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腹膜透析溶质清除和超滤的机制

Authors
Madhukar Misra, MD, FRCP
Ramesh Khanna, MD, FACP
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD
Translators
齐华林, 副主任医师

引言

长期腹膜透析，正如持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis, CAPD)一样，可并发一些溶质清除(溶质从血浆扩散到透析液)或超滤(由高渗透析液和血浆之间的渗透梯度所驱动)方面的问题。本专题将总结跨腹膜溶质清除和超滤的机制，可出现的临床问题将单独讨论。 (参见“连续腹膜透析中溶质清除和超滤问题的探讨”)

跨腹膜转运的一般原理

成人腹膜的平均表面积为1-1.3m2[1,2]；腹膜透析时，鉴于在给定时间内由于只有近1/3的脏腹膜接触透析液，参与腹膜转运的主要是壁腹膜[3]。在整个腹膜的转运特征中，除了毛细血管表面积，透析液与腹膜间皮之间的扩散距离也发挥着重要作用。

在腹膜内透析液与毛细管内血液之间有3道屏障：毛细血管壁(是最重要的)、间质组织和间皮细胞层。在跨腹膜溶质或水的转运过程中，间皮细胞层并不构成主要的屏障，而间质组织提供了主要限于大分子溶质转运的一些阻力[4]。

溶质转运孔 — 根据溶质转运的三孔模型，毛细血管壁包含一个有3种孔径的转运系统，在限制溶质转运过程中起到大小选择的作用[5,6]：

●有大量的小孔(平均半径为40-50Å)介导小分子量溶质的转运，这些溶质的转运受到小孔数量的限制。

            

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Literature review current through: 2017-06 . | This topic last updated: 2015-11-02.
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