Phillip Veit, Saugel Bernd, Ernesti Christina, Hapfelmeier Alexander, Schultheiß Caroline, Thies Philipp, Mayr Ulrich, Schmid Roland M, Huber Wolfgang
II, Medizinische Klinik und Poliklinik, Klinikum rechts der Isar der Technischen Universität München, Ismaninger Straße 22, 81675 München, Germany.
BMC Gastroenterol. 2014 Jan 27;14:18. doi: 10.1186/1471-230X-14-18.
Ascites is a major and common complication of liver cirrhosis. Large or refractory ascites frequently necessitates paracentesis. The aim of our study was to investigate the effects of paracentesis on hemodynamic and respiratory parameters in critically ill patients.
Observational study comparing hemodynamic and respiratory parameters before and after paracentesis in 50 critically ill patients with advanced hemodynamic monitoring. 28/50 (56%) required mechanical ventilation.Descriptive statistics are presented as mean ± standard deviation for normally distributed data and median, range, and interquartile range (IQR) for non-normally distributed data. Comparisons of hemodynamic and respiratory parameters before and after paracentesis were performed by Wilcoxon signed-rank tests. Bivariate relations were assessed by Spearman's correlation coefficient and univariate regression analyses.
Median amount of ascites removed was 5.99 L (IQR, 3.33-7.68 L). There were no statistically significant changes in hemodynamic parameters except a decrease in mean arterial pressure (-7 mm Hg; p = 0.041) and in systemic vascular resistance index (-116 dyne·sec/cm5/m2; p = 0.016) when measured 2 hours after paracentesis. In all patients, oxygenation ratio (PaO2/FiO2; median, 220 mmHg; IQR, 161-329 mmHg) increased significantly when measured immediately (+58 mmHg; p = 0.001), 2 hours (+9 mmHg; p = 0.004), and 6 hours (+6 mmHg); p = 0.050) after paracentesis. In mechanically ventilated patients, lung injury score (cumulative points without x-ray; median, 6; IQR, 4-7) significantly improved immediately (5; IQR, 4-6; p < 0.001), 2 hours (5; IQR, 4-7; p = 0.003), and 6 hours (6; IQR 4-6; p = 0.012) after paracentesis.
Paracentesis in critically ill patients is safe regarding circulatory function and is related to immediate and sustained improvement of respiratory function.
腹水是肝硬化的一种主要且常见的并发症。大量或难治性腹水常常需要进行腹腔穿刺术。我们研究的目的是调查腹腔穿刺术对重症患者血流动力学和呼吸参数的影响。
一项观察性研究，对50例进行了高级血流动力学监测的重症患者在腹腔穿刺术前后的血流动力学和呼吸参数进行比较。50例中有28例（56%）需要机械通气。对于正态分布的数据，描述性统计以均值±标准差表示；对于非正态分布的数据，则以中位数、范围和四分位间距（IQR）表示。采用Wilcoxon符号秩检验对腹腔穿刺术前后的血流动力学和呼吸参数进行比较。通过Spearman相关系数和单变量回归分析评估双变量关系。
抽出腹水的中位数为5.99 L（IQR，3.33 - 7.68 L）。腹腔穿刺术后2小时测量时，除平均动脉压下降（-7 mmHg；p = 0.041）和全身血管阻力指数下降（-116达因·秒/厘米⁵/平方米；p = 0.016）外，血流动力学参数无统计学显著变化。在所有患者中，腹腔穿刺术后立即测量时氧合比（PaO₂/FiO₂；中位数，220 mmHg；IQR，161 - 329 mmHg）显著升高（+58 mmHg；p = 0.001），术后2小时（+9 mmHg；p = 0.004）和6小时（+6 mmHg；p = 0.050）时也升高。在机械通气患者中，腹腔穿刺术后立即（5；IQR，4 - 6；p < 0.001）、2小时（5；IQR，4 - 7；p = 0.003）和6小时（6；IQR 4 - 6；p = 0.012）时肺损伤评分（无X线检查的累积分数；中位数，6；IQR，4 - 7）显著改善。
对于重症患者，腹腔穿刺术在循环功能方面是安全的，并且与呼吸功能的即刻和持续改善有关。
