Buhac I, Flesh L, Kishore R
J Lab Clin Med. 1984 Aug;104(2):264-70.
We determined the levels of total intraabdominal pressure and the tension resulting from the distention of the abdominal wall in 12 patients with ascites resulting from alcoholic cirrhosis of the liver. The measurements were performed first when ascites was tense, and were repeated later when ascites became non-tense with treatment. Using intraperitoneal injections of 131I-labeled human serum albumin, we measured the ascites volume and the resorption of albumin from the ascitic compartment at the same time as the pressure studies. Reduction in intra-abdominal pressure from 29.5 +/- 4.1 to 21.7 +/- 6.0 cm H2O (p less than 0.001) and in tension from 8.3 +/- 2.7 to 2.9 +/- 1.6 cm H2O (p less than 0.001) did not result in significant changes in resorption of albumin from the peritoneal cavity. Lowering of intra-abdominal pressure was not associated with any change in the volume of the resorbed ascitic fluid or the amount of albumin resorbed. We conclude that the ascites resorption rate in cirrhosis is not linearly related to intra-abdominal pressure and that in tense ascites, the decreased permeability of the parietal peritoneum counteracts the effects of the increased intra-abdominal pressure on albumin resorption. Cirrhotic ascites is associated with a changing permeability of the peritoneal membrane.
我们测定了12例酒精性肝硬化腹水患者的腹腔内总压力水平以及腹壁扩张所产生的张力。首先在腹水处于紧张状态时进行测量，之后在腹水经治疗变为非紧张状态时再次测量。在进行压力研究的同时，通过腹腔注射131I标记的人血清白蛋白，我们测量了腹水量以及白蛋白从腹水腔室的吸收情况。腹腔内压力从29.5±4.1厘米水柱降至21.7±6.0厘米水柱（p<0.001），张力从8.3±2.7厘米水柱降至2.9±1.6厘米水柱（p<0.001），但这并未导致白蛋白从腹腔的吸收出现显著变化。腹腔内压力降低与吸收的腹水量或吸收的白蛋白量的任何变化均无关联。我们得出结论，肝硬化患者的腹水吸收速率与腹腔内压力并非呈线性相关，并且在紧张性腹水中，壁腹膜通透性降低抵消了腹腔内压力升高对白蛋白吸收的影响。肝硬化腹水与腹膜的通透性变化有关。
