Kwon E D, Schedl H P, Donovan J F
Department of Urology, University of Iowa, College of Medicine.
J Surg Res. 1994 Nov;57(5):549-55. doi: 10.1006/jsre.1994.1181.
In vivo luminal perfusion of in situ intestinal segments isolated from continuity with the alimentary tract has been used to treat uremia. One prior study showed that 2 mM deoxycholate markedly increased clearances of inorganic phosphorus, urate, urea, and creatinine. The other investigation failed to confirm the increased inorganic phosphorus or urate clearance. Because of the clinical potential of the findings, we systematically examined the effects of perfusing deoxycholate (2, 7, 15, and 30 mM) on clearance of plasma solutes by a 90-cm jejunal Thiry-Vella loop in the conscious dog. During control perfusion, clearance of all solutes was in a steady state in the final five of seven successive 30-min samples. During deoxycholate perfusion, all solutes except inorganic phosphorus and urate also attained a steady state of clearance in these final five samples. Inorganic phosphorus and urate clearances were elevated several orders of magnitude above control, but only during the first two 30-min collection periods. This increase was deoxycholate concentration-dependent and progressively declined during the subsequent five 30-min collection periods (P < 0.0001). Steady-state clearances of sodium, potassium, calcium, chloride, and creatinine were increased (P < 0.05) by 2 mM deoxycholate. Clearance of urea was decreased by deoxycholate. In summary, (a) deoxycholate increased clearances of most solutes, but steady-state increases were modest; (b) clearances tended to increase further with increasing deoxycholate; (c) the markedly increased clearances in a prior study were probably non-steady state; (d) urea clearance was decreased by deoxycholate. We conclude that detergents such as deoxycholate cause only modest increases in steady-state gastrointestinal clearance of plasma solutes.
将离体肠道段与消化道分离后进行体内肠腔灌注已被用于治疗尿毒症。一项先前的研究表明，2 mM脱氧胆酸盐可显著提高无机磷、尿酸盐、尿素和肌酐的清除率。另一项研究未能证实无机磷或尿酸盐清除率的增加。鉴于这些发现的临床潜力，我们系统地研究了在清醒犬中，用脱氧胆酸盐（2、7、15和30 mM）灌注90 cm空肠Thiry-Vella袢对血浆溶质清除率的影响。在对照灌注期间，在连续七个30分钟样本的最后五个样本中，所有溶质的清除率均处于稳定状态。在脱氧胆酸盐灌注期间，除无机磷和尿酸盐外，所有溶质在这最后五个样本中也达到了清除率的稳定状态。无机磷和尿酸盐的清除率比对照升高了几个数量级，但仅在最初两个30分钟的收集期内。这种增加呈脱氧胆酸盐浓度依赖性，并在随后的五个30分钟收集期内逐渐下降（P < 0.0001）。2 mM脱氧胆酸盐使钠、钾、钙、氯和肌酐的稳态清除率增加（P < 0.05）。脱氧胆酸盐使尿素清除率降低。总之，（a）脱氧胆酸盐增加了大多数溶质的清除率，但稳态增加幅度较小；（b）随着脱氧胆酸盐浓度的增加，清除率有进一步增加的趋势；（c）先前研究中显著增加的清除率可能是非稳态的；（d）脱氧胆酸盐使尿素清除率降低。我们得出结论，脱氧胆酸盐等去污剂仅使血浆溶质的稳态胃肠道清除率有适度增加。
