Graziotto A, Rossaro L, Inturri P, Salvagnini M
Division of Gastroenterology, School of Medicine, University of Padova, Italy.
Dig Dis Sci. 1997 Aug;42(8):1708-14. doi: 10.1023/a:1018865516168.
We compared the efficacy and safety of apheresis and reinfusion of concentrated ascites (ARCA) versus total paracentesis plus intravenous albumin (PARA) in a prospective trial on cirrhotic patients with tense ascites. Twenty-four patients were randomized to either ARCA (N = 12) or PARA (N = 12), and followed for two years. Sex, age, Child's class, and renal and liver function were similar in the two groups. The times the procedures were 2.7 +/- 1.0 (ARCA) vs 2.2 +/- 1.1 (PARA) hr, with removal of 8.8 +/- 3.5 (ARCA) and 6.9 +/- 3.4 (PARA) liters of ascites and intravenous infusion of 59.8 +/- 35.2 (ARCA) and 42.5 +/- 20.5 (PARA) g of albumin. Both procedures were safe. Biochemical signs of coagulative disturbances having no clinical relevance were observed after ARCA, with an increase in prothrombin time (P = 0.005) and serum FSP (P = 0.02). No significant changes in renal function, serum albumin, or plasma and urinary electrocytes were shown. Plasma renin activity increased after PARA (P = 0.02) and plasma atrial natriuretic factor increased after ARCA (P = 0.008), although no differences were observed in diuresis in the immediate follow-up. During the long-term follow-up, patient survival and recurrence of tense ascites were the same in both groups. We conclude that apheresis and reinfusion of concentrated ascites are as safe and effective as total paracentesis with albumin infusion for the treatment of tense ascites in cirrhotic patients.
在一项针对肝硬化腹水患者的前瞻性试验中，我们比较了腹水去除并回输浓缩腹水（ARCA）与单纯腹腔穿刺放液加静脉输注白蛋白（PARA）的疗效和安全性。24例患者被随机分为ARCA组（N = 12）或PARA组（N = 12），并随访两年。两组患者的性别、年龄、Child分级以及肝肾功能相似。操作时间方面，ARCA组为2.7±1.0小时，PARA组为2.2±1.1小时；腹水去除量方面，ARCA组为8.8±3.5升，PARA组为6.9±3.4升；静脉输注白蛋白量方面，ARCA组为59.8±35.2克，PARA组为42.5±20.5克。两种操作均安全。ARCA术后观察到无临床意义的凝血功能紊乱生化指标，凝血酶原时间升高（P = 0.005），血清纤维蛋白降解产物升高（P = 0.02）。肾功能、血清白蛋白、血浆及尿电解质无显著变化。PARA术后血浆肾素活性升高（P = 0.02），ARCA术后血浆心钠素升高（P = 0.008），尽管在近期随访中尿量无差异。在长期随访中，两组患者的生存率和顽固性腹水复发率相同。我们得出结论，对于肝硬化患者顽固性腹水的治疗，腹水去除并回输浓缩腹水与单纯腹腔穿刺放液加白蛋白输注一样安全有效。
