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首页> 外文期刊>Journal of clinical gastroenterology >Comparison of midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients: A randomized pilot study
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Comparison of midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction in cirrhotic patients: A randomized pilot study

机译：比较米多君和白蛋白预防肝硬化患者穿刺穿刺引起的循环功能障碍：一项随机试验研究

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GOALS:: In this pilot study, we compared midodrine and albumin in the prevention of paracentesis-induced circulatory dysfunction (PICD). BACKGROUND:: PICD with pronounced arterial vasodilatation in cirrhotics with tense ascites can be prevented by the infusion of albumin, which is an expensive treatment modality. Various vasoconstrictors have also been used to prevent PICD, but there are few studies about the usage of midodrine. STUDY:: Fifty patients with cirrhosis and tense refractory ascites were randomly assigned to be treated with either midodrine (n=25) (12.5 mg 3 times/d; over 3 d) or albumin (n=25) (8 g/L of removed ascites) after a large-volume paracentesis. Effective arterial blood volume was assessed indirectly by measuring serum creatinine, serum sodium, plasma renin activity, and aldosterone concentration before and 6 days after paracentesis. RESULTS:: Midodrine therapy was cheaper compared with albumin therapy, but serum creatinine, serum sodium, plasma renin activity, and plasma aldosterone concentration values after treatment [0.99±0.19 to 3.02±2.58 mg/dL (P=0.001), 132.36±3.2 to 130.2±4.1 mEq/L (P<0.001), 3.03±0.33 to 4.2±0.76 ng/mL/h (P<0.001), and 166.72±64.26 to 298.64±130 pg/mL (P<0.001), respectively] significantly differed in the midodrine group from that in the albumin group [1.10±0.22 to 1.11±0.161 mg/dL (P=0.885), 132.2±3.524 to 131.88±3.09 mEq/L (P=0.246), 4±0.91 to 4.11±0.74 ng/mL/h (P=0.440), and 204.88±115.9 to 177.08±100.5 pg/mL (P<0.001), respectively]. Seven patients, among whom 6 were hepatocellular carcinoma (HCC) positive, in the midodrine group of our study died as a consequence of liver failure complicated by acute renal failure, followed by hepatic encephalopathy. Whereas in the albumin group, even among the 7 patients with HCC, no patient died or developed hepatorenal syndrome or developed hepatic encephalopathy. CONCLUSIONS:: This pilot study suggests that midodrine is not as effective as intravenous albumin in preventing circulatory dysfunction after large-volume paracentesis in patients with cirrhosis and tense ascites, especially with HCC-positive patients.
机译：目标：在这项先导研究中，我们比较了米多君和白蛋白在预防穿刺引起的循环功能障碍（PICD）中的作用。背景：输注白蛋白可预防肝硬化并伴有腹水的明显血管扩张的PICD，这是一种昂贵的治疗方法。各种血管收缩药也已被用于预防PICD，但关于米多君的用法研究很少。研究：将五十例肝硬化和紧张性顽固性腹水患者随机分配接受米多君（n = 25）（12.5 mg 3次/ d;超过3 d）或白蛋白（n = 25）（8 g / L大量腹腔穿刺术后取出腹水）。通过测量穿刺前和穿刺后6天的血清肌酐，血清钠，血浆肾素活性和醛固酮浓度间接评估有效动脉血容量。结果：米多君治疗较白蛋白治疗便宜，但治疗后血清肌酐，血清钠，血浆肾素活性和血浆醛固酮浓度值[0.99±0.19至3.02±2.58 mg / dL（P = 0.001），132.36±3.2分别为130.2±4.1 mEq / L（P <0.001），3.03±0.33至4.2±0.76 ng / mL / h（P <0.001）和166.72±64.26至298.64±130 pg / mL（P <0.001）]米多君组与白蛋白组有显着差异[1.10±0.22至1.11±0.161 mg / dL（P = 0.885），132.2±3.524至131.88±3.09 mEq / L（P = 0.246），4±0.91至4.11分别为±0.74 ng / mL / h（P = 0.440）和204.88±115.9至177.08±100.5 pg / mL（P <0.001）]。在我们的研究的米多君组中，有7位患者死亡，其中6位是肝细胞癌（HCC）阳性，是由于肝功能衰竭并发急性肾功能衰竭，然后是肝性脑病死亡的。而在白蛋白组中，即使在7例HCC患者中，也没有患者死亡或发展为肝肾综合征或发展为肝性脑病。结论：这项初步研究表明，米多君在预防肝硬化和紧张性腹水尤其是HCC阳性患者大面积穿刺后的循环功能障碍方面不如静脉白蛋白有效。

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