Moreau R, Asselah T, Condat B, de Kerguenec C, Pessione F, Bernard B, Poynard T, Binn M, Grangé J D, Valla D, Lebrec D
Laboratoire d'Hémodynamique Splanchnique et de Biologie Vasculaire, INSERM U-481, Clichy, France.
Gut. 2002 Jan;50(1):90-4. doi: 10.1136/gut.50.1.90.
Patients with cirrhosis and tense ascites treated by paracentesis alone have a decrease in effective arterial blood volume after ascites removal. Although intravenous albumin is effective in preventing paracentesis induced decreased arterial blood volume, its clinical use is controversial. As paracentesis induces arteriolar vasodilation which plays a role in the development of decreased effective arterial blood volume, administration of a vasoconstrictor (terlipressin) could prevent circulatory alterations due to paracentesis.
To perform a pilot study comparing the effects of terlipressin and albumin on effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites.
Twenty patients with cirrhosis and tense ascites were randomly assigned to be treated by either paracentesis and terlipressin or paracentesis and albumin. Terlipressin (3 mg) or albumin (8 g/l of removed ascites) were administered on the day of paracentesis. Effective arterial blood volume was assessed by measuring plasma renin concentrations at baseline and on the day of hospital discharge (4-6 days after treatment). Decreased effective arterial blood volume was defined as an increase in plasma renin concentrations on the day of hospital discharge of more than 50% of baseline values.
Irrespective of the treatment group, mean values for plasma renin concentrations at hospital discharge did not differ from their respective baseline values (p=0.10). Baseline plasma levels of renin concentrations did not differ between the terlipressin and albumin groups (p=0.61). Changes from baseline in plasma renin concentrations did not differ between groups (p=0.39). Three patients in the terlipressin group and three in the albumin group developed decreased arterial blood volume.
This randomised pilot study suggests that terlipressin may be as effective as intravenous albumin in preventing a decrease in effective arterial blood volume in patients with cirrhosis treated by paracentesis for tense ascites.
仅通过腹腔穿刺术治疗的肝硬化合并张力性腹水患者在腹水清除后有效动脉血容量会减少。尽管静脉输注白蛋白可有效预防腹腔穿刺术引起的动脉血容量减少，但其临床应用仍存在争议。由于腹腔穿刺术会诱发小动脉血管舒张，而这在有效动脉血容量减少的发生过程中起作用，因此给予血管收缩剂（特利加压素）可预防腹腔穿刺术引起的循环改变。
进行一项初步研究，比较特利加压素和白蛋白对因张力性腹水接受腹腔穿刺术治疗的肝硬化患者有效动脉血容量的影响。
20例肝硬化合并张力性腹水患者被随机分配接受腹腔穿刺术加特利加压素治疗或腹腔穿刺术加白蛋白治疗。在腹腔穿刺术当天给予特利加压素（3毫克）或白蛋白（每清除1升腹水给予8克）。通过在基线时和出院当天（治疗后4 - 6天）测量血浆肾素浓度来评估有效动脉血容量。有效动脉血容量减少定义为出院当天血浆肾素浓度升高超过基线值的50%。
无论治疗组如何，出院时血浆肾素浓度的平均值与各自的基线值无差异（p = 0.10）。特利加压素组和白蛋白组之间的基线血浆肾素浓度水平无差异（p = 0.61）。两组间血浆肾素浓度相对于基线的变化无差异（p = 0.39）。特利加压素组有3例患者和白蛋白组有3例患者发生了动脉血容量减少。
这项随机初步研究表明，在预防因张力性腹水接受腹腔穿刺术治疗的肝硬化患者有效动脉血容量减少方面，特利加压素可能与静脉输注白蛋白同样有效。
