Clinical Observation Of Peritoneal Water Ultrafiltration And Concentrated Autologous Abdominal Retransfusion In The Treatment Of Cirrhotic Ascites

Objective（s）:Patients with recalcitrant ascites in liver cirrhosis were treated with Large volume paracentesis（LVP）and Concentrated ascites reinfusion therapy （CART）.A comparison of serum biochemical and inflammatory indices prior to and following treatment,as well as ascites and ultrafiltrate biochemical and inflammatory indexes prior to and after ultrafiltration concentrated autologous abdominal retransfusion,is to be made.Observing the alterations in clinical signs and symptoms of patients before and after treatment,as well as the emergence of postoperative complications,will further elucidate the efficacy and security of ascites ultrafiltration concentrated autologous abdominal retransfusion.Methods:A total of 66 patients with cirrhotic intractable ascites hospitalized at Ganmei Hospital,Kunming Medical University from March 2021 to March 2022 were collected according to the inclusion and exclusion criteria.According to the patients’treatment wishes,informed consent was signed and divided into LVP+ albumin infusion（group A）and CART+albumin infusion（group B）,with 33 cases in each group.All patients were treated with salt and water restriction,diuresis and other conventional treatments.lvp did not exceed 3000 ml at one time;CART was performed with 4000-10000 ml of ultrafiltrate at one time.compare the changes of serum CAR,NLR,IL-6,PCT,CRP,liver function,creatinine,electrolytes,INR,blood ammonia before and after treatment in the two groups;collect and analyze ascites and ultrafiltrate before and after ultrafiltration Albumin,electrolytes(Na⁺,K⁺,Mg²⁺,Ca²⁺),IL-6,PCT indexes were compared and analyzed with ultrafiltrate respectively;the degree of improvement of clinical symptoms and signs（abdominal distension,nasal distension,weight,abdominal circumference,etc.）and the incidence of postoperative complications such as fever,abdominal pain and hypotension were observed in patients before and after treatment in groups A and B.Results:1.After treatment,serum CAR,NLR,IL-6,PCT and CRP levels in groups A and B decreased compared with those before treatment.The difference was statistically significant（P<0.05）;the serum ALB level in both groups increased after treatment,and the rising level in group B was higher than that in group A,and the difference was statistically significant（P<0.05）;the creatinine in group A increased after treatment,and the creatinine in group B decreased after treatment,and the difference was statistically significant（P<0.05）;the serum INR level in both groups increased after treatment,and the rising level in group A was higher than that in group B,and the difference was statistically significant（P<0.05）.There was a statistically significant difference（P<0.05）;the blood ammonia level in group A was higher than that before treatment,and the difference was statistically significant（P<0.05）;there was no significant change in serum TBIL,AST,ALT,Na⁺,K⁺,Mg²⁺,Ca²⁺and blood ammonia level in both groups after treatment,and the difference was not statistically significant（P>0.05）.2.The ALB,IL-6 and PCT in the ultrafiltrate after treatment were compared with those in the ascites before and after ultrafiltration were significantly reduced compared with those before and after ultrafiltration,and the difference was statistically significant（P<0.05）;ALB,IL-6 and PCT of post-ultrafiltration ascites were significantly higher compared with ALB,IL-6 and PCT of pre-ultrafiltration ascites,and the difference was statistically significant（P<0.05）;There was no significant change in Na⁺,K⁺,Mg²⁺,Ca²⁺in the ultrafiltrate after treatment compared with Na⁺,K⁺,Mg²⁺,Ca²⁺in the ascites before and after ultrafiltration,and the difference was not statistically significant（P>0.05）.3.Group B’s disappearance rate of abdominal distension and dyspnea was significantly higher than that of group A after treatment,with a statistically significant difference（P<0.05）.However,when comparing the disappearance rates of dyspnea and fatigue in the two groups,the difference was not statistically significant（P>0.05）.4.Group B’s abdominal circumference and body weight were significantly reduced after treatment,a difference that was statistically significant（P<0.05）.Additionally,the urine volume in group B was more pronounced than in group A,a difference that was also statistically significant（P<0.05）.5.The incidence of abdominal pain in group A was 24%after treatment,which was higher than that in group B by 3%,and the difference was statistically significant（P<0.05）.The incidence of hepatic encephalopathy was 15%in group A after treatment,which was higher than 0%in group B.The total incidence of postoperative complications was 18%in 33 patients in group B,which was lower than the total incidence of postoperative complications in 33 patients in group A,which was 73%,and the difference was statistically significant（P<0.05）.6.The significant efficiency and total effective rate in group B were higher than those in group A,and the difference was statistically significant（P<0.05）.Conclusion（s）:1.CART has an advantage over LVP in clearing serum inflammatory factors in patients with recalcitrant ascites in cirrhosis,while CART can remove more excess water molecules from the body at one time,reduce the loss of albumin and maintain effective circulating blood volume.2.CART compared with LVP can significantly improve patients’symptoms of abdominal distension and dyspnea,reduce abdominal circumference,increase urine output,and reduce the incidence of postoperative complications,with higher safety and efficacy.