Shapiro M D, Nicholls K M, Groves B M, Kluge R, Chung H M, Bichet D G, Schrier R W
Kidney Int. 1985 Aug;28(2):206-11. doi: 10.1038/ki.1985.142.
The effect of head-out water immersion (HWI) in decompensated cirrhotic patients to correct sodium and water excretion has been found to be incomplete and variable. The explanation may be that the efficacy of HWI in correcting a decreased effective arterial blood volume (EABV) in decompensated cirrhotic patients is limited by an accompanying decrease in systemic vascular resistance (SVR) and thus a relative increase in arterial vascular holding capacity. The present studies were undertaken to examine this possibility by maintaining SVR (dynes X sec X cm-5) nearly constant during HWI with an exogenous infusion of norepinephrine (HWI + NE). In six decompensated cirrhotic patients, neither HWI nor NE infusion alone significantly increased sodium excretion (UNaV, 13 vs. 19 and 13 microEq/min, respectively), but each maneuver increased the excretion of a 20 ml/kg water load (28 to 60 and 61%, respectively, both P less than 0.05). The combination of HWI + NE, however, significantly increased UNaV to 70 microEq/min (P less than 0.05) and percentage of water excretion to 95 (P less than 0.001), values significantly greater than those achieved with either maneuver alone. These differences were not explained by any changes in inulin clearance. With HWI alone, cardiac index (CI) increased (4.2 to 5.3 liter/min/m2, P less than 0.01), but SVR decreased (872 to 613 dynes X sec X cm-5, P less than 0.001) and mean arterial pressure (MAP) remained constant (83 vs. 78 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS)
已发现头露出水面的水浸（HWI）对失代偿期肝硬化患者纠正钠和水排泄的作用并不完全且存在差异。其原因可能是，HWI纠正失代偿期肝硬化患者有效动脉血容量（EABV）降低的功效受到全身血管阻力（SVR）随之降低的限制，进而导致动脉血管容纳能力相对增加。本研究旨在通过在HWI期间外源性输注去甲肾上腺素（HWI + NE）使SVR（达因×秒×厘米⁻⁵）基本保持恒定来检验这种可能性。在6例失代偿期肝硬化患者中，单独进行HWI或输注NE均未显著增加钠排泄（尿钠排泄量分别为13与19以及13微当量/分钟），但每种操作均增加了20毫升/千克水负荷的排泄量（分别为28%至60%和61%，P均小于0.05）。然而，HWI + NE联合使用显著将尿钠排泄量增加至70微当量/分钟（P小于0.05），水排泄百分比增加至95%（P小于0.001），这些值显著高于单独进行任何一种操作所达到的值。这些差异无法用菊粉清除率的任何变化来解释。单独进行HWI时，心脏指数（CI）增加（4.2至5.3升/分钟/平方米，P小于0.01），但SVR降低（872至613达因×秒×厘米⁻⁵，P小于0.001），平均动脉压（MAP）保持恒定（83与78毫米汞柱）。（摘要截断于250字）
