intrahepatic portosystemic shunt, and liver transplantation. In the future, with the development of vasoactive drugs, rifaximin, ascites drainage pump, and other new therapies, the treatment of refractory ascites may be more effective to reduce the need for liver transplantation.
肝硬化内脏血管扩张，导致肾素-血管紧张素-醛固酮-血管加压素系统激活是腹水形成的关键因素。理论上讲，拮抗醛固酮、收缩血管、血管加压素V2受体及血管紧张素受体拮抗剂均是防治肝硬化腹水的重要靶点。15%～20%肝硬化腹水患者即使强化利尿剂治疗（螺内酯160 mg/d联合呋塞米80 mg/d)治疗至少l周仍无应答反应，被认为是顽固性腹水。目前托伐普坦、腹腔穿刺大量放腹水（4 000～6 000 ml/次，1次/d）联合白蛋白（4 g/L）、腹水超滤浓缩回输、经颈静脉肝内门体分流术及肝脏移植是治疗顽固性腹水的有效方法。在未来，缩血管活性药物、利福昔明及腹水引流泵等新的治疗方法研究与应用，可进一步提高顽固性腹水的治疗效果，减少对肝脏移植的需求。.
Keywords: Liver cirrhosis; Refractory ascites; Therapy.