Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis
Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis
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DOI：
10.1016/s0016-5085(96)70068-9
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发表时间：
1996-10-01
期刊：
影响因子：
29.4
通讯作者：
Rodes, J
中科院分区：
文献类型：
--
作者：
Gines, A;FernandezEsparrach, G;Rodes, J
背景与目的：腹腔穿刺联合血浆扩容剂被广泛用于肝硬化腹水的治疗。本研究探讨了腹腔穿刺诱导的循环功能障碍的临床重要性，并比较了白蛋白、右旋糖酐70和聚明胶肽在预防该并发症方面的疗效。
方法：将289例肝硬化腹水患者随机分为三组，分别接受完全腹腔穿刺联合静脉输注白蛋白（97例）、右旋糖酐70（93例）或聚明胶肽（99例）治疗。腹腔穿刺后循环功能障碍定义为腹腔穿刺后第6天血浆肾素活性较治疗前升高超过50%且达到＞4 ng·mL⁻¹·h⁻¹的水平。
结果：接受右旋糖酐70（34.4%；P = 0.018）或聚明胶肽（37.8%；P = 0.004）治疗的患者腹腔穿刺后循环功能障碍的发生率高于接受白蛋白治疗的患者（18.5%）。所使用的血浆扩容剂和抽取的腹水量是该并发症的独立预测因素。腹腔穿刺后循环功能障碍在随访期间持续存在，且与首次再入院时间缩短（1.3 ± 0.5个月对3.5 ± 0.8个月，中位数±标准误；P = 0.03）和生存期缩短（9.3 ± 4.2个月对16.9 ± 4.3个月；P = 0.01）相关。血清肌酐和钠水平、入组时的Child - Pugh评分以及腹腔穿刺后循环功能障碍是生存期的独立预测因素。
结论：腹腔穿刺后循环功能障碍不能自发逆转，且与首次再入院时间缩短和生存期缩短相关。白蛋白是预防该并发症的最佳血浆扩容剂。
Background & Aims: Paracentesis associated with plasma expanders is widely used for the treatment of ascites in cirrhosis. This study investigated the clinical importance of paracentesis-induced circulatory dysfunction and compared the efficacy of albumin, dextran 70, and polygeline in preventing this complication. Methods: A total of 289 cirrhotic patients with ascites were randomized to treatment by total paracentesis plus intravenous albumin (97 patients), dextran 70 (93 patients), or polygeline (99 patients). Postparacentesis circulatory dysfunction was defined as an increase in plasma renin activity on the sixth day after paracentesis of more than 50% of the pretreatment value to a level >4 ng . mL(-1). h(-1). Results: Postparacentesis circulatory dysfunction occurred more frequently in patients treated with dextran 70 (34.4%; P = 0.018) or polygeline (37.8%; P = 0.004) than in those receiving albumin (18.5%). The plasma expander used and the volume of ascites removed were independent predictors of this complication. Postparacentesis circulatory dysfunction persisted during follow-up and was associated with a shorter time to first readmission (1.3 +/- 0.5 vs. 3.5 +/- 0.8 months, median +/- SEM; P = 0.03) and shorter survival (9.3 +/- 4.2 vs. 16.9 +/- 4.3 months; P = 0.01). Creatinine and sodium levels in serum, and Child-Pugh score at inclusion, and postparacentesis circulatory dysfunction were independent predictors of survival. Conclusions: Postparacentesis circulatory dysfunction is not spontaneously reversible and is associated with a shorter time to first readmission and shorter survival. Albumin is the best plasma expander to prevent this complication.