Titó L, Ginès P, Arroyo V, Planas R, Panés J, Rimola A, Llach J, Humbert P, Badalamenti S, Jiménez W
Liver Unit, Hospital Clinic i Provincial of Barcelona, Spain.
Gastroenterology. 1990 Jan;98(1):146-51. doi: 10.1016/0016-5085(90)91303-n.
Repeated large-volume paracentesis (4-6 L/day) is an effective and safe therapy of ascites in patients with cirrhosis provided albumin is infused intravenously. To investigate whether ascites can be safely mobilized in only one paracentesis session ("total paracentesis"), 38 cirrhotic patients with tense ascites were treated with total paracentesis plus intravenous albumin (6-8 g/L ascites removed). Standard liver tests and renal function tests, glomerular filtration rate, free water clearance, plasma volume, plasma renin activity, and plasma aldosterone and norepinephrine concentrations were measured before and after treatment. Total paracentesis was effective in mobilizing ascites in all but 1 patient and did not impair any of the parameters studied. The volume of ascitic fluid removed and the duration of the procedure were 10.7 +/- 0.5 L (mean +/- SEM) and 60 +/- 3 min, respectively. Five of the 38 patients (13%) developed complications during the first hospital stay (hepatic encephalopathy and gastrointestinal hemorrhage in 2 patients each and culture-negative bacterial peritonitis in 1). No patient developed renal impairment. This complication rate, as well as the clinical course of the disease during follow-up, estimated by the probability of readmission to hospital, causes of readmission, and survival probability after treatment, was similar to that reported in patients treated with repeated large-volume paracentesis. These results indicate that total paracentesis associated with intravenous albumin can be safely performed in cirrhotic patients with tense ascites and suggest that these patients could be treated in a single-day hospitalization regime.
反复大量腹腔穿刺放液（4 - 6升/天）是肝硬化腹水患者一种有效且安全的治疗方法，前提是静脉输注白蛋白。为了研究腹水是否能在单次腹腔穿刺放液（“完全腹腔穿刺放液”）中安全排出，对38例有张力性腹水的肝硬化患者进行了完全腹腔穿刺放液加静脉输注白蛋白治疗（每排出1升腹水输注6 - 8克白蛋白）。在治疗前后测量了标准肝功能和肾功能检查、肾小球滤过率、自由水清除率、血浆容量、血浆肾素活性以及血浆醛固酮和去甲肾上腺素浓度。除1例患者外，完全腹腔穿刺放液在所有患者中均有效排出了腹水，且未损害所研究的任何参数。排出的腹水量和操作持续时间分别为10.7±0.5升（均值±标准误）和60±3分钟。38例患者中有5例（13%）在首次住院期间出现并发症（2例发生肝性脑病，2例发生胃肠道出血，1例发生培养阴性的细菌性腹膜炎）。无患者出现肾功能损害。该并发症发生率以及随访期间疾病的临床进程，通过再次入院概率、再次入院原因和治疗后生存概率评估，与反复大量腹腔穿刺放液治疗的患者报告情况相似。这些结果表明，对于有张力性腹水的肝硬化患者，与静脉输注白蛋白相关的完全腹腔穿刺放液可以安全进行，并提示这些患者可以在单日住院模式下接受治疗。
