Altman C, Bernard B, Roulot D, Vitte R L, Ink O
Department of Hepatology, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
Eur J Gastroenterol Hepatol. 1998 Jan;10(1):5-10. doi: 10.1097/00042737-199801000-00002.
Large-volume paracentesis associated with plasma volume expansion with albumin is an effective, safe, but costly therapy for ascites in patients with cirrhosis. The aim of this study was to compare the use of a synthetic plasma expander, hydroxyethyl starch (HES), with that of albumin.
Sixty cirrhotic patients with ascites were studied. Patients were randomly assigned to be infused with either albumin (8 g/l of ascites removed, n = 33) or HES (200 ml/l of ascites removed, n = 27). None of the patients was treated with diuretics or had renal impairment or hyponatremia at entry. Clinical and laboratory data were obtained before and 1, 3 and 15 days after treatment.
There were no significant differences in clinical and laboratory parameters between the two groups at entry into the study. None of the patients developed renal impairment during the trial. One patient (HES group) presented with hyponatremia. Plasma atrial natriuretic factor and aldosterone levels did not differ between the two groups at baseline or at 1 and 3 days after paracentesis. The volume of ascites removed did not differ between the albumin (7.9 +/- 4.4 l) and HES (6.9 +/- 5.3 l) groups. However, there was a significant difference in weight loss between the albumin and HES groups (7.9 +/- 5.2 kg vs 4.7 +/- 3.4 kg; p = 0.01). Clinical and laboratory parameters indicated that HES was well tolerated except for hypoalbuminemia.
HES is well tolerated in patients with cirrhosis. There is no difference between HES and albumin in the prevention of complications related to large-volume paracentesis. The lesser degree of weight loss observed with HES needs further study.
大量腹腔穿刺放液联合白蛋白扩容是治疗肝硬化腹水患者的一种有效、安全但成本较高的方法。本研究旨在比较合成血浆扩容剂羟乙基淀粉（HES）与白蛋白的使用效果。
对60例肝硬化腹水患者进行研究。患者被随机分配接受白蛋白输注（每抽出1升腹水输注8克，n = 33）或HES输注（每抽出1升腹水输注200毫升，n = 27）。所有患者在入组时均未接受利尿剂治疗，也没有肾功能损害或低钠血症。在治疗前以及治疗后1天、3天和15天获取临床和实验室数据。
研究入组时两组的临床和实验室参数无显著差异。试验期间没有患者出现肾功能损害。1例患者（HES组）出现低钠血症。血浆心钠素和醛固酮水平在基线时以及腹腔穿刺放液后1天和3天两组之间没有差异。白蛋白组（7.9±4.4升）和HES组（6.9±5.3升）抽出的腹水量没有差异。然而，白蛋白组和HES组之间的体重减轻存在显著差异（7.9±5.2千克对4.7±3.4千克；p = 0.01）。临床和实验室参数表明，除了低白蛋白血症外，HES耐受性良好。
肝硬化患者对HES耐受性良好。在预防与大量腹腔穿刺放液相关的并发症方面，HES和白蛋白之间没有差异。HES观察到的体重减轻程度较小需要进一步研究。
