,对有恰当适应证的患者行腹腔穿刺术通常利大于弊。腹腔穿刺术有一些相 对禁忌证，但大多数情况下可以采取一些措施使患者能够行腹腔穿刺术， 即使是有相对禁忌证时。（参见上文相对禁忌证 相对禁忌证包括： 临末表现出弥海性血管内疑 原发性纤溶 ,广泛肠梗阳伴肠扩护张 ·计划穿 刺部位有手术瘢痕 ,国际标准化比值(N)升高或血小板减少并不是腹腔穿刺的禁忌证。对于 大多数患者，不鼓励在腹腔穿刺前输血，因为现有数据不支持这种做法， 其可延误穿刺，使患者暴露于输血风险，并且费用较高。但临床表现出弥 漫性血管内凝血或纤溶亢进的患者除外，这些患者需要接受治疗以降低出 血风险， (参见上文凝血检查结果异常和血小板减少， ,正确的操作技术对于降低发生标本污染和并发症的风险很重要。尤其是正 确的Z-路径技术，可大大降低腹水渗漏（腹腔穿刺最常见的并发症）的可能 性。其他并发症少见得多。（参见上文穿刺技术和并发症） ,所有腹水标本均应行细胞计数和分类计数，包括计划治疗性腹腔穿刺术获 取的标本。（参见上文收集腹水进行检查） 使用UpToDate临床顾问须遵循用户协议 参考文献 1.Runyon BA.Ascites and spontaneous bacterial peritonitis.In:Sleisenger and Fordtran's Gastrointestinal and l iver Diseases 8th edition Feldman M Friedman l Brandt L (Eds)Elsevier 2010 p 1517 2.Runyon BA,AASLD Practice Guidelines Comr mittee.Ma ent of adult patients with ascites due to cirhosis:an update.Hepatology 2009:49:2087 3.Orman ES,Hayashi PH,Bataller R.Barritt AS 4th.Paracentesis is associated with reduced mortality in patients hospitalized with cimrhosis and ascites.clin Gastroenterol Hepatol 2014:12:496. 4 Gunawan B.Runyon B.The efficacy and safety of epsilon-aminocaproic acid treatment in patie nts with cirrhosis and hyperfibrinolysis.Aliment Pharmacol Ther2006:23:115. 5.Runyon BA.Paracentesis of ascitic fluid.A safe procedure.Arch Intern Med 1986:146:2259. 6.McVay PA.Toy PT.Lack of increased bleeding afterparacentesis and ntesis s in patients with mild coagulation abnormalities.Transfusion 1991:31:164 7.Grabau CM.Crago SF,Hoff LK,et al.Performance standards for therapeutic abdominal paracentesis.Hepatology 2004:40:484. 8.Pache l,Bilodeau M.Severe haemorrhage following abdominal paracentesis for ascites with liver disease. 21:525 ●对有恰当适应证的患者行腹腔穿刺术通常利大于弊。腹腔穿刺术有一些相 对禁忌证，但大多数情况下可以采取一些措施使患者能够行腹腔穿刺术， 即使是有相对禁忌证时。(参见上文‘相对禁忌证’) 相对禁忌证包括： •临床表现出弥漫性血管内凝血 •原发性纤溶 •广泛肠梗阻伴肠扩张 •计划穿刺部位有手术瘢痕 ●国际标准化比值(INR)升高或血小板减少并不是腹腔穿刺的禁忌证。对于 大多数患者，不鼓励在腹腔穿刺前输血，因为现有数据不支持这种做法， 其可延误穿刺，使患者暴露于输血风险，并且费用较高。但临床表现出弥 漫性血管内凝血或纤溶亢进的患者除外，这些患者需要接受治疗以降低出 血风险。(参见上文‘凝血检查结果异常和血小板减少’) ●正确的操作技术对于降低发生标本污染和并发症的风险很重要。尤其是正 确的 Z-路径技术，可大大降低腹水渗漏(腹腔穿刺最常见的并发症)的可能 性。其他并发症少见得多。(参见上文‘穿刺技术’和‘并发症’) ●所有腹水标本均应行细胞计数和分类计数，包括计划治疗性腹腔穿刺术获 取的标本。(参见上文‘收集腹水进行检查’) 使用 UpToDate 临床顾问须遵循用户协议. 参考文献 1. Runyon BA. Ascites and spontaneous bacterial peritonitis. In: Sleisenger and Fordtran’s Gastrointestinal and Liver Diseases, 8th edition, Feldman M, Friedman L, Brandt LJ (Eds), Elsevier, 2010. p.1517. 2. Runyon BA, AASLD Practice Guidelines Committee. Management of adult patients with ascites due to cirrhosis: an update. Hepatology 2009; 49:2087. 3. Orman ES, Hayashi PH, Bataller R, Barritt AS 4th. Paracentesis is associated with reduced mortality in patients hospitalized with cirrhosis and ascites. Clin Gastroenterol Hepatol 2014; 12:496. 4. Gunawan B, Runyon B. The efficacy and safety of epsilon-aminocaproic acid treatment in patients with cirrhosis and hyperfibrinolysis. Aliment Pharmacol Ther 2006; 23:115. 5. Runyon BA. Paracentesis of ascitic fluid. A safe procedure. Arch Intern Med 1986; 146:2259. 6. McVay PA, Toy PT. Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion 1991; 31:164. 7. Grabau CM, Crago SF, Hoff LK, et al. Performance standards for therapeutic abdominal paracentesis. Hepatology 2004; 40:484. 8. Pache I, Bilodeau M. Severe haemorrhage following abdominal paracentesis for ascites in patients with liver disease. Aliment Pharmacol Ther 2005; 21:525