Cade R, Wagemaker H, Vogel S, Mars D, Hood-Lewis D, Privette M, Peterson J, Schlein E, Hawkins R, Raulerson D
Am J Med. 1987 Mar;82(3):427-38. doi: 10.1016/0002-9343(87)90442-6.
Eleven patients with well-documented hepatorenal syndrome were studied by measurement of blood volume, glomerular filtration rate, renal plasma flow, plasma aldosterone concentration, renin substrate concentration, and plasma renin activity. They were then given 750 ml of stored plasma, 750 ml of fresh frozen plasma, and then an infusion of angiotensin II, in random order on successive days. Infusion of fresh frozen plasma improved function more than did stored plasma and in addition returned a very low filtration fraction toward normal. Angiotensin II infusion increased filtration fraction, but decreased glomerular filtration rate, renal plasma flow, and urine flow sharply. Patients were then given a daily infusion of 1,000 ml of fresh frozen plasma for seven to 18 days to expand the blood volume to supranormal levels as assayed by serial measurement of blood volume. Plasma aldosterone levels decreased to a normal range, glomerular filtration rate and renal plasma flow both increased, and urinary excretion of sodium and potassium both returned toward normal. The effect of intraperitoneal pressure was then studied by measuring glomerular filtration rate, renal plasma flow, pressure in the vena cava, hepatic vein free flow, and hepatic vein wedged pressure before, during, and after paracentesis to reduce the intraperitoneal pressure from 30 to 40 cm H2O to 12 to 17 cm H2O. Venous pressures moved parallel to ascitic fluid pressures, and glomerular filtration rate, renal plasma flow, and urine flow all improved sharply; then, as ascitic fluid continued to form, reducing vascular volume, urine flow, glomerular filtration rate, and renal plasma flow all decreased slowly. Six patients then underwent placement of a LeVeen shunt. Improvement in glomerular filtration rate and renal plasma flow and clinical condition was dramatic. During postoperative observation of up to two years, progressive improvement in hepatic function has occurred.
对11例有充分记录的肝肾综合征患者进行了研究，测定了血容量、肾小球滤过率、肾血浆流量、血浆醛固酮浓度、肾素底物浓度和血浆肾素活性。然后，在连续的几天里，他们被随机给予750毫升库存血浆、750毫升新鲜冷冻血浆，然后输注血管紧张素II。输注新鲜冷冻血浆比库存血浆更能改善功能，此外还使极低的滤过分数恢复正常。输注血管紧张素II可提高滤过分数，但会急剧降低肾小球滤过率、肾血浆流量和尿量。然后，每天给患者输注1000毫升新鲜冷冻血浆，持续7至18天，以使血容量增加至超正常水平，这是通过连续测量血容量来测定的。血浆醛固酮水平降至正常范围，肾小球滤过率和肾血浆流量均增加，钠和钾的尿排泄量均恢复正常。然后，通过在腹腔穿刺术前、术中及术后测量肾小球滤过率、肾血浆流量、腔静脉压力、肝静脉自由血流和肝静脉楔压，研究腹腔压力的影响，腹腔穿刺术可将腹腔压力从30至40厘米水柱降至12至17厘米水柱。静脉压力与腹水压力平行变化，肾小球滤过率、肾血浆流量和尿量均急剧改善；然后，随着腹水继续形成，血管容量减少，尿量、肾小球滤过率和肾血浆流量均缓慢下降。6例患者随后接受了LeVeen分流术。肾小球滤过率、肾血浆流量和临床状况有显著改善。在长达两年的术后观察期间，肝功能持续改善。
