Mactier R A, Khanna R, Moore H, Twardowski Z J, Nolph K D
Department of Medicine, Harry S. Truman VA Hospital, Columbia, Mo.
Nephron. 1988;50(3):229-32. doi: 10.1159/000185164.
Lymphatic drainage from the peritoneal cavity occurs mainly via the subdiaphragmatic stomata and significantly reduces net ultrafiltration and solute clearances during long-dwell peritoneal dialysis. Intraperitoneal cholinergic drugs constrict these stomata and may reduce peritoneal cavity lymphatic absorption. We evaluated ultrafiltration kinetics, solute transport, and lymphatic drainage during single hypertonic exchanges in rats using 2.5% dextrose dialysis solution with and without added neostigmine. Net ultrafiltration was enhanced in the neostigmine group (p less than 0.01) by a reduction in cumulative lymphatic absorption (p less than 0.01) and without an increase in total transcapillary ultrafiltration during the dwell time. Likewise solute clearances were significantly augmented with neostigmine primarily due to the increase in dialysate drain volume (p less than 0.01) since dialysate/serum solute ratios were unchanged. Pharmacological manipulation of peritoneal lymphatic absorption provides an alternative means of increasing the efficiency of long-dwell peritoneal dialysis without altering peritoneal transport of solutes and water.
腹腔的淋巴引流主要通过膈下气孔进行，在长时间的腹膜透析过程中，会显著减少净超滤和溶质清除率。腹腔内使用胆碱能药物会使这些气孔收缩，并可能减少腹腔淋巴吸收。我们在大鼠单次高渗交换过程中，使用添加和未添加新斯的明的2.5%葡萄糖透析液，评估超滤动力学、溶质转运和淋巴引流情况。新斯的明组的净超滤通过累积淋巴吸收减少而增强（p小于0.01），且在驻留时间内总跨毛细血管超滤未增加。同样，新斯的明使溶质清除率显著提高，这主要是由于透析液排出量增加（p小于0.01），因为透析液/血清溶质比率未变。对腹膜淋巴吸收进行药理学调控提供了一种提高长时间腹膜透析效率的替代方法，而不会改变溶质和水的腹膜转运。
