Ginès P, Titó L, Arroyo V, Planas R, Panés J, Viver J, Torres M, Humbert P, Rimola A, Llach J
Liver Unit, Hospital Clinic i Provincial of Barcelona, Spain.
Gastroenterology. 1988 Jun;94(6):1493-502. doi: 10.1016/0016-5085(88)90691-9.
It has recently been shown that repeated large-volume paracentesis associated with intravenous albumin infusion is a rapid, effective, and safe therapy of ascites in cirrhosis. To investigate whether intravenous albumin infusion is necessary in the treatment of cirrhotics with large-volume paracentesis, 105 patients with tense ascites were randomly allocated into two groups. Fifty-two patients (group 1) were treated with paracentesis (4-6 L/day until disappearance of ascites) plus intravenous albumin infusion (40 g after each tap), and 53 (group 2) with paracentesis without albumin infusion. After disappearance of ascites, patients were discharged from the hospital with diuretics. Patients developing tense ascites during follow-up were treated according to their initial schedule. Paracentesis was effective in eliminating the ascites in 50 patients from group 1 and in 48 from group 2, with the duration of the hospital stay being approximately 11 days in both groups. Paracentesis plus intravenous albumin did not induce significant changes in standard renal function tests, plasma renin activity, and plasma aldosterone. In contrast, paracentesis without albumin was associated with a significant increase in blood urea nitrogen, a marked elevation in plasma renin activity and plasma aldosterone concentration, and a significant reduction in serum sodium concentration. One patient from group 1 and 11 from group 2 developed renal impairment or severe hyponatremia after treatment, or both (chi 2 = 9.19; p less than 0.01). The development of these complications could not be predicted by clinical and laboratory data before treatment. Although the probability of survival after entry into the study was similar in patients from both groups, a multivariate analysis identified the development of hyponatremia or renal impairment, or both, following the first paracentesis treatment and the occurrence of other complications during the first hospitalization (encephalopathy, gastrointestinal bleeding, and severe infection) as being the only independent predictors of mortality. These results indicate that intravenous albumin infusion is important in avoiding renal and electrolyte complications and activation of endogenous vasoactive systems in cirrhotics with ascites who are treated with repeated large-volume paracentesis. The development of such complications may impair survival in these patients.
最近研究表明，反复大量腹腔穿刺放液联合静脉输注白蛋白是治疗肝硬化腹水快速、有效且安全的方法。为研究静脉输注白蛋白在大量腹腔穿刺放液治疗肝硬化患者中是否必要，将105例张力性腹水患者随机分为两组。52例患者（第1组）接受腹腔穿刺放液（4 - 6升/天，直至腹水消失）加静脉输注白蛋白（每次放液后40克）治疗，53例（第2组）仅接受腹腔穿刺放液而不输注白蛋白。腹水消失后，患者出院并服用利尿剂。随访期间出现张力性腹水的患者按初始方案治疗。腹腔穿刺放液使第1组50例患者和第2组48例患者的腹水消除，两组住院时间均约为11天。腹腔穿刺放液加静脉输注白蛋白对标准肾功能检查、血浆肾素活性和血浆醛固酮无显著影响。相比之下，不放液时腹腔穿刺放液会导致血尿素氮显著升高、血浆肾素活性和血浆醛固酮浓度明显升高以及血清钠浓度显著降低。第1组1例患者和第2组11例患者治疗后出现肾功能损害或严重低钠血症，或两者皆有（χ2 = 9.19；P < 0.01）。治疗前的临床和实验室数据无法预测这些并发症的发生。尽管两组患者进入研究后的生存概率相似，但多因素分析确定首次腹腔穿刺放液治疗后出现低钠血症或肾功能损害，或两者皆有，以及首次住院期间出现其他并发症（肝性脑病、胃肠道出血和严重感染）是死亡的唯一独立预测因素。这些结果表明，对于接受反复大量腹腔穿刺放液治疗的肝硬化腹水患者，静脉输注白蛋白对于避免肾和电解质并发症以及内源性血管活性系统激活很重要。这些并发症的发生可能会损害这些患者的生存。
