Ring-Larsen H, Henriksen J H, Wilken C, Clausen J, Pals H, Christensen N J
Br Med J (Clin Res Ed). 1986 May 24;292(6532):1351-3. doi: 10.1136/bmj.292.6532.1351.
The diuretic effect of the supine position was evaluated in six patients with cirrhosis and ascites and six with congestive cardiac failure. After fasting overnight in bed the patients received bumetanide 1 mg intravenously and were then immediately randomly assigned to either bed rest in the supine position or normal daily activity in the upright position for the next six hours. Two days later the procedure was repeated, the patients being assigned to the other posture. The diuretic response was similar in patients with heart failure and cirrhosis, and was significantly greater in the supine than in the upright position: mean 1133 v 626 ml/6 h (p less than 0.01). The natriuresis was similarly larger during recumbency: mean sodium 96 v 45 mmol(mEq)/6h (p less than 0.01), and the excreted potassium in six hours was similar in both postures. The glomerular filtration rate was 100 and 66 ml/min (p less than 0.01) and heart rate 76 and 83 beats/min (p less than 0.01) in the supine and upright positions respectively. Plasma concentrations of noradrenaline, renin, and aldosterone were all raised even when the patient adopted the supine position, and a further significant rise was observed during the upright position. The results suggest that the attenuated response to intravenous bumetanide in the upright position and during normal daily activity may be due to the activation of several homeostatic mechanisms that may reduce the excretion of water and salt.
对6例肝硬化腹水患者和6例充血性心力衰竭患者评估了仰卧位的利尿作用。患者在床上过夜禁食后，静脉注射布美他尼1毫克，然后立即随机分为仰卧位卧床休息或直立位正常日常活动，持续6小时。两天后重复该操作，患者改为另一种姿势。心力衰竭和肝硬化患者的利尿反应相似，且仰卧位时的反应明显大于直立位：平均为1133比626毫升/6小时（p<0.01）。卧位时的利钠作用同样更大：平均钠排泄量为96比45毫摩尔（mEq）/6小时（p<0.01），两种姿势下6小时内的钾排泄量相似。仰卧位和直立位时的肾小球滤过率分别为100和66毫升/分钟（p<0.01），心率分别为76和83次/分钟（p<0.01）。即使患者采取仰卧位，去甲肾上腺素、肾素和醛固酮的血浆浓度也均升高，且直立位时观察到进一步显著升高。结果表明，直立位及正常日常活动期间对静脉注射布美他尼的反应减弱可能是由于几种稳态机制的激活，这些机制可能会减少水和盐的排泄。
