Greig P D, Blendis L M, Langer B, Taylor B R, Colapinto R F
Gastroenterology. 1981 Jan;80(1):119-25.
The long-term renal and hemodynamic effects of the peritoneovenous shunt for intractable ascites were studied in 11 patients to elucidate the mechanism of its persistent beneficial effect. Sodium balance studies were performed in 7 patients. All had patent shunts and no clinically detectable ascites. On a 20-mEq sodium diet, the mean sodium excretion was 17.2 +/- 5.3 mEq/day which was increased over the preoperative mean of 2.4 +/- 0.4 (p < 0.025) on the same diet. There was a 100% increase in creatinine clearance over the preoperative level (p < 0.0005). The mean plasma renin activity and serum aldosterone levels were within normal limits in most patients, and the sodium excretion correlated inversely with the levels of each. During 100-mEq sodium challenge diet, the sodium excretion ranged from 4 to 130 mEq/day with a mean of 56.1 +/- 16.5 and with 6 of the 7 patients displaying sodium retention. On this diet the mean creatinine clearance was 104.3 +/- 6.4 ml/min, and the mean plasma renin activity and serum aldosterone levels had decreased physiologically with the higher sodium intake. Again the sodium excretion correlated inversely with the serum aldosterone on the 100-mEq sodium diet. In 8 patients, the portal pressure, as reflected by the wedge hepatic vein pressure, had decreased by a mean of 37% (p < 0.0005). But, despite this, 2 of the 8 patients had major variceal hemorrhages postoperatively. There was a significant inverse correlation between the increase in sodium excretion and the fall in portal pressure in 4 patients. Thus, sodium retention in cirrhosis is multifactorial with the reninaldosterone system and, possibly, portal hypertension per se both playing a role. Peritoneovenous shunting in carefully selected patients partially reverses the sodium retention and renders patients more manageable over the long term.
为阐明腹膜静脉分流术对顽固性腹水的长期肾脏及血流动力学影响的机制，我们对11例患者进行了研究。对7例患者进行了钠平衡研究。所有患者的分流管均通畅，且无临床可检测到的腹水。在摄入20毫当量钠的饮食时，平均钠排泄量为17.2±5.3毫当量/天，较术前在相同饮食下的平均排泄量2.4±0.4有所增加（p<0.025）。肌酐清除率较术前水平提高了100%（p<0.0005）。大多数患者的平均血浆肾素活性和血清醛固酮水平在正常范围内，且钠排泄量与二者水平呈负相关。在摄入100毫当量钠的激发饮食期间，钠排泄量在4至130毫当量/天之间，平均为56.1±16.5，7例患者中有6例出现钠潴留。在此饮食下，平均肌酐清除率为104.3±6.4毫升/分钟，随着钠摄入量增加，平均血浆肾素活性和血清醛固酮水平出现生理性下降。在摄入100毫当量钠的饮食时，钠排泄量再次与血清醛固酮呈负相关。在8例患者中，经楔形肝静脉压反映的门静脉压力平均下降了37%（p<0.0005）。但是，尽管如此，8例患者中有2例术后发生了严重的静脉曲张出血。4例患者的钠排泄量增加与门静脉压力下降之间存在显著的负相关。因此，肝硬化患者的钠潴留是多因素的，肾素 - 醛固酮系统以及可能门静脉高压本身都发挥了作用。在精心挑选的患者中进行腹膜静脉分流术可部分逆转钠潴留，并使患者在长期内更易于管理。
