Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan, USA.
Gastroenterology Section, VA Ann Arbor Healthcare System, Ann Arbor, Michigan, USA.
United European Gastroenterol J. 2024 Nov;12(9):1222-1229. doi: 10.1002/ueg2.12675. Epub 2024 Oct 8.
BACKGROUND & AIMS: Paracentesis is commonly used to manage patient discomfort due to ascites. The relationship between ascites pressure, ascites volume, and patient discomfort has not been elucidated.
We prospectively enrolled adult patients with non-malignant ascites undergoing outpatient therapeutic paracenteses from 2021 to 2024 at a tertiary care hospital. Patients completed a validated symptom questionnaire (ASI-7, maximum score 35) before, immediately after, and 1 week after paracentesis. An open-ended manometer was used to measure ascites pressure at the beginning and end of paracentesis. Mixed effect linear regression was performed to evaluate the relationships between patient characteristics, pressure, volume, and symptoms.
One hundred and fifty paracentesis procedures among 48 unique patients with an average Model for End Stage Liver Disease-Sodium 3.0 of 16.7 were included. An average of 6.5 L was drained, which reduced abdominal pressure from a mean of 13.7 to 6.0 cm HO (10.1 to 4.4 mmHg, p < 0.001) and mean symptom score from 22.6 to 6.5 (p < 0.001). Regression models identified that symptoms and abdominal pressure linearly correlated above a pressure of 6 cm HO or ASI-7 score of 16 (p < 0.01). Taller patients required about 670 ml additional drainage per inch above the cohort mean height (5'8″) to achieve the same symptom relief.
Pressure measured at the bedside can be used to explore changes in abdominal pressure during paracentesis. Pressure, volume, and patient level factors such as height contribute to patient symptoms but cannot fully explain discomfort associated with ascites and relief after paracentesis.
腹腔穿刺术常用于缓解腹水引起的患者不适。目前尚未阐明腹水压力、腹水容量与患者不适之间的关系。
我们前瞻性地招募了 2021 年至 2024 年在一家三级保健医院接受门诊治疗性腹腔穿刺术的非恶性腹水成年患者。患者在腹腔穿刺术前、术后即刻和术后 1 周完成了经过验证的症状问卷（ASI-7，最高得分为 35 分）。在腹腔穿刺术开始和结束时，使用开放式压力计测量腹水压力。采用混合效应线性回归评估患者特征、压力、容量和症状之间的关系。
纳入了 48 例患者的 150 次腹腔穿刺术，平均终末期肝病模型钠评分 3.0 为 16.7。平均引流 6.5 L，使腹部压力从平均 13.7 cm HO 降至 6.0 cm HO（10.1 至 4.4 mmHg，p < 0.001），平均症状评分从 22.6 降至 6.5（p < 0.001）。回归模型确定，症状和腹部压力在压力超过 6 cm HO 或 ASI-7 评分超过 16 时呈线性相关（p < 0.01）。比队列平均身高（5'8″）高的患者，每增加 1 英寸需要额外引流约 670 ml 才能达到相同的症状缓解效果。
床边测量的压力可用于探讨腹腔穿刺术期间腹部压力的变化。压力、容量以及患者身高等因素会影响患者症状，但不能完全解释与腹水相关的不适以及腹腔穿刺术后的缓解情况。
