DIAGNOSTIC PARACENTESIS - A POTENT CLINICAL TOOL
DIAGNOSTIC PARACENTESIS - A POTENT CLINICAL TOOL
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DOI：
10.1016/0016-5085(90)91317-y
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发表时间：
1990-01-01
期刊：
影响因子：
29.4
通讯作者：
HOEFS, JC
中科院分区：
文献类型：
--
作者：
HOEFS, JC
在过去的10年里，诊断性腹腔穿刺术作为评估腹水患者的关键初始检查变得越来越重要。系统研究，包括本期的两篇文章（121），阐明了腹腔穿刺术在快速诊断细菌性腹膜炎、利用化学分析鉴别自发性腹膜炎和继发性腹膜炎以及依靠血清和腹水之间的白蛋白梯度作为门静脉高压指标进行鉴别诊断方面的巨大价值。促使重新评价诊断性腹腔穿刺术的两个主要因素是：（a）腹水患者自发性细菌性腹膜炎（SBP）的发生率低至25%（3-11）;（B）腹水总蛋白浓度在新发腹水鉴别诊断中的不足（12-19）。这些最近的研究也证明了穿刺术的基本安全性（3-11，16，20，21）。即使在患有严重凝血障碍的重病患者中，与未检测到的原发性或继发性腹膜炎的风险相比，使用Z号针进行中线下腹部穿刺术也不太可能有害。腹膜炎是慢性肝病患者病情恶化的常见潜在可逆原因（23，241。未确诊的腹膜炎在新发腹水患者中也很重要，因为慢性肝病是主要原因。因此，对于所有新发腹水患者、所有入院的腹水患者以及腹水患者临床恶化的情况，都需要在入院后短时间内进行穿刺或重复穿刺（3-11，23，24）。
D iagnostic paracentesis has become increasingly important over the last 10 yr as the key initial test in the assessment of the ascitic patient. Systematic studies, including two articles in this issue (121, have clarified the immense value of paracentesis in the rapid diagnosis of bacterial peritonitis, in the differentiation of spontaneous from secondary peritonitis using the chemical analysis, and in differential diagnosis relying on the albumin gradient between serum and ascites as an index of portal hypertension. The two major factors stimulating reevaluation of diagnostic paracentesis were (a) the lo%-25% incidence of spontaneous bacterial peritonitis (SBP) in ascitic cirrhotic patients (3-11) and (b) the inadequacy of the ascitic fluid total protein concentration in the differential diagnosis of new-onset ascites (12-19). These recent studies have also demonstrated the basic safety of paracentesis (3-11, 16, 20, 21). Even in very ill patients with severe coagulopathy, a midline lower abdominal paracentesis with a Z-gauge needle is unlikely to be harmful compared with the risk of undetected primary or secondary peritonitis. Peritonitis is a common potentially reversible cause of deterioration in patients with chronic liver disease (23,241. Undiagnosed peritonitis is also important in patients with new-onset ascites because chronic liver disease is the major cause. Thus there is a consensus that paracentesis or repeat paracentesis is required within a short time of admission for all patients with newonset ascites, for all cirrhotics patients with ascites admitted to the hospital, and in the setting of clinical deterioration in the cirrhotic patient (3-11, 23, 24).