Division of Gastroenterology and Hepatology, San Giovanni Battista Hospital - University of Turin, Turin, Italy.
Dig Liver Dis. 2011 Nov;43(11):881-6. doi: 10.1016/j.dld.2011.06.001. Epub 2011 Jul 8.
Paracentesis-induced circulatory dysfunction is a well-known complication of large volume paracentesis. Albumin infusion (8g of albumin/L of ascites removed) is effective in preventing it, but high costs and scant availability limit its use.
To compare standard vs half albumin doses.
Seventy cirrhotic patients treated with large volume paracentesis were randomized to receive intravenous albumin as prevention of paracentesis-induced circulatory dysfunction: group 1 (35 patients) received 4g/L of ascites removed, group 2 (35 patients) received 8g/L of ascites removed.
The incidence of paracentesis-induced circulatory dysfunction (14% vs 20% in group 1 and group 2, respectively; p=ns), hyponatremia (9% vs 6%, p=ns) and renal impairment (0% in both groups) on the 6th day from paracentesis was similar between the two groups. After 6 months of follow-up, rates of survival and of recurrence of ascites requiring large volume paracentesis were not different between the two groups.
This unblinded, randomized, pilot study suggests that treatment with half doses of albumin is effective in the prevention of paracentesis-induced circulatory dysfunction and its related clinical complications in cirrhotic patients with tense ascites treated by large volume paracentesis. If confirmed, these results could support a significant costs reduction in the management of ascites in cirrhotic patients.
大量放腹水可引起循环功能障碍，是一种已知的并发症。输注白蛋白（每升腹水移除 8g 白蛋白）可有效预防，但费用高且供应有限，限制了其应用。
比较标准剂量与半剂量白蛋白。
70 例肝硬化大量放腹水患者随机分为两组，静脉输注白蛋白预防放腹水引起的循环功能障碍：第 1 组（35 例）接受每升腹水移除 4g 白蛋白，第 2 组（35 例）接受每升腹水移除 8g 白蛋白。
两组第 6 天放腹水后循环功能障碍（第 1 组 14%，第 2 组 20%；p=ns）、低钠血症（第 1 组 9%，第 2 组 6%；p=ns）和肾功能损害（两组均为 0%）的发生率相似。随访 6 个月，两组的生存率和需要大量放腹水治疗的复发性腹水率无差异。
这项非盲、随机、初步研究表明，对于大量放腹水治疗的张力性腹水肝硬化患者，用半剂量白蛋白治疗可有效预防放腹水引起的循环功能障碍及其相关临床并发症。如果得到证实，这些结果可能会降低肝硬化腹水患者管理的成本。
