RESUMEN
El desarrollo de ascitis es la complicación más frecuente del paciente con cirrosis hepática y generalmente marca el paso hacia la descompensación, con lo cual empeora el pronóstico y se deteriora la calidad de vida. Los estudios clínicos demuestran que aproximadamente el 50%de los pacientes cirróticos con ascitis no complicada mueren a los 2 años y que el 50% de los que desarrollan ascitis refractaria mueren a los 6 meses si no reciben tratamiento. Las medidas terapéuticas actuales en el paciente cirrótico con ascitis se encaminan a mantener un balance negativo de sodio, mediante la restricción del consumo de sal y el uso de diuréticos. Tales medidas pueden ser insuficientes en el caso de la ascitis a tensión, por lo que se requiere un tratamiento que mejore rápidamente la sintomatología y restaure la funcionalidad del paciente, además de medidas de soporte para prevenir la acumulación de líquido en la cavidad peritoneal y por ende reducir las enfermedades asociadas. Por lo anterior, la paracentesis evacuante seguida de fármacos diuréticos es el tratamiento de elección en los pacientes con ascitis a tensión.
The development of ascites is the most frequent complication of patients with hepatic cirrhosis; usually it leads to decompensation which is associated with worsening prognosis and deterioration of life quality. Clinical studies reveal that approximately 50%of cirrhotic patients with uncomplicated ascites die within two years while 50%of those with refractory ascites, if left untreated, die within six months. Currently, therapeutic measures in cirrhotic patients with ascites are designed to maintain a negative balance of sodium, which is achieved by a restricted salt intake and the use of diuretics. In the case of tense ascites those measures may be insufficient and, therefore, a treatment is required that quickly controls symptoms and improves function. Such treatment must be accompanied by support measures to prevent fluid accumulation in the peritoneal cavity, thus reducing the risk of associated diseases. Paracentesis of great volumes followed by diuretics is considered as the therapy of choice for managing patients with tense ascites.
Asunto(s)
Humanos , Alcoholismo , Ascitis , Cavidad Peritoneal , Cirrosis Hepática , Diuréticos/administración & dosificación , Diuréticos/efectos adversos , MorbilidadRESUMEN
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 assigned 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 associated with sodium homeostasis(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 significant difference in clinical and laboratory parameters between two groups at entry into the study. Plasma renin activity was significantly increased 48 hour after a SLVP in patients without albumin administration, but the change of plasma renin activity before and after paracentesis((delta)plasma renin activity) was not significantly different between two groups. There 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 aldosterone between two groups after SLVP. CONCLUSION: Single large volume paracentesis without albumin administration is a safe and effective treatment in cirrhosis with tense ascites.