肝硬化患者腹腔穿刺引流流速对腹腔穿刺诱发循环功能障碍发生的影响

The impact of paracentesis flow rate in patients with liver cirrhosis on the development of paracentesis induced circulatory dysfunction.

作者信息

Elsabaawy Maha Mohammad, Abdelhamid Shimaa Rashad, Alsebaey Ayman, Abdelsamee Eman, Obada Manar Abdelaal, Salman Tary Abdelhamid, Rewisha Eman

机构信息

Department of Hepatology, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.

Department of Clinical Biochemistry, National Liver Institute, Menoufia University, Shebeen El-Kom, Egypt.

出版信息

Clin Mol Hepatol. 2015 Dec;21(4):365-71. doi: 10.3350/cmh.2015.21.4.365. Epub 2015 Dec 24.

DOI:10.3350/cmh.2015.21.4.365

PMID:26770925

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4712164/

Abstract

BACKGROUND/AIMS: Ascites is a dreadful complication of liver cirrhosis associated with short survival. Large volume paracentesis (LVP) is used to treat tense or refractory ascites. Paracentesis induced circulatory dysfunction (PICD) develops if no plasma expanders are given with ominous complications. To study the effect of ascites flow rate on PICD development.

METHODS

Sixty patients with cirrhosis and tense ascites underwent LVP of 8 L were randomized into 3 equal groups of different flow rate extraction; group I (80 mL/minute), group II (180 mL/minute) and group III (270 mL/minute). Plasma renin activity (PRA) was measured baseline and on day six. PICD was defined as increase in PRA >50% of the pretreatment value.

RESULTS

In group I through 3; the mean age was (52.5±9.4 vs. 56.4±8.5 vs. 55.8±7.1 years; P>0.05), mean arterial pressure (81.4±5.6 vs. 81.5±7 vs. 79.5±7.2 mmHg; P>0.05), MELD (17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5). Baseline PRA was comparable (1,366.0±1244.9 vs. 1,151.3±1,444.8 vs. 951.9±1,088 pg/mL; P>0.05). There was no statistically significant (P>0.05) flow mediated changes (Δ) of creatinine (0.23±0.27 vs. 0.38±0.33 vs. 0.26±0.18 mg/dL), MELD (1.25±5.72 vs. 1.70±2.18 vs. 1.45±2.21) or PRA (450.93±614.10 vs. 394.61±954.64 vs. 629.51±1,116.46 pg/mL). PICD was detected in a similar frequency in the three groups (P>0.05). On univariate logistic analysis only female sex was a fairly significant PICD predictor (Wald 3.85, odds ratio 3.14; P=0.05).

CONCLUSIONS

The ascites flow rate does not correlate with PICD development.

摘要

背景/目的：腹水是肝硬化的一种严重并发症，与生存期缩短相关。大量腹腔穿刺放液术（LVP）用于治疗张力性或难治性腹水。如果不放扩容剂，腹腔穿刺放液诱发的循环功能障碍（PICD）会发生，且伴有严重并发症。本研究旨在探讨腹水引流速度对PICD发生的影响。

方法

60例肝硬化伴张力性腹水患者接受8L的LVP，随机分为3组，每组引流速度不同；第一组（80mL/分钟），第二组（180mL/分钟）和第三组（270mL/分钟）。在基线及第六天测量血浆肾素活性（PRA）。PICD定义为PRA升高超过治疗前值的50%。

结果

第一组至第三组；平均年龄分别为（52.5±9.4岁 vs. 56.4±8.5岁 vs. 55.8±7.1岁；P>0.05），平均动脉压（81.4±5.6mmHg vs. 81.5±7mmHg vs. 79.5±7.2mmHg；P>0.05），终末期肝病模型（MELD）评分（17.6±4.1 vs. 15.8±4.1 vs. 14.7±4.5）。基线PRA相当（分别为1,366.0±1244.9pg/mL vs. 1,151.3±1,444.8pg/mL vs. 951.9±1,088pg/mL；P>0.05）。肌酐（分别为0.23±0.27mg/dL vs. 0.38±0.33mg/dL vs. 0.26±0.18mg/dL）、MELD评分（分别为1.25±5.7 vs. 1.70±2.18 vs. 1.45±2.21）或PRA（分别为450.93±614.10pg/mL vs. 394.61±954.64pg/mL vs. 629.51±1,116.46pg/mL）的流量介导变化（Δ）无统计学意义（P>0.05）。三组中PICD的检出频率相似（P>0.05）。单因素逻辑回归分析显示，仅女性是PICD的显著预测因素（Wald值3.85，比值比3.14；P=0.05）。