Stewart R H, Laine G A
Michael E. DeBakey Institute, Texas A&M University, College Station, TX 77843-4466, USA.
Microcirculation. 2001 Aug;8(4):221-7. doi: 10.1038/sj/mn/7800081.
Lymph from both the liver and intestine flows into the cisterna chyli. We hypothesized that increasing liver lymph flow would increase cisterna chyli pressure and, thereby, decrease intestinal lymph flow, potentiating intestinal edema formation.
Anesthetized dogs were instrumented to measure and manipulate portal vein pressure and cisterna chyli pressure. The effects of directly increasing portal pressure with and without directly increasing cisterna chyli pressure on intestinal wet-to-dry ratio and intestinal ascites formation rate were determined. Target values for portal and cisterna chyli pressures were determined following elevation of inferior vena caval pressure to levels seen in patients with obstructive caval disease.
Direct elevation of portal pressure (P(port)) alone to 17.5 mm Hg caused a significant increase in intestinal wet-to-dry ratio (3.98 +/- 0.24 vs. 3.40 +/- 0.43) and the rate of ascites formation (0.36 +/- 0.12 vs. 0.05 +/- 0.03 mL/g dry wt/h). Simultaneous direct elevation of cisterna chyli pressure to 6.0 mm Hg and P(port) to 17.5 mm Hg caused further increases in intestinal wet-to-dry ratio (5.52 +/- 1.20) and ascites formation (0.57 +/- 0.11 mL/g dry wt./h).
Inferior vena caval hypertension increases liver lymph flow that elevates cisterna chyli pressure, which inhibits intestinal lymph flow and augments intestinal edema formation.
肝脏和肠道的淋巴液均流入乳糜池。我们推测，增加肝脏淋巴液流量会增加乳糜池压力，从而减少肠道淋巴液流量，加重肠道水肿的形成。
对麻醉的犬进行仪器安装，以测量和控制门静脉压力及乳糜池压力。测定在直接增加门静脉压力以及同时直接增加乳糜池压力的情况下，对肠干湿比和肠腹水形成速率的影响。在将下腔静脉压力升高至梗阻性腔静脉疾病患者所见水平后，确定门静脉和乳糜池压力的目标值。
仅将门静脉压力（P(port)）直接升高至17.5 mmHg，会导致肠干湿比显著增加（3.98±0.24对3.40±0.43）以及腹水形成速率增加（0.36±0.12对0.05±0.03 mL/g干重/h）。同时将乳糜池压力直接升高至6.0 mmHg且将P(port)升高至17.5 mmHg，会使肠干湿比进一步增加（5.52±1.20）以及腹水形成增加（0.57±0.11 mL/g干重/h）。
下腔静脉高压会增加肝脏淋巴液流量，进而升高乳糜池压力，这会抑制肠道淋巴液流量并加重肠道水肿的形成。
