• 作者： 王聖賢; 陳俊嘉; 趙毅; 吳淑玲; 李發耀; 林漢傑; 江志桓; 蔡養德; 李壽東
• 作者服務機構： 台北榮民總醫院內科部胃腸科; 台北榮民總醫院加護中心暨國立陽明大學
• 中文摘要： 為尋找大量腹水放液術後併發嚴重低血壓的臨床指標，以及決定靜脈注射頂防性血容擴張劑的恰當時問，我們於42位肝炎後肝硬化合併巨量腹水病患施行大量腹水放液術（4.8~5.5公升）。其中32位病患施行72小時連續性系統血流動力學檢查。結果顯示，十三位病患（31.0％）於腹水放液後4~62小時間發生嚴重低血壓。我們以Mantel-Cox檢驗比較Kaplan-Meier曲線作單變項分析，並進一步以Stepwise Cox Regression步驟做多變項分析，獲得預測發生嚴重低血壓的兩個變項—腹水放液超過7.5公升(P = 0.0121)及無末稍水腫(P = 0.0148)—具有統計學上的意義。與基礎值比較，未發生嚴重低血壓病患放液1小時後的心輸出量增高(6.26　±　0.66 vs. 6.65　±　0.09 L/min, p < 0.01)，而右心房壓降低(11.2 ±2.4 vs. 8.7 ± 2.3 mmHg，p ﹤0.05)。心輸出量於第9小時回復至基礎值。結論：肝炎後肝硬化合併巨量腹水病患施行大量腹水放液術之72小時內產生嚴重低血壓之比率甚高，而無末稍水腫病患或腹水放液超過7.5公升病患之危險性更高。大量腹水放掖術後4小時內應施行靜脈注射預防性血容擴張劑。
• 英文摘要： Large volume paracentesis (4.8 to 15.5 liters) was performed in 42 patients with post-hepatitic cirrhosisand massive ascites, not only to derive parameters capable of predicting the development of severe clinicalhypotension after large volume paracentesis, but also to determine the optimal time to introduce preventivevolume expanders. Systemic hemodynamics were sequentially measured for 72 hours in thirty-two patients.Severe clinical hypotension occurred in 13 (31.0%) patients 4-62 hours from the start of paracentesis. Univariateanalysis, with the Mantel-Cox test used to compare Kaplan-Meier curves, and the subsequent multivariateanalysis by stepwise Cox regression procedure were utilized to identify two variables, withdrawn ascitic fluidgreater than 7.5 liters (p = 0.0121) and the absence of peripheral edema (p = 0.0148), reaching statisticalsignificance to predict the occurrence of severe clinical hypotension. Compared to the baseline value, thecardiac output of patients not developing severe clinical hypotension increased (6.26 ± 0.66 vs. 6.65 ± 0.69liter/min, p < 0.01) one hour from the start of paracentesis and right atrial pressure decreased (11.2 ± 2.4 vs. 8.7± 2.3 mmHg, p < 0.05). The cardiac output returned to the baseline value at the 9th hour. Based on the resultspresented herein, we can conclude that severe clinical hypotension occurs in a high percentage of patientswith post-hepatitic cirrhosis and massive ascites within 72 hours from the start of large volume paracentesis.At potential risk of this occurring are those patients without peripheral edema and withdrawn ascitic fluidgreater than 7.5 liters. Volume expanders should be introduced before 4th hour from the start of large volumeparacentesis.
• 中文關鍵字： cirhosis; ascitic fluid; hemodynamics; paracentesis.
• 英文關鍵字： --