Total paracentesis in non-alcoholic cirrhotics with massive ascites: mid-term effects on systemic and hepatic haemodynamics and renal function.
Single total paracentesis (4.8-11 L) was performed in 23 patients with hepatitis B surface antigen (HBsAg)-positive cirrhosis and massive ascites and its effects on systemic and hepatic haemodynamics and renal function were examined over 5 days. Severe hypotension occurred in six (26.1%) patients from 6 to 54 h after paracentesis. In the remaining 17 patients, compared to the baseline, there was an increase in the cardiac output (6.1 +/- 0.3 vs 6.7 +/- 0.3 L/min, P < 0.001) and a decrease in right atrial pressure (8.8 +/- 0.8 vs 4.3 +/- 0.7 mmHg, P < 0.001), systemic vascular resistance (1160 +/- 61 vs 976 +/- 50 dyne.s.cm-5, P < 0.001), and wedged hepatic venous pressure 30 min after completion of paracentesis. After 5 days, right atrial pressure, systemic vascular resistance and wedged hepatic venous pressure returned to baseline, while the cardiac output dropped to a level lower than the baseline (5.7 +/- 0.7 L/min, P < 0.05). Hepatic venous pressure gradient had returned to baseline after 5 days. Serial tests of serum creatinine level showed an increase from day 3 (1.34 +/- 0.14 vs 1.04 +/- 0.10 mg/dL, P < 0.05). On day 5, creatinine clearance (55.7 +/- 5.4 vs 41.9 +/- 5.3 mL/min, P < 0.05) and effective renal plasma flow (351 +/- 32 vs 293 +/- 29 mL/min, P < 0.05) were decreased, compared to the baseline. Based on these data, infusion of a volume expander may be necessary for total paracentesis to avoid systemic haemodynamic complications in non-alcoholic cirrhosis.
Wang
S S
SS
Division of Gastroenterology, Veterans General Hospital, Taipei, Taiwan, ROC.
Lu
C W
CW
Chao
Y
Y
Lee
F Y
FY
Chen
T W
TW
Lin
H C
HC
Lee
S D
SD
Tsai
Y T
YT
Lo
K J
KJ
D001201:Ascites / Q000209:etiology / Q000628:therapy*; D004322:Drainage / Q000379:methods; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006514:Hepatitis B Surface Antigens / Q000032:analysis; D006801:Humans; D007022:Hypotension / Q000209:etiology; D007668:Kidney / Q000503:physiopathology*; D008102:Liver Circulation / Q000502:physiology*; D008103:Liver Cirrhosis / Q000150:complications* / Q000503:physiopathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D010952:Plasma Substitutes / Q000627:therapeutic use; D011677:Punctures; D013997:Time Factors
D006514:Hepatitis B Surface Antigens; D010952:Plasma Substitutes