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Tens Asitli Dekompanse Sirotik Hastalarda Terlipressin İle Birlikte Albumin Uygulamasının 24 Saatlik İdrar Volümü ve Üriner Sodyum Atılımına Etkisi

Effect Of Terlipressin Plus Albumin Administration On 24 Hours Urine Volume And Urinary Sodium Excretion In Decompensated Cirrhotic Patients With Tense Ascites

Journal Name:

  • Uludağ Üniversitesi Tıp Fakültesi Dergisi

Publication Year:

  • 2003

Key Words:

Keywords (Original Language):

Author NameUniversity of Author
Abstract (2. Language): 
Large volume paracentesis is a commonly used treatment method in decompensated cirrhotic patients with tence ascites. However, hypovolemia and arterial vasodilatation that may be caused by paracentesis lead to some negative consequences, such as renal functional impairements, hyponatremia and hepatorenal syndrome all of which are called as “paracentesis-related circulatory dysfunction”. In this study, comparison of efficacy of Terlipressin plus Albumin versus Albumin alone on 24 hours urine volume and urinary sodium excretion during therapeutic paracentesis in decompensated cirrhotic patients with tence ascites was made. Statistically significant increases in 24 hour-urine volume and sodium excretion were found at the end of the treatment compared to the pretreatment levels in each group. [In the Terlipressin plus Albumin group, pre and pos-treatment urine volume 1103±220 mL/24 h, 1269±474 mL/24 h, respectively (p=0.03), pre and post-treatment urinary sodium excretion 26.0±9.1 mEq/24 h, 40.7±31.0 mEq/24 h, respectively (p=0.03). In the Albumin group, pre and pos-treatment urine volume 1229±351 mL/24 h, 1561±459 mL/24 h, respectively (p=0.003), pre and pos-treatment urinary sodium excretion 48.7±37.3 meq/24 h, 102.3±86.1 meq/24 h, respectively (p=0.008)]. A statistically significant decrease in serum creatinin level was observed in the combination group, but not in the Albumin group. As a result, the administration of Terlipressin plus Albumin during paracentesis was found to be able to effective in selected patients. However, it was concluded that this application can not routinely be suggested because of the fact that Terlipressin has systemic adverse effects and an expensive treatment modality, that limit its clinical use.
Abstract (Original Language): 
Tens asitli dekompanse sirotik hastalarda geniş volümlü parasentez sıklıkla kullanılan bir tedavi yöntemidir. Ancak parasenteze bağlı gelişebilen hipovolemi ve arteriyel vazodilatasyon; renal fonksiyonlarda bozulma, hiponatremi ve hepatorenal sendrom gibi “parasenteze bağlı dolaşım bozukluğu” adı verilen bir takım olumsuz sonuçlara yol açmaktadır. Bu çalışmada dekompanse sirotik hastalarda, terapötik parasentez esnasında Terlipressin ve Albumin’in birlikte kullanılması ile Albumin’in tek başına kullanılmasının 24 saatlik idrar volümü ve üriner sodyum atılımındaki etkinlikleri karşılaştırıldı. Tedavi sonunda hem kombinasyon grubunda hemde tekli Albumin grubunda tedavi öncesine göre 24 saatlik idrar volümünde ve sodyum atılımında istatistiksel olarak anlamlı düzeyde artış tespit edildi. [Terlipressiin + Albumin grubunda; tedavi öncesi ve sonrası idrar volümü 1103±220 mL/24 saat, 1269±474 mL/24 saat (p=0.03), tedavi öncesi ve sonrası üriner sodyum atılımı 26.0±9.1 meq/24 saat, 40.7±31.0 meq/24 saat (p=0.03). Albumin grubunda tedavi öncesi ve sonrası idrar volümü 1229±351 mL/24 saat, 1561±459 mL/24 saat (p=0.003), tedavi öncesi ve sonrası üriner sodyum atılımı 48.7±37.3 meq/24 saat, 102.3±86.1 meq/24 saat (p=0.008)]. Kombinasyon grubunda tekli Albumin grubundan farklı olarak sadece serum kreatinin düzeylerinde istatistiksel anlamlılığa ulaşan bir düşüş olduğu görüldü. Sonuç olarak seçilmiş vakalarda parasentez esnasında Terlipressin ile birlikte Albümin uygulamasının faydalı olabileceği tespit edildi. Ancak, Terlipressin’in klinik kullanımını sınırlandıran sistemik yan etkileri ve yüksek maliyetli bir tedavi olması nedeni ile bu uygulamanın rutin olarak önerilemeyeceği kanaatine varıldı.
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