Krediet R T, Boeschoten E W, Struijk D G, Arisz L
Department of Internal Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
Nephrol Dial Transplant. 1988;3(2):198-204.
In eight, CAPD patients who either had insufficient results of dialysis treatment (six) or loss of ultrafiltration (two) on a normal scheme (4 X 2-1), the effects of a 3-1 dialysate exchange on the in situ intraperitoneal volume, solute mass transfer, and mass transfer area coefficients were compared with a 2-1 exchange. The solutes investigated were urea, lactate, creatinine, glucose, kanamycin, inulin, beta 2-microglobulin, albumin and IgG. The time course of the intraperitoneal volume showed marked interindividual variations. However, delta mean volume was lower with the 3-1 exchanges than with 2-1. This was the result of an increased water reabsorption rate during 3-1 (2.18 ml/min vs 0.94 ml/min, P less than 0.01), probably caused by increased lymphatic absorption. Peritoneal mass transfer of low-molecular-weight solutes (up to 500) was increased with the 3-1 exchange, but there was no evidence of any alteration in effective peritoneal surface area or peritoneal permeability. By comparing the mass transfer area coefficients of the various solutes to their free diffusion coefficients, it appeared likely that the diffusion of the low-molecular-weight solutes was unrestricted by membrane permeability and only hampered by the effective peritoneal surface area. For the proteins a size-selective restricted diffusion was found.
在8例持续性非卧床腹膜透析（CAPD）患者中，6例患者在常规方案（4×2 - 1）下透析治疗效果不佳，2例患者出现超滤丧失。将3 - 1透析液交换与2 - 1透析液交换对原位腹腔容积、溶质质量传递和传质面积系数的影响进行了比较。所研究的溶质包括尿素、乳酸盐、肌酐、葡萄糖、卡那霉素、菊粉、β2 - 微球蛋白、白蛋白和免疫球蛋白G。腹腔容积的时间变化过程显示出明显的个体差异。然而，3 - 1交换时的平均容积变化量低于2 - 1交换。这是由于3 - 1交换期间水重吸收率增加（2.18 ml/分钟对0.94 ml/分钟，P＜0.01），这可能是淋巴吸收增加所致。3 - 1交换时低分子量溶质（分子量达500）的腹膜质量传递增加，但没有证据表明有效腹膜表面积或腹膜通透性有任何改变。通过比较各种溶质的传质面积系数与其自由扩散系数，似乎低分子量溶质的扩散不受膜通透性限制，仅受有效腹膜表面积的阻碍。对于蛋白质，发现存在大小选择性限制扩散。
