Pockros P J, Reynolds T B
Gastroenterology. 1986 Jun;90(6):1827-33. doi: 10.1016/0016-5085(86)90249-0.
Serial measurements of plasma volume and ascites volume were made during treatment with large doses of oral diuretics in 14 patients with stable chronic liver disease. Eight patients had pitting edema in addition to ascites. Reproducibility of ascites and plasma volume measurements was verified in 10 control subjects not receiving diuretics. Six patients without edema undergoing rapid diuresis lost a mean of 1.2 +/- 0.2 L of ascites and an equivalent amount of weight (1.3 +/- 0.4 kg) per day. All had a rise in blood urea nitrogen or creatinine, or both, and a fall in creatinine clearance. Eight patients with edema undergoing rapid diuresis lost more weight (1.8 +/- 0.5 kg/day, p = 0.06) but less ascites (0.7 +/- 0.35 L/day, p less than 0.05) than those without edema, and none developed renal insufficiency. After edema disappeared, ascites mobilization increased (1.4 +/- 0.7 L/day) and renal dysfunction occurred. Plasma volume fell an average of 24% +/- 9% in patients without edema but did not change in patients with edema (-0.4% +/- 3%). When edema disappeared, plasma volume fell significantly (28% +/- 8%, p less than 0.001). Electrolyte changes including hyponatremia, hyperkalemia, and hypochloremia were seen only in the group without edema. Patients with ascites and no edema are able to mobilize more than 1 L/day during rapid diuresis, but at the expense of plasma volume contraction and renal insufficiency. Patients with peripheral edema appear to be protected from these effects because of the preferential mobilization of edema and may safely undergo diuresis at a rapid rate (greater than 2 kg/day) until edema disappears.
对14例病情稳定的慢性肝病患者使用大剂量口服利尿剂治疗期间，进行了血浆容量和腹水量的系列测量。8例患者除腹水外还有凹陷性水肿。在10名未接受利尿剂治疗的对照受试者中验证了腹水和血浆容量测量的可重复性。6例无水肿的患者进行快速利尿时，平均每天腹水减少1.2±0.2L，体重减轻相当量（1.3±0.4kg）。所有患者血尿素氮或肌酐或两者均升高，肌酐清除率下降。8例有水肿的患者进行快速利尿时，体重减轻更多（1.8±0.5kg/天，p = 0.06），但腹水减少较少（0.7±0.35L/天，p<0.05），且均未发生肾功能不全。水肿消失后，腹水消退增加（1.4±0.7L/天），并出现肾功能障碍。无水肿患者的血浆容量平均下降24%±9%，但有水肿患者的血浆容量无变化（-0.4%±3%）。当水肿消失时，血浆容量显著下降（28%±8%，p<0.001）。电解质变化包括低钠血症、高钾血症和低氯血症仅见于无水肿组。有腹水但无水肿的患者在快速利尿期间每天能够排出超过1L的腹水，但代价是血浆容量收缩和肾功能不全。有外周水肿的患者似乎因水肿优先消退而免受这些影响，并且可以安全地以快速速率（>2kg/天）进行利尿，直到水肿消失。
