Wang S S, Lu C W, Chao Y, Lee F Y, Chen T W, Lin H C, Lee S D, Tsai Y T, Lo K J
Division of Gastroenterology, Veterans General Hospital, Taipei, Taiwan, ROC.
J Gastroenterol Hepatol. 1994 Nov-Dec;9(6):592-6. doi: 10.1111/j.1440-1746.1994.tb01567.x.
Single total paracentesis (4.8-11 L) was performed in 23 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis and massive ascites and its effects on systemic and hepatic haemodynamics and renal function were examined over 5 days. Severe hypotension occurred in six (26.1%) patients from 6 to 54 h after paracentesis. In the remaining 17 patients, compared to the baseline, there was an increase in the cardiac output (6.1 +/- 0.3 vs 6.7 +/- 0.3 L/min, P < 0.001) and a decrease in right atrial pressure (8.8 +/- 0.8 vs 4.3 +/- 0.7 mmHg, P < 0.001), systemic vascular resistance (1160 +/- 61 vs 976 +/- 50 dyne.s.cm-5, P < 0.001), and wedged hepatic venous pressure 30 min after completion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to baseline, while the cardiac output dropped to a level lower than the baseline (5.7 +/- 0.7 L/min, P < 0.05). Hepatic venous pressure gradient had returned to baseline after 5 days. Serial tests of serum creatinine level showed an increase from day 3 (1.34 +/- 0.14 vs 1.04 +/- 0.10 mg/dL, P < 0.05). On day 5, creatinine clearance (55.7 +/- 5.4 vs 41.9 +/- 5.3 mL/min, P < 0.05) and effective renal plasma flow (351 +/- 32 vs 293 +/- 29 mL/min, P < 0.05) were decreased, compared to the baseline. Based on these data, infusion of a volume expander may be necessary for total paracentesis to avoid systemic haemodynamic complications in non-alcoholic cirrhosis.
对23例乙型肝炎表面抗原（HBsAg）阳性肝硬化并大量腹水患者进行单次完全放腹水（4.8 - 11升），并在5天内检查其对全身和肝脏血流动力学及肾功能的影响。6例（26.1%）患者在放腹水后6至54小时出现严重低血压。在其余17例患者中，与基线相比，放腹水完成30分钟后心输出量增加（6.1±0.3对6.7±0.3升/分钟，P<0.001），右心房压力降低（8.8±0.8对4.3±0.7毫米汞柱，P<0.001），全身血管阻力降低（1160±61对976±50达因·秒·厘米⁻⁵，P<0.001），肝静脉楔压降低。5天后，右心房压力、全身血管阻力和肝静脉楔压恢复到基线水平，而心输出量降至低于基线的水平（5.7±0.7升/分钟，P<0.05）。肝静脉压力梯度在5天后恢复到基线水平。血清肌酐水平的系列检测显示从第3天开始升高（1.34±0.14对1.04±0.10毫克/分升，P<0.05）。在第5天，与基线相比，肌酐清除率（55.7±5.4对41.9±5.3毫升/分钟，P<0.05）和有效肾血浆流量（351±32对293±29毫升/分钟，P<0.05）降低。基于这些数据，对于完全放腹水，可能有必要输注扩容剂以避免非酒精性肝硬化患者出现全身血流动力学并发症。
