A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis
A randomized unblinded pilot study comparing albumin versus hydroxyethyl starch in spontaneous bacterial peritonitis
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DOI：
10.1002/hep.20829
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发表时间：
2005-09-01
期刊：
影响因子：
13.5
通讯作者：
Navasa, M
中科院分区：
文献类型：
--
作者：
Fernández, J;Monteagudo, J;Navasa, M
白蛋白给药可改善肝硬化和自发性细菌性腹膜炎患者的循环功能，预防肝肾综合征，并降低住院死亡率。这项随机、非盲、初步研究比较了白蛋白（10例患者）和合成血浆扩张剂羟乙基淀粉200/0.5（10例患者）对自发性细菌性腹膜炎患者全身血流动力学的影响。在诊断感染后12小时内进行基线测量。然后患者接受2剂容量扩张剂（基线测量后为1.5 g/kg体重，第3天为1 g/kg体重）。感染消退后重复测量。白蛋白治疗与动脉压显著升高和血浆肾素活性抑制相关，表明循环功能改善。这发生在中心血容量显著扩张（心肺压力和心钠素增加）以及收缩期容量和全身血管阻力增加的情况下。相比之下，在接受羟乙基化酶治疗的患者中未观察到这些参数的显著变化。淀粉.白蛋白治疗患者的血管性血友病相关抗原血浆水平显著降低，但羟乙基淀粉治疗患者的血管性血友病相关抗原血浆水平未显著降低。接受羟乙基淀粉治疗的患者血清硝酸盐和亚硝酸盐增加，但接受白蛋白治疗的患者则没有增加。这些数据表明白蛋白对内皮功能的影响。总之，白蛋白而不是羟乙基淀粉改善了自发性细菌性腹膜炎患者的全身血流动力学。这种效应不仅是由于体积膨胀，而且是由于对外周动脉循环的作用。
The administration of albumin improves circulatory function, prevents hepatorenal syndrome, and reduces hospital mortality in patients with cirrhosis and spontaneous bacterial peritonitis. This randomized unblinded pilot study compared the effect of albumin (10 patients) and the synthetic plasma expander hydroxyethyl starch 200/0.5 (10 patients) on the systemic hemodynamics of patients with spontaneous bacterial peritonitis. Baseline measurements were performed within 12 hours after diagnosis of infection. Patients then received 2 doses of the volume expander (1.5 g/kg body weight after baseline measurements and I g/kg body weight on day 3). Measurements were repeated after infection resolution. Treatment with albumin was associated with a significant increase in arterial pressure and a suppression of plasma renin activity, indicating an improvement in circulatory function. This occurred in the setting of a significant expansion of central blood volume (increase in cardiopulmonary pressures and atrial natriuretic factor) and an increase in systolic volume and systemic vascular resistance. In contrast, no significant changes were observed in these parameters in patients treated with hydroxyethyl. starch. Von Willebrand-related antigen plasma levels significantly decreased in patients treated with albumin but not in those treated with hydroxyethyl starch. Serum nitrates and nitrites increased in patients treated with hydroxyethyl starch but not in those treated with albumin. These data suggest an effect of albumin on endothelial function. In conclusion, albumin but not hydroxyethyl starch improves systemic hemodynamics in patients with spontaneous bacterial peritonitis. This effect is due not only to volume expansion but also to an action on the peripheral arterial circulation.