口服米多君与输注大量腹腔穿刺的难治性腹水的肝硬化患者

StephenW

Oral midodrine is comparable to albumin infusion in cirrhotic patients with refractory ascites undergoing large-volume paracentesis
results of a pilot study

Yosry, Aymana; Soliman, Zeinab A.a; Eletreby, Rashaa; Hamza, Imana; Ismail, Alaab; Elkady, Mohammad A.b
European Journal of Gastroenterology & Hepatology: March 2019 - Volume 31 - Issue 3 - p 345–351
doi: 10.1097/MEG.0000000000001277
Original Articles: Hepatology

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Background and aims Albumin infusion reduces the incidence of postparacentesis circulatory dysfunction among patients with cirrhosis and tense ascites compared with no treatment. Less costly treatment alternatives such as vasoconstrictors have been investigated, but the results are controversial. Midodrine, an oral α1-adrenergic agonist, increases effective circulating blood volume and renal perfusion by increasing systemic and splanchnic blood pressure. Our aim is to assess whether or not morbidity in terms of renal dysfunction, hyponatremia, systemic, or portal hemodynamics derangement or mortality differed in patients receiving albumin versus midodrine.

Patients and methods Seventy-five patients with cirrhosis and refractory ascites were randomized to receive albumin infusion, oral midodrine for 2 days, or oral midodrine for 30 days after therapeutic large volume paracentesis (LVP). The primary endpoints were development of renal impairment or hyponatremia, change in systemic and portal hemodynamics, cost, and mortality in the short-term and long-term follow-up.

Results No significant difference was found between groups in the development of renal impairment, hyponatremia, or mortality 6 and 30 days after LVP. A significant increase in 24-h urine sodium excretion was noted in the midodrine 30-day group. Renal perfusion improved significantly with the midodrine intake for 30 days only. The cost of midodrine therapy was significantly lower than albumin.

Conclusion Midodrine is as effective as albumin in reducing morbidity and mortality among patients with refractory ascites undergoing LVP at a significantly lower cost. Long-duration midodrine intake can be more useful than shorter duration intake in terms of improvement of renal perfusion and sodium excretion.
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StephenW

口服米多君与输注大量腹腔穿刺的难治性腹水的肝硬化患者输注白蛋白相当
试点研究的结果

Yosry，Aymana; Soliman，Zeinab A.a; Eletreby，Rashaa;哈马扎，伊马纳;伊斯梅尔，阿拉巴;埃尔卡迪，穆罕默德A.b.
欧洲胃肠病学和肝病学杂志：2019年3月 - 第31卷 - 第3期 - 第345-351页
doi：10.1097 / MEG.0000000000001277
原创文章：肝脏病学

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背景和目的与没有治疗相比，白蛋白输注降低了肝硬化和紧张腹水患者的腹腔穿刺术后循环功能障碍的发生率。已经研究了成本较低的治疗方案，例如血管收缩剂，但结果存在争议。米多君是一种口服α1-肾上腺素能激动剂，通过增加全身和内脏血压来增加有效循环血容量和肾脏灌注。我们的目的是评估接受白蛋白与米多君的患者肾功能不全，低钠血症，全身或门静脉血流动力学紊乱或死亡率的发病率是否不同。

患者和方法75例肝硬化和难治性腹水患者随机接受白蛋白输注，口服米多君2天，或口服米多君治疗大量腹腔穿刺术（LVP）后30天。主要终点是短期和长期随访中肾功能损害或低钠血症的发生，全身和门静脉血流动力学的变化，成本和死亡率。

结果各组间LVP发生后6~30天肾功能不全，低钠血症或死亡率无明显差异。米多君30天组中24小时尿钠排泄量显着增加。米多君摄入量仅30天，肾灌注显着改善。米多君治疗的费用明显低于白蛋白。

结论米多君与降低发病率和死亡率的米多君一样有效，可降低患有LVP的难治性腹水患者的成本。在改善肾脏灌注和钠排泄方面，长时间的米多君摄入量比短期摄入量更有用。
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