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Total paracentesis in non‐alcoholic cirrhotics with massive ascites: Mid‐term effects on systemic and hepatic haemodynamics and renal function

1994; Wiley; Volume: 9; Issue: 6 Linguagem: Inglês

10.1111/j.1440-1746.1994.tb01567.x

1440-1746

Sun-Sang Wang, Chi-Wen Lu, Yee Chao, FA‐YAUH LEE, TZEN‐WEN CHEN, Han‐Chieh Lin, SHOU‐DONG LEE, YANG‐TE TSAI, Kwang‐Juei Lo,

Hemodynamic Monitoring and Therapy

Abstract 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.