Randomized trial comparing albumin and saline in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients with ascites

被引:147
作者
Sola-Vera, J
Miñana, J
Ricart, E
Planella, M
González, B
Torras, X
Rodríguez, J
Such, J
Pascual, S
Soriano, G
Pérez-Mateo, M
Guarner, C
机构
[1] Hosp Santa Cruz & San Pablo, Hormonal Lab, E-08025 Barcelona, Spain
[2] Hosp Santa Cruz & San Pablo, Dept Gastroenterol, Liver Unit, E-08025 Barcelona, Spain
[3] Hosp Gen Univ Alicante, Dept Internal Med, Liver Unit, Alicante, Spain
关键词
D O I
10.1053/jhep.2003.50169
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Paracentesis-induced circulatory dysfunction (PICD) is a recently described complication that can be prevented with the administration of plasma expanders. The aim of this study was to compare the efficacy of saline versus albumin in the prevention of PICD. Patients were randomized to receive albumin or saline after total paracentesis. Patients readmitted as a consequence of a second episode of tense ascites were treated with total paracentesis and the alternative plasma expander. After randomization, 35 patients received saline and 37 received albumin. Twenty-one patients were readmitted for tense ascites and treated with the alternative expander. Significant increases in plasma renin activity (PRA) were found 24 hours and 6 days after paracentesis when saline was used (baseline, 5.6 +/- 5.7; 24 hours, 7.6 +/- 6.9; 6 days, 8.5 +/- 8.0 ng . mL(-1) (.) hr(-1); P < .05 and P < .01 vs. baseline, respectively), whereas no significant changes were observed with albumin. The incidence of PICD was significantly higher in the saline group versus the albumin group (33.3% vs. 11.4%, respectively, P = .03). However, no significant differences were found when less than 6 L of ascitic fluid was evacuated (6.7% vs. 5.6% in the saline and albumin groups, respectively; P =.9). Similar results were observed when analyzing patients who received 2 consecutive paracentesis (i.e., a significant increase in PRA after saline [P < .01] without significant variations after albumin). In conclusion, albumin is more effective than saline in the prevention of PICD. Saline is a valid alternative to albumin when less than 6 L of ascitic fluid is evacuated.
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页码:1147 / 1153
页数:7
相关论文
共 16 条
[1]   Definition and diagnostic criteria of refractory ascites and hepatorenal syndrome in cirrhosis [J].
Arroyo, V ;
Gines, P ;
Gerbes, AL ;
Dudley, FJ ;
Gentilini, P ;
Laffi, G ;
Reynolds, TB ;
RingLarsen, H ;
Scholmerich, J .
HEPATOLOGY, 1996, 23 (01) :164-176
[2]  
CABRERA J, 1991, HEPATOLOGY, V14, P1025
[3]   PARACENTESIS WITH DEXTRAN-70 VS PARACENTESIS WITH ALBUMIN IN CIRRHOSIS WITH TENSE ASCITES - RESULTS OF A RANDOMIZED STUDY [J].
FASSIO, E ;
TERG, R ;
LANDEIRA, G ;
ABECASIS, R ;
SALEMNE, M ;
PODESTA, A ;
RODRIGUEZ, P ;
LEVI, D ;
KRAVETZ, D .
JOURNAL OF HEPATOLOGY, 1992, 14 (2-3) :310-316
[4]   Randomized trial comparing albumin, dextran 70, and polygeline in cirrhotic patients with ascites treated by paracentesis [J].
Gines, A ;
FernandezEsparrach, G ;
Monescillo, A ;
Vila, C ;
Domenech, E ;
Abecasis, R ;
Angeli, P ;
RuizDelArbol, L ;
Planas, R ;
Sola, R ;
Gines, P ;
Terg, R ;
Inglada, L ;
Vaque, P ;
Salerno, F ;
Vargas, V ;
Clemente, G ;
Quer, JC ;
Jimenez, W ;
Arroyo, V ;
Rodes, J .
GASTROENTEROLOGY, 1996, 111 (04) :1002-1010
[5]   RANDOMIZED COMPARATIVE-STUDY OF THERAPEUTIC PARACENTESIS WITH AND WITHOUT INTRAVENOUS ALBUMIN IN CIRRHOSIS [J].
GINES, P ;
TITO, L ;
ARROYO, V ;
PLANAS, R ;
PANES, J ;
VIVER, J ;
TORRES, M ;
HUMBERT, P ;
RIMOLA, A ;
LLACH, J ;
BADALAMENTI, S ;
JIMENEZ, W ;
GAYA, J ;
RODES, J .
GASTROENTEROLOGY, 1988, 94 (06) :1493-1502
[6]   COMPARISON OF PARACENTESIS AND DIURETICS IN THE TREATMENT OF CIRRHOTICS WITH TENSE ASCITES - RESULTS OF A RANDOMIZED STUDY [J].
GINES, P ;
ARROYO, V ;
QUINTERO, E ;
PLANAS, R ;
BORY, F ;
CABRERA, J ;
RIMOLA, A ;
VIVER, J ;
CAMPS, J ;
JIMENEZ, W ;
MASTAI, R ;
GAYA, J ;
RODES, J .
GASTROENTEROLOGY, 1987, 93 (02) :234-241
[7]  
GUARNER C, 1993, HEPATOLOGY, V18, P1139
[8]  
HAGEGE H, 1992, GASTROEN CLIN BIOL, V16, P751
[9]   DEXTRAN-70 VERSUS ALBUMIN AS PLASMA EXPANDERS IN CIRRHOTIC-PATIENTS WITH TENSE ASCITES TREATED WITH TOTAL PARACENTESIS - RESULTS OF A RANDOMIZED STUDY [J].
PLANAS, R ;
GINES, P ;
ARROYO, V ;
LLACH, J ;
PANES, J ;
VARGAS, V ;
SALMERON, JM ;
GINES, A ;
TOLEDO, C ;
RIMOLA, A ;
JIMENEZ, W ;
ASBERT, M ;
GASSULL, MA ;
RODES, J .
GASTROENTEROLOGY, 1990, 99 (06) :1736-1744
[10]   Paracentesis-induced circulatory dysfunction: Mechanism and effect on hepatic hemodynamics in cirrhosis [J].
RuizdelArbol, L ;
Monescillo, A ;
Jimenez, W ;
GarciaPlaza, A ;
Arroyo, V ;
Rodes, J .
GASTROENTEROLOGY, 1997, 113 (02) :579-586