Fajardo B, Gonzalez G, Tannenberg A M
Renal Section, Metropolitan Hospital, New York, NY 10029.
ASAIO Trans. 1988 Jul-Sep;34(3):617-9.
Ascites formation is a recognized complication of chronic hemodialysis (CHD). The cause is an enigma after tumors, tuberculosis, and heart, liver, and pancreatic diseases are excluded. A 55-year-old patient who developed intractable ascites about 6 months after starting CHD was studied. The premise was that osmotic disequilibrium during HD may be the causative factor. Other causes of ascites were excluded. The study method relied on determining simultaneous serum and ascites osmolality (Sosm and Aosm) at the start and finish of a standard 4 hour HD session.
Sosm and Aosm at the start averaged 310 and 309 mosm/L, respectively. At the end, Sosm averaged 285 and Aosm averaged 301 mosm/L, giving a 16 mosm concentration gradient. Two days later, Sosm and Aosm were equal again. It is concluded that the osmotic gradient at the end of 4 hours of HD favors movement of water from the intravascular space into the ascitic fluid space until osmotic equilibrium is once again achieved.
腹水形成是慢性血液透析（CHD）公认的并发症。在排除肿瘤、结核病以及心脏、肝脏和胰腺疾病后，病因仍是个谜。对一名55岁患者进行了研究，该患者在开始CHD约6个月后出现顽固性腹水。前提是血液透析期间的渗透不平衡可能是致病因素。排除了腹水的其他病因。研究方法是在标准的4小时血液透析疗程开始和结束时同时测定血清和腹水渗透压（Sosm和Aosm）。
开始时Sosm和Aosm平均分别为310和309 mosm/L。结束时，Sosm平均为285，Aosm平均为301 mosm/L，产生了16 mosm的浓度梯度。两天后，Sosm和Aosm再次相等。得出的结论是，4小时血液透析结束时的渗透梯度有利于水从血管内空间进入腹水液空间，直到再次达到渗透平衡。
