Singh V, Kumar B, Nain C K, Singh B, Sharma N, Bhalla A, Sharma A K
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Intern Med. 2006 Jul;260(1):62-8. doi: 10.1111/j.1365-2796.2006.01654.x.
Therapeutic paracentesis in patients with cirrhosis is associated with a circulatory dysfunction. Intravenous albumin has been used to prevent the circulatory dysfunction; however, the use of albumin is controversial and costly. Splanchnic vasodilation is mainly responsible for circulatory dysfunction in these patients. There are no reports of use of noradrenaline, a vasoconstrictor, on the prevention of paracentesis-induced circulatory dysfunction in patients with cirrhosis. Therefore, we studied the preventive effect of noradrenaline on paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis and compared it with that of intravenous albumin in a randomized pilot study.
Forty patients with cirrhosis and tense ascites underwent therapeutic paracentesis with albumin or noradrenaline in a randomized controlled trial at a tertiary centre. Effective arterial blood volume was assessed by measuring plasma renin activity at baseline and at 6 days after treatment.
Effective arterial blood volume as indicated by plasma renin activity before and 6 days after paracentesis did not differ in the two groups (20.62 +/- 10.27-22.02 +/- 10.15 ng mL(-1) h(-1); P = 0.11 in the albumin group and 19.66 +/- 8.91-20.78 +/- 9.41 ng mL(-1) h(-1); P = 0.37 in the noradrenaline group). Plasma aldosterone concentration before and 6 days after paracentesis were also similar in both groups (1196.5 +/- 434.2-1217.0 +/- 405.7 pg mL(-1); P = 0.7 in the albumin group and 1206.0 +/- 522.5-1273.5 +/- 444.8 pg mL(-1); P = 0.22 in the noradrenaline group). The cost of noradrenaline treatment was significantly lower when compared with that of albumin (P < 0.001).
Noradrenaline is as effective as albumin in preventing paracentesis-induced circulatory dysfunction in patients with cirrhosis after therapeutic paracentesis, but at a fraction of the cost.
肝硬化患者进行治疗性腹腔穿刺放液与循环功能障碍相关。静脉输注白蛋白已被用于预防循环功能障碍；然而，白蛋白的使用存在争议且成本高昂。内脏血管舒张是这些患者循环功能障碍的主要原因。尚无关于使用血管收缩剂去甲肾上腺素预防肝硬化患者腹腔穿刺放液引起的循环功能障碍的报道。因此，我们在一项随机对照试验中研究了去甲肾上腺素对肝硬化患者治疗性腹腔穿刺放液后腹腔穿刺放液引起的循环功能障碍的预防作用，并将其与静脉输注白蛋白的预防作用进行比较。
在一家三级中心，40例肝硬化合并大量腹水患者在一项随机对照试验中接受了白蛋白或去甲肾上腺素治疗性腹腔穿刺放液。通过在基线和治疗后第6天测量血浆肾素活性来评估有效动脉血容量。
两组患者腹腔穿刺放液前及放液后6天血浆肾素活性所提示的有效动脉血容量无差异（白蛋白组：20.62±10.27 - 22.02±10.15 ng mL⁻¹ h⁻¹；P = 0.11；去甲肾上腺素组：19.66±8.91 - 20.78±9.41 ng mL⁻¹ h⁻¹；P = 0.37）。两组患者腹腔穿刺放液前及放液后6天的血浆醛固酮浓度也相似（白蛋白组：1196.5±434.2 - 1217.0±405.7 pg mL⁻¹；P = 0.7；去甲肾上腺素组：1206.0±522.5 - 1273.5±444.8 pg mL⁻¹；P = 0.22）。与白蛋白相比，去甲肾上腺素治疗的成本显著更低（P < 0.001）。
在预防肝硬化患者治疗性腹腔穿刺放液后腹腔穿刺放液引起的循环功能障碍方面，去甲肾上腺素与白蛋白效果相当，但成本仅为白蛋白的一小部分。
