Angueira C E, Kadakia S C
Department of Medicine, Brooke Army Medical Center, San Antonio, Texas.
Hepatology. 1994 Oct;20(4 Pt 1):825-8. doi: 10.1002/hep.1840200409.
Large-volume paracentesis is an accepted therapeutic modality for the treatment of tense ascites in patients with cirrhosis. Whereas the effects of large-volume paracentesis on the cardiovascular system have been studied in great detail, the effects of tense ascites and large-volume paracentesis on the respiratory system have undergone only limited evaluation. Most patients report symptomatic improvement in breathing after large-volume paracentesis. The aim of our study was to prospectively evaluate the effects of large-volume paracentesis on the pulmonary function of patients with tense ascites. Nine patients with alcoholic cirrhosis and tense ascites underwent large-volume paracentesis (mean, 3,500 ml of ascites removed) followed by intravenous albumin infusion (10 gm/L ascites removed). Pulmonary function tests were performed just before and 2 hr after large-volume paracentesis. The functional residual capacity increased from 2.46 +/- 0.92 to 2.99 +/- 0.97 L (p = 0.01) and total lung capacity from 5.08 +/- 1.18 to 5.72 +/- 1.32 L (p = 0.03). The forced vital capacity, expiratory reserve volume and residual volume also increased but were not statistically significant (p = 0.07 for all). We noted no significant improvement in forced expiratory volume in 1 sec, forced expiratory effort 25% to 75%, vital capacity or diffusion capacity. There was marked symptomatic improvement in all patients. We conclude that large-volume paracentesis improves measured lung volumes within hours in patients with tense ascites.
大量腹腔穿刺放液术是治疗肝硬化患者张力性腹水的一种公认的治疗方式。虽然大量腹腔穿刺放液术对心血管系统的影响已得到详细研究，但张力性腹水和大量腹腔穿刺放液术对呼吸系统的影响仅得到有限评估。大多数患者在大量腹腔穿刺放液术后报告呼吸症状有所改善。我们研究的目的是前瞻性评估大量腹腔穿刺放液术对张力性腹水患者肺功能的影响。9例酒精性肝硬化合并张力性腹水患者接受了大量腹腔穿刺放液术（平均放腹水3500 ml），随后静脉输注白蛋白（每放1 L腹水输注10 g）。在大量腹腔穿刺放液术前及术后2小时进行肺功能测试。功能残气量从2.46±0.92 L增加至2.99±0.97 L（p = 0.01），肺总量从5.08±1.18 L增加至5.72±1.32 L（p = 0.03）。用力肺活量、呼气储备量和残气量也有所增加，但无统计学意义（均p = 0.07）。我们注意到1秒用力呼气量、25%至75%用力呼气量、肺活量或弥散量无显著改善。所有患者的症状均有明显改善。我们得出结论，大量腹腔穿刺放液术可在数小时内改善张力性腹水患者的测量肺容积。
