Matsumoto Naoki, Ogawa Masahiro, Kanda Tatsuo, Matsuoka Shunichi, Moriyama Mitsuhiko, Matsusaki Keisuke
Division of Gastroenterology and Hepatology, Department of Medicine, Nihon University School of Medicine, 30-1 Oyaguchi Kamimachi, Itabashi-ku, Tokyo, 173-8610, Japan.
Ascites Treatment Center, Kanamecho Hospital, 1-11-13 Kanamecho, Toshima-ku, Tokyo, 171-0043, Japan.
J Med Ultrason (2001). 2021 Jul;48(3):315-322. doi: 10.1007/s10396-021-01094-2. Epub 2021 Apr 9.
Hemodynamic change after total paracentesis was investigated because it might lead to various complications. Although cell-free and concentrated ascites reinfusion therapy (CART) is safer and more effective than total paracentesis in theory, hemodynamic change after CART has been never reported. And previous studies did not mention hemodynamics of the venous system.
We investigated the hemodynamic change, including that of the venous system, before and after CART using color Doppler ultrasonography and fast Fourier transform analysis. Twenty-eight patients with tensive cirrhotic ascites underwent ultrasonography the day before and after total volume CART. The diameter and velocity of the main, right, and left portal vein; inferior vena cava (IVC); and right renal vein were measured using ultrasonography.
A total of 11.8 ± 4.4 L of ascites (range 3.6-20.9 L) was filtered and concentrated to 0.85 ± 0.40 L (range 0.36-1.50 L). The diameter of the IVC increased from median 13.5 ± 5.4 mm (range 4-25 mm) to 18.5 ± 4.1 mm (range 7-29 mm) (p = 0.007). The diameter of the right segmental renal vein significantly increased after KM-CART [from 5.0 ± 1.0 (4-8) mm to 7.0 ± 2.0 (3-10) mm] (p = 0.011). Hemodynamic change of the portal venous system was not significant. The time to the next CART in patients with an IVC diameter ≥ 20 mm and < 20 mm was 86 days and 20.5 days (p = 0.035), respectively.
Tensive ascites results in venous congestion in patients with cirrhotic ascites. CART improved venous flow, but it did not change the hemodynamics of the portal venous system.
研究大量腹腔穿刺放液后的血流动力学变化，因为其可能导致各种并发症。尽管理论上无细胞浓缩腹水回输疗法（CART）比大量腹腔穿刺放液更安全、更有效，但此前从未有关于CART后血流动力学变化的报道。而且既往研究未提及静脉系统的血流动力学情况。
我们使用彩色多普勒超声和快速傅里叶变换分析，研究了CART前后的血流动力学变化，包括静脉系统的变化。28例肝硬化张力性腹水患者在进行全量CART的前一天和后一天接受了超声检查。使用超声测量门静脉主干、右支和左支、下腔静脉（IVC）以及右肾静脉的直径和流速。
共过滤并浓缩了11.8±4.4L腹水（范围3.6 - 20.9L）至0.85±0.40L（范围0.36 - 1.50L）。IVC直径从中位数13.5±5.4mm（范围4 - 25mm）增加至18.5±4.1mm（范围7 - 29mm）（p = 0.007）。右段肾静脉直径在KM - CART后显著增加[从5.0±1.0（4 - 8）mm增加至7.0±2.0（3 - 10）mm]（p = 0.011）。门静脉系统的血流动力学变化不显著。IVC直径≥20mm和<20mm的患者下次进行CART的时间分别为86天和20.5天（p = 0.035）。
肝硬化腹水患者的张力性腹水导致静脉淤血。CART改善了静脉血流，但未改变门静脉系统的血流动力学。
