Chao Y, Wang S S, Lee S D, Shiao G M, Chang H I, Chang S C
Department of Medicine, Veterans General Hospital-Taipei, Taiwan, Republic of China.
J Hepatol. 1994 Jan;20(1):101-5. doi: 10.1016/s0168-8278(05)80474-x.
The effect of large-volume paracentesis on lung function was evaluated in 12 male patients with cirrhosis. All underwent pulmonary function tests including spirometry, plethysmography and single-breath carbon-monoxide diffusing capacity 1 day before and after paracentesis. The amount of ascitic fluid removed ranged from 3.6 to 131 (mean +/- SD, 7.4 +/- 3.01). After paracentesis, forced vital capacity, forced expiratory volume at 1 s, total lung capacity, functional residual capacity, inspiratory capacity, expiratory reserve volume, diffusing capacity and alveolar volume increased significantly. In contrast, Kco (diffusing capacity corrected by alveolar volume) decreased significantly. After paracentesis, the increase in diffusing capacity was highly correlated with lung volumes and the amount of removed ascitic fluid. Nevertheless, a significantly negative correlation was found between the change of Kco before and after paracentesis and that of lung volumes. The increase in lung volumes and ventilation to the lower lungs with unfavorable ventilation-perfusion matching might explain the discrepancy between changes in diffusing capacity and Kco after large-volume paracentesis. In conclusion, these results suggest that pulmonary function in patients with cirrhosis and tense ascites is partly improved by large-volume paracentesis. Large-volume paracentesis might be useful for symptomatic relief in selected patients with tense ascites.
对12例男性肝硬化患者评估了大量腹腔穿刺放液对肺功能的影响。所有患者在腹腔穿刺放液前后1天均接受了肺功能测试，包括肺活量测定、体积描记法和单次呼吸一氧化碳弥散量测定。放液量为3.6至131（均值±标准差，7.4±3.01）。腹腔穿刺放液后，用力肺活量、第1秒用力呼气量、肺总量、功能残气量、吸气量、呼气储备量、弥散量和肺泡容积均显著增加。相比之下，Kco（经肺泡容积校正的弥散量）显著降低。腹腔穿刺放液后，弥散量的增加与肺容积及放液量高度相关。然而，腹腔穿刺放液前后Kco的变化与肺容积的变化之间存在显著负相关。肺容积增加以及向通气灌注匹配不佳的下肺通气增加，可能解释了大量腹腔穿刺放液后弥散量和Kco变化之间的差异。总之，这些结果表明，大量腹腔穿刺放液可部分改善肝硬化合并张力性腹水患者的肺功能。大量腹腔穿刺放液可能对部分有症状的张力性腹水患者缓解症状有用。
