Jaundice, the circulation and the kidney.
Jaundice, the circulation and the kidney.
复制标题
黄疸，循环和肾脏。
作者：
J. Green;R. Beyar;L. Bomzon;J. Finberg;O. Better
(图1)胆汁血症本身(即与肝实质损害无关)会引起严重的全身血流动力学紊乱。这包括总外周血管阻力的降低，以及可能的左心功能损害。这反过来会导致有效血量的减少，有失血性休克和肾功能衰竭的倾向。在胆汁血症的早期，循环中胆盐的利钠作用可能会加重低血容量。与总外周血管阻力的下降形成鲜明对比的是，在胆汁血症期间，肾脏和大脑的局部血管床收缩。因此，胆汁血症的综合作用可能导致心输出量的重新分配，远离肾脏和大脑。当肝实质损害并发梗阻性黄疸时，动脉低血压的倾向加重。黄疸和循环内稳态之间的整体相互关系如图1所示。
(Fig. 1) Cholemia per se (i.e. independent of parenchymal liver damage) causes a profound disturbance of systemic hemodynamics. This includes decrease in total peripheral vascular resistance, and possible impairment of left ventricular performance. These, in turn, lead to a decrease in effective blood volume, a tendency to hemorrhagic shock and prerenal failure. Early in the course of cholemia , the natriuretic effects of bile salts in the circulation may aggravate the hypovolemia. In marked contrast to the decrease in total peripheral vascular resistance, the regional vascular beds of the kidney and the brain constrict during cholemia . The combined effect of cholemia may thus lead to redistribution of cardiac output away from the kidney and the brain. When parenchymal liver damage complicates obstructive jaundice, the tendency to arterial hypotension is aggravated. The overall interrelationship between jaundice and circulatory homeostasis is depicted in figure 1.