Luca A, Feu F, García-Pagán J C, Jiménez W, Arroyo V, Bosch J, Rodés J
Liver Unit, Hospital Clínic i Provincial, University of Barcelona, Spain.
Hepatology. 1994 Jul;20(1 Pt 1):30-3. doi: 10.1016/0270-9139(94)90130-9.
Total paracentesis is widely used in the treatment of patients with cirrhosis and tense ascites. However, very little information is available regarding its consequences on splanchnic circulation, and its effects on portocollateral blood flow have not been investigated. Ten cirrhotic patients admitted because of tense ascites had measurements of hepatic and systemic hemodynamics, renal function and endogenous vasoactive neurohumoral systems at baseline, just after total paracentesis and 1 hr later. Total paracentesis caused a significant increase in cardiac output (+11%; 95% confidence interval, +4% to +19%) and a rapid fall in portal pressure, as shown by significant decreases in both the wedged hepatic venous pressure (-27% +/- 8%; p < 0.005) and the hepatic venous pressure gradient (-10%; 95% confidence interval, -3% to -18%). This was accompanied by a marked decrease in azygos blood flow (-28%; 95% confidence interval, -13% to -43%). These favorable hemodynamic effects were associated with a fall of the elevated levels of plasma renin activity (-47% +/- 9%; p < 0.05), plasma aldosterone (-31% +/- 21%; p < 0.05) and plasma norepinephrine and by a decrease in levels of serum creatinine (-24% +/- 15%; p < 0.05) and blood urea nitrogen (-4% +/- 3%; p < 0.05). These changes were maintained 1 hr later. This study indicates that in patients with cirrhosis and tense ascites total paracentesis favorably influences the systemic hemodynamics, portocollateral blood flow and portal pressure.
大量腹腔穿刺术广泛应用于肝硬化合并张力性腹水患者的治疗。然而，关于其对内脏循环的影响的信息非常少，且其对门体侧支血流的影响尚未得到研究。10例因张力性腹水入院的肝硬化患者在基线、大量腹腔穿刺术后即刻及1小时后测量了肝和全身血流动力学、肾功能及内源性血管活性神经体液系统。大量腹腔穿刺术使心输出量显著增加（+11%；95%置信区间，+4%至+19%），门静脉压力迅速下降，这表现为肝静脉楔压（-27%±8%；p<0.005）和肝静脉压力梯度（-10%；95%置信区间，-3%至-18%）均显著降低。同时奇静脉血流明显减少（-28%；95%置信区间，-13%至-43%）。这些有利的血流动力学效应与血浆肾素活性升高水平下降（-47%±9%；p<0.05）、血浆醛固酮（-31%±21%；p<0.05）、血浆去甲肾上腺素下降以及血清肌酐水平（-24%±15%；p<0.05）和血尿素氮水平（-4%±3%；p<0.05）降低有关。这些变化在1小时后仍持续存在。本研究表明，对于肝硬化合并张力性腹水患者，大量腹腔穿刺术对全身血流动力学、门体侧支血流和门静脉压力有有利影响。
