Peltekian K M, Wong F, Liu P P, Logan A G, Sherman M, Blendis L M
Department of Medicine, Toronto Hospital, Ontario, Canada.
Am J Gastroenterol. 1997 Mar;92(3):394-9.
Large volume paracentesis is an effective treatment for refractory ascites, but the need for routine infusion of albumin or other volume expanders remains controversial. The aim of this study was to assess the short term effects of a single 5-L paracentesis without albumin replacement on total central blood volume, systemic and renal hemodynamics, sodium homeostasis, and neurohumoral factors.
Twelve patients with biopsy-proven cirrhosis and tense, diuretic-resistant ascites were studied before and 48 h after a single 5-L paracentesis without albumin infusion. Systemic hemodynamics and total central blood volume were assessed using radionuclide angiography. Glomerular filtration rate and effective renal plasma flow were measured by inulin and para-aminohippurate clearances, respectively. Lithium clearance was used as an index of proximal tubular reabsorption of sodium. In addition, plasma concentrations of neurohumoral factors were determined.
Total central blood volume was 2.41 +/- 0.33 L/m2 (mean +/- SEM) before and 2.34 +/- 0.18 L/m2 48 h after large volume paracentesis (p = 0.76). Similarly, no differences were detected in the cardiac index, glomerular filtration rate, effective renal plasma flow, urinary sodium excretion, hematocrit, plasma renin activity, or concentrations of plasma aldosterone, norepinephrine, or atrial natriuretic factor.
A single large volume paracentesis without albumin replacement causes no disturbances in systemic and renal hemodynamics 48 h after the procedure. These results suggest that a single 5-L paracentesis without albumin infusion is a safe and satisfactory short term option for the management of patients with cirrhosis and tense, diuretic-resistant ascites.
大量腹腔穿刺放液是治疗顽固性腹水的有效方法，但常规输注白蛋白或其他扩容剂的必要性仍存在争议。本研究旨在评估单次5升腹腔穿刺放液且不补充白蛋白对总中心血容量、全身及肾脏血流动力学、钠稳态和神经体液因子的短期影响。
对12例经活检证实为肝硬化且有张力性、利尿剂抵抗性腹水的患者，在单次5升腹腔穿刺放液且不输注白蛋白之前及之后48小时进行研究。使用放射性核素血管造影评估全身血流动力学和总中心血容量。分别通过菊粉和对氨基马尿酸清除率测量肾小球滤过率和有效肾血浆流量。锂清除率用作近端肾小管钠重吸收的指标。此外，测定血浆神经体液因子浓度。
大量腹腔穿刺放液前总中心血容量为2.41±0.33升/平方米（均值±标准误），放液后48小时为2.34±0.18升/平方米（p = 0.76）。同样，在心脏指数、肾小球滤过率、有效肾血浆流量、尿钠排泄、血细胞比容、血浆肾素活性或血浆醛固酮、去甲肾上腺素或心房利钠因子浓度方面未检测到差异。
单次大量腹腔穿刺放液且不补充白蛋白在操作后48小时不会引起全身和肾脏血流动力学紊乱。这些结果表明，单次5升腹腔穿刺放液且不输注白蛋白是治疗肝硬化和张力性、利尿剂抵抗性腹水患者的一种安全且令人满意的短期选择。
