간경변증 환자에서 일회성 대량 복수천자에 따른 혈역동학적 변화 -혈장증량제로서 알부민 투여가 미치는 영향을 중심으로

Abstract

Background : In patients with cirrhosis, single large volume paracentesis(SLVP) is an effective and safe treatment for the tense ascites. But the need for routine administration of albumin remains controversial. We investigated the necessity of albumin administration in cirrhosis with tense ascites after SLVP. Methods : 23 patients with cirrhosis with tense ascites were recruited, and examined before and 48 hour after a SLVP. Patients were randomly ass igned to be administrated with albumin(6 g/L of ascites removed, n=11) or not(n=12). Systemic and renal hemodynamic parameters (mean arterial blood pressure, cardiac index, systemic vascular resistance index, resistive index of kidney, and serum creatinine), indices as sociated with sodium homeostas is (urine sodium and osmolarity) and neurohumoral factors such as plasma renin activity and plasma concentration of aldosterone were measured before and 48 hour after a SLVP. Results : There was no s ignificant difference in clinical and laboratory parameters between two groups at entry into the s tudy. Plasma renin activity was s ignificantly increased 48 hour after a SLVP in patients without albumin administration, but the change of plasma renin activity before and after paracentesis(Δplasma renin activity) was not significantly different between two groups. T here was no difference in the mean arterial blood pressure, cardiac index, systemic vascular resistance index, resistive index of kidney, serum creatinine, urine sodium and osmolarity and plasma concentration of aldos terone between two groups after SLVP. Conclus ion : Single large volume paracentesis without albumin administration is a safe and effective treatment in cirrhosis with tense ascites.(Korean J Med 58:276- 282, 2000)