Ribitsch Werner, Lehner Thomas A, Sauseng Notburga, Rosenkranz Alexander R, Schneditz Daniel
Clinical Division of Nephrology, Department of Internal Medicine, Medical University of Graz, Austria.
Division of Physiology and Pathophysiology, Otto Loewi Research Center for Vascular Biology, Immunology and Inflammation, Medical University of Graz, Austria.
Perit Dial Int. 2024 Aug 28:8968608241275922. doi: 10.1177/08968608241275922.
The impact of peritoneal filling on hepato-splanchnic perfusion during peritoneal dialysis has not been fully elucidated yet.
Measurements were done in 20 prevalent peritoneal dialysis patients during a peritoneal equilibration test (PET) with 2L of standard dialysate. Data were obtained in the drained state at baseline (), after instillation (), and after 2 h of dwell time (). Intra-abdominal pressure (IAP) was measured by Durand's approach. The hepatic clearance index (KI) of indocyanine-green (ICG) was determined as an indirect measure of hepato-splanchnic blood flow. Cardiac index (CI), heart rate (HR), and total peripheral resistance index (TPRI) were derived from continuous arterial pulse analysis. Fluid volume overload (VO) was evaluated by multifrequency bioimpedance analysis. Ejection fraction (EF) was obtained from echocardiographic examination.
IAP was 5.8 ± 3.5 mmHg at baseline (), rose to 9.4 ± 2.8 mmHg after instillation of dialysate (), and further to 9.7 ± 2.8 mmHg after 2 h of dwell time (< 0.001). KI slightly declined from 0.60 ± 0.22 L/min/m at to 0.53 ± 0.15 L/min/m at (= 0.075), and returned to 0.59 ± 0.22 L/min/m at (= 0.052). CI, HR, and TPRI did not change significantly. In five patients with an EF < 40% KI was significantly lower at (0.42 ± 0.12 L/min/m; = 0.039), and further decreased at (0.40 ± 0.04 L/min/m; = 0.016) compared to patients with normal EF (: 0.58 ± 0.15 L/min/m and : 0.67 ± 0.22 L/min/m).
Overall, hepatic clearance of ICG as a marker of hepato-splanchnic blood flow is not affected by the filling of the peritoneal cavity.
腹膜透析过程中腹腔充盈对肝脾灌注的影响尚未完全阐明。
对20例接受腹膜透析的患者在腹膜平衡试验（PET）期间使用2L标准透析液进行测量。在基线引流状态（）、注入后（）和保留2小时后（）获取数据。采用杜兰德方法测量腹内压（IAP）。测定吲哚菁绿（ICG）的肝清除指数（KI）作为肝脾血流的间接测量指标。通过连续动脉脉搏分析得出心脏指数（CI）、心率（HR）和总外周阻力指数（TPRI）。通过多频生物电阻抗分析评估液体容量超负荷（VO）。通过超声心动图检查获得射血分数（EF）。
基线时IAP为5.8±3.5mmHg（），注入透析液后升至9.4±2.8mmHg（），保留2小时后进一步升至9.7±2.8mmHg（<0.001）。KI从时的0.60±0.22L/min/m略有下降至时的0.53±0.15L/min/m（=0.075），并在时恢复至0.59±0.22L/min/m（=0.052）。CI、HR和TPRI无显著变化。在5例EF<40%的患者中，与EF正常的患者相比（时：0.58±0.15L/min/m和时：0.67±0.22L/min/m），KI在时显著降低（0.42±0.12L/min/m；=0.039），并在时进一步降低（0.40±0.04L/min/m；=0.016）。
总体而言，作为肝脾血流标志物的ICG肝清除不受腹腔充盈的影响。
