Smart H L, Triger D R
University of Sheffield, Department of Medicine, Royal Hallamshire Hospital, United Kingdom.
J Hepatol. 1990 Mar;10(2):191-7. doi: 10.1016/0168-8278(90)90051-r.
We report a randomised trial in 40 consecutive patients with diuretic refractory ascites comparing our standard therapy of ascites recirculation (Rhodiascit apparatus) with the newly proposed method of daily paracentesis (3-4 litre) and intravenous albumin infusion. A mean of five (range 2-13) paracenteses removed 13.3 (2.0-36.0) l of ascites. 12 (5-32) h of recirculation produced 6.0 (2.0-12.0) l of waste. A significant diuresis occurred in 14 recirculation patients compared to four treated by paracentesis. No significant changes in electrolyte levels or renal function occurred. Complications were commoner with paracentesis (12) than with recirculation (5). Following recirculation, 18 patients were discharged after 7 (2-21) days; significantly (p less than 0.04) shorter than after paracentesis (11 (4-34) days, 16 discharges). Ascites reaccumulation and survival were identical in both groups. Fewer complications, shorter hospital stay and lower consumables costs (recirculation 240 pounds, paracentesis 400 pounds) make ascites recirculation an attractive therapeutic option to daily paracentesis and intravenous albumin in diuretic refractory ascites.
我们报告了一项针对40例连续性利尿剂难治性腹水患者的随机试验，比较了我们的腹水再循环标准疗法（Rhodiascit装置）与新提出的每日腹腔穿刺放液（3 - 4升）及静脉输注白蛋白的方法。平均进行了5次（范围2 - 13次）腹腔穿刺放液，排出腹水13.3（2.0 - 36.0）升。12（5 - 32）小时的再循环产生了6.0（2.0 - 12.0）升废液。与4例接受腹腔穿刺放液治疗的患者相比，14例接受再循环治疗的患者出现了显著的利尿作用。电解质水平或肾功能未发生显著变化。腹腔穿刺放液的并发症（12例）比再循环治疗（5例）更常见。再循环治疗后，18例患者在7（2 - 21）天后出院；明显（p小于0.04）短于腹腔穿刺放液后（11（4 - 34）天，16例出院）。两组的腹水再积聚和生存率相同。并发症更少、住院时间更短且耗材成本更低（再循环治疗240英镑，腹腔穿刺放液400英镑），使得腹水再循环成为利尿剂难治性腹水每日腹腔穿刺放液和静脉输注白蛋白的一种有吸引力的治疗选择。
