Karnad D R, Abraham P, Karnad P D, Ramakantan R
Department of Medicine, King Edward Memorial Hospital, Bombay.
Indian J Gastroenterol. 1992 Apr;11(2):55-8.
Cirrhotics with tense ascites fail to achieve increased diuresis in the supine position. To assess the role of inferior vena cava compression in this phenomenon, we studied cirrhotics with mild to moderate (n = 11) and tense (n = 2) ascites, and patients with membranous inferior vena cava obstruction (n = 2) before and after balloon dilatation, in the sitting, supine and 10 degrees head down tilted positions for 2 hours each. Urinary output (p < 0.005), creatinine clearance (p < 0.025) and sodium excretion (p < 0.025) increased in cirrhotics with mild to moderate ascites in the supine position, and further in the head down position. Similar changes occurred in patients with inferior vena cava membrane. In cirrhotics with tense ascites, these parameters did not change significantly in the supine position, but increased in the head down position. We conclude that failure to augment diuresis in the supine position in cirrhotics with tense ascites is not due to inferior vena cava obstruction alone but is probably also due to compression of the collateral vessels. This clinical observation may serve as a criterion for diagnosing tense ascites.
患有张力性腹水的肝硬化患者在仰卧位时利尿作用未增强。为评估下腔静脉受压在此现象中的作用，我们研究了轻度至中度腹水（n = 11）和张力性腹水（n = 2）的肝硬化患者，以及膜性下腔静脉阻塞患者（n = 2）在球囊扩张前后，分别处于坐位、仰卧位和头低10度倾斜位各2小时的情况。轻度至中度腹水的肝硬化患者在仰卧位时尿量（p < 0.005）、肌酐清除率（p < 0.025）和钠排泄量（p < 0.025）增加，在头低卧位时进一步增加。下腔静脉膜性病变患者也出现类似变化。对于患有张力性腹水的肝硬化患者，这些参数在仰卧位时无显著变化，但在头低卧位时增加。我们得出结论，患有张力性腹水的肝硬化患者在仰卧位时利尿作用未增强并非仅由于下腔静脉阻塞，可能还由于侧支血管受压。这一临床观察结果可作为诊断张力性腹水的标准。
