Naslov
Postparacentesis neurohumoral changes in Child-Pugh C cirrhosis with and without volume replacement

Autori
Degoricija, Vesna ; Šefer, Siniša ; Zjačić-Rotkvić, Vanja ; Marout, Jasminka ; Troskot Branko

Vrsta, podvrsta i kategorija rada
Sažeci sa skupova, sažetak, znanstveni

Izvornik
Intensive Care Medicine / Falke, Konrad ; Gerlach, Herwig - Rim : Springer, 2000, S 247-S 247

Skup
13th Annual Congress of European Society of Intensive Care Medicine

Mjesto i datum
Rim, Italija, 01.10.2000. - 04.10.2000

Vrsta sudjelovanja
Poster

Vrsta recenzije
Međunarodna recenzija

Ključne riječi
liver cirrhosis; therapy; ascites; therapy; paracentesis; neurohumoral changes; volume replacement

Sažetak
INTRODUCTION. In advanced stages of the cirrhosis ascites may become refractory to medical treatment. In many centers paracentesis is considered the treatment of choice for tense ascites. However, the mechanism of effective hypovolemia after paracentesis, the main cause of postparacentesis circulatory dysfunction syndrome remains unknown. The aim of the study was to assess neurohumoral changes of effective hypovolemia after paracentesis with and without volume replacement and bed rest 24 h before and after the procedure. METHODS. 4o patients with Child-Pugh C cirrhosis and tense ascites were randomly allocated into 4 groups. Mean arterial pressure, laboratory parameters of hepatic and renal function, plasma renin activity, plasma aldosteron and atrial natriuretic peptide were measured before, 6 h and on the 2nd, 3rd, and 6th day after paracentesis. 30 patients were treated with paracentesis (6 L) associated with plasma volume expansion (200 mL 20% human albumin, 600 mL fresh frosen plasma, 900 mL solution of synthetic gelatin-doses with comparable oncotic power) and bed rest 24 h before and after the procedure, versus 10 patients treated with paracentesis of 6 L of ascites without volume replacement and bed rest. RESULTS. Paracentesis, bed rest 24 h before and after the procedure and intravenous substitution of volume with albumin, fresh frosen plasma and solution of synthetic gelatin do not induce significant changes in mean arterial pressure, laboratory parameters of hepatic and renal function, plasma renin activity and plasma aldosteron concentration. Immediately after procedure there is marked increase in the plasma concentration of atrial natriuretic peptide. In contrast, paracentesis without bed rest 24 h before and after the procedure and plasma volume expansion is associated with a significant increase in plasma renin activity, plasma aldosteron concentration and significant decrease in plasma atrial natriuretic peptide levels, development of postparacentesis circulatory dysfunction and greater risk of hepatorenal syndrome, massive variceal bleeding and death. Paracentesis induced circulatory dysfunction is predominantly caused by an accentuation of the arteriolar vasodilation already present in cirrhotic patients with ascites. CONCLUSION. In Child-Pugh C cirrhosis, with tense, symptomatic ascites, therapeutic paracentesis of 6 L is safe, rapid and effective therapy, if intravascular volume is substituted simultaneously. Albumin is superior to the other plasma expanders with exception of cost. REFERENCES. 1. Arroyo V, Gines A, Salo J. European survey on the treatment of ascites in cirrhosis. J Hepatol 1994 ; 21:667-72. 2. Arroyo V. Treatment of ascites. Cro J Gastroent Hepatol 1997 ; Suppl 1:43-6. 3. Ruiz de Arbol L, Monescillo A, Jimenez W et al.Paracentesis induced circulatory dysfunction: mechanism and effect on hepatic hemodynamics in cirrhosis. Gastroenterology 1997 ; 113:579-86. 4. Bernardi M, Trevisani F, Fornale L et al. Renal sodium handling in cirrhosis with ascites: mechanisms of impaired natriuretic response to reclining. J Hepatol 1994 ; 21:1116-22.

Izvorni jezik
Engleski

Znanstvena područja
Kliničke medicinske znanosti

POVEZANOST RADA