Cardiac function in cases of hepatorenal syndrome during the performance of plasma exchange: Investigation on difference between infusion volume and drainage volume.
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Plasma exchange was carried out on 3 patients with hepatorenal syndrome, with measurement of cardiac function using a Swan-Ganz catheter. Fischer proposed to classify hepatorenal syndrome into 2 types, i. e. type I (effective hypovolemia) and type II (disturbed water distribution). Case 1 had a markedly depressed cardiac function prior to plasma exchange, with cardiac output, cardiac index and systemic vascular resistance values of 1.95 L/min, 1.25 L/min/m<SUP>2</SUP> and 4954 dyn. sec/cm<SUP>5</SUP>, respectively. Hence the case was judged to be of type I hepatorenal syndrome and the volume of plasma to be infused during plasma exchange was set 500 ml larger than the volume to be removed. The therapeutic procedure successfully resulted in an increase of cardiac output and cardiac index with a concurrent decrease in systemic vascular resistance. In case 2, assessment of cardiac function before plasma exchange revealed slightly increased values of cardiac output (7.67 L/min) and car-diac index (4.12 L/min/m<SUB>2</SUB>) with a low systemic vascular resistance value of 463 dyne. sec/ cm<SUP>5</SUP>, thus leading to a diagnosis of type II hepetorenal syndrome. Accordingly, plasma volumes to be infused and removed during the course of plasma exchange were set identical. Plasma exchange was performed uneventfully and was not followed by any noticeable changes in the parameters, aside from a slight increase in systemic vascular resistance. In case, assess ment of cardiac function before plasma exchange revealed increased values of cardiac output (8.91 L/min) and cardiac index (4.74 L/min/m<SUB>2</SUB>) with slightly low systemic vascular resistance value of 732 dyne. sec/cm<SUP>5</SUP>, leading to a diagnosis of type II hepatorenal syndrome. Accordingly, plasma exchange was carried out with a plasma infusion volume 500 ml less than the volume to be removed. The therapeutic procedure successfully resulted in slight decrease of cardiac output and cardiac index without changes in systemic vascular resistance. Hepatorenal syndrome takes two clinically distinct forms. These facts make it all the more mandatory for the physician to have complete understanding of existing circulatory dynamics of the patient with hepatorenal syndrome by the use of an appropriate means, e. g, a Swan -Ganz catheter, before attempting plasma exchange.
- 社団法人 日本腎臓学会の論文
社団法人 日本腎臓学会 | 論文
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