罗库溴铵对眼轮匝肌和拇收肌临床药效学比较

目的比较罗库溴铵对眼轮匝肌和拇收肌临床药效学的差异。方法选择心、肺、肝、肾和神经肌肉功能基本正常的30~50岁全麻普外及妇科手术患者男女各10例,丙泊酚和芬太尼维持麻醉。静注罗库溴铵0.3mg/kg后,记录同侧眼轮匝肌和拇收肌诱发颤搐反应的抑制过程和恢复过程。结果拇收肌的显效时间和达到最大抑制程度的时间[(41.0±8.3)s和(241.3±60.8)s]与眼轮匝肌[(42.0±7.9)s和(276.0±62.6)s]基本相同(P>0.05),而最大抑制程度(95.3%±5.2%)比眼轮匝肌(67.7%±15.3%)显著增高(P<0.01)。T1(4个成串刺激中的第1个肌颤搐反应)恢复到基础值50%和75%的时间,拇收肌[(19.8±5.1)min和(24.1±6.2)min]与眼轮匝肌的[(17.5±8.7)min和(27.3±8.6)min]差异无统计学意义(P>0.05),但T1恢复到基础值95%和100%的时间,拇收肌[(29.2±7.6)min和(31.1±8.3)min]明显比眼轮匝肌[(37.4±9.0)min和(40.0±9.1)min]快,差异有统计学意义(P<0.01)。TOFr恢复到基础值80%的时间,拇收肌[(30.2±8.1)min]和眼轮匝肌[(28.8±8.8)min]基本相同(P>0.05)。结论中青年患者给予1倍ED95罗库溴铵对眼轮匝肌和拇收肌阻滞过程的差异主要表现在眼轮匝肌最大阻滞程度显著比拇收肌低,以及肌肉松弛效应完全消除时间显著比拇收肌长,而起效时间则基本相同。     

罗库溴铵对眼轮匝肌和拇收肌临床药效学比较

目的 比较罗库溴铵对眼轮匝肌和拇收肌临床药效学的差异.方法 选择心、肺、肝、肾和神经肌肉功能基本正常的30～50岁全麻普外及妇科手术患者男女各10例,丙泊酚和芬太尼维持麻醉.静注罗库溴铵0.3 mg/kg后,记录同侧眼轮匝肌和拇收肌诱发颤搐反应的抑制过程和恢复过程.结果 拇收肌的显效时间和达到最大抑制程度的时间[(41.0±8.3)s和(241.3±60.8)s]与眼轮匝肌[(42.0±7.9)s和(276.0±62.6)s]基本相同(P＞0.05),而最大抑制程度(95.3%±5.2%)比服轮匝肌(67.7%±15.3%)显著增高(P＜0.01).T1(4个成串刺激中的第1个肌颤搐反应)恢复到基础值50%和75%的时间,拇收肌[(19.8±5.1)min和(24.1±6.2)min]与眼轮匝肌的[(17.5±8.7)min和(27.3±8.6)min]差异无统计学意义(P＞0.05),但T1恢复到基础值95%和100%的时间,拇收肌[(29.2±7.6)min和(31.1±8.3)min]明显比眼轮匝肌[(37.4±9.0)min和(40.0±9.1)min]快,差异有统计学意义(P＜0.01).TOFr恢复到基础值80%的时间,拇收肌[(30.2±8.1)min]和眼轮匝肌[(28.8±8.8)min]基本相同(P＞0.05).结论 中青年患者给予1倍ED95罗库溴铵对眼轮匝肌和拇收肌阻滞过程的差异主要表现在眼轮匝肌最大阻滞程度显著比拇收肌低,以及肌肉松弛效应完全消除时间显著比拇收肌长,而起效时间则基本相同.     

罗库溴铵与七氟烷用于气管插管的麻醉效果对比分析

目的 对比罗库溴铵与七氟烷用于气管插管全麻中的效果。方法 选取2017年7月~12月我院108例行气管插管全麻的手术患者,采用随机数字表法分为实验组和参照组,各54例。实验组予以罗库溴铵进行麻醉,参照组予以七氟烷进行麻醉,对比两组患者的插管条件评分、平均动脉压及心率。结果 实验组患者的插管条件评分为（5.21±0.52）分,优于参照组的（7.85±0.83）分,差异具有统计学意义（P＜0.05）。实验组患者的MAP及HR波动范围小于参照组,差异具有统计学意义（P＜0.05）。结论 在气管插管全身麻醉中选用罗库溴铵,插管条件优于七氟烷,且罗库溴铵对患者的血流动力学影响较小。     

腰椎手术中椎旁肌不同脂肪浸润程度对罗库溴铵使用剂量及效果的影响

目的探讨在腰椎手术中, 椎旁肌不同程度的脂肪浸润对罗库溴铵使用剂量及效果的影响。方法前瞻性队列研究。纳入2021年12月—2022年9月山西医科大学第二医院择期行经L4～5节段椎管减压+椎体融合手术患者87例, 其中男42例、女45例, 年龄31～65岁。美国麻醉协会Ⅰ级22例、Ⅱ级65例。87例患者术前行MR检查, 测量L4～5节段手术区域的椎旁肌(包括脊肌、多裂肌)的横截面积(CSA)、功能性肌肉面积(FMA)、脂肪浸润率。按照患者的脂肪浸润率将87例患者分为3组:脂肪浸润率<30%的28例为轻度脂肪浸润组(L组), 脂肪浸润率30%～50%的30例为中度脂肪浸润组(M组), 脂肪浸润率>50%的29例为重度脂肪浸润组(H组)。术中采用Drager Trident肌松监测仪监测斜方肌的肌肉松弛情况;术中麻醉维持期间罗库溴铵连续泵注, 根据强直刺激后计数(PTC)调整罗库溴铵泵速(维持0相似文献   

利多卡因配合止血带预处理对罗库溴铵注射痛的影响

目的：观察利多卡因配合止血带预处理对罗库溴铵注射痛的影响。方法选择接受经口气管插管全麻的患者60例,年龄18~60岁,ASA分级I~I 级。入选病例按分层随机方式分成3组院对照组(C组),利多卡因静推组(L1),利多卡因配合止血带静推组(L2),每组20例。入室后以20G留置针开放前臂桡侧头静脉,以三通管连接输液器,静脉滴注复方氯化钠溶液,组成静脉注射通道。以咪达唑仑1.5mg/kg进行麻醉诱导,待患者意识消失及睫毛反射消失后,对照组给予生理盐水2mg,L1组给予1%利多卡因30mg后,即刻推注罗库溴铵0.8mg/kg,2s内推注完毕,观察患者上肢退缩反应。 L3组在前臂中上1/3处扎止血带,阻断静脉滴注后,给予利多卡因30mg,20s后松开止血带后,推注罗库溴铵0.8mg/kg,2s内推注完毕,观察并记录患者上肢退缩反应。结果 C组、L1组、L2组的罗库溴铵注射痛发生率分别为50%,30%,1%,与L1、L2相比,C组的罗库溴铵注射痛发生率较高(P<0.05)。而对比L1,L2组,L2组的罗库溴铵注射痛发生率明显降低(P<0.05)。结论利多卡因配合止血带预处理能更加有效的预防罗库溴铵注射痛。     

不同麻醉药物对老年人全麻术中血流动力学影响的临床研究

目的目的分析研究不同麻醉药物对老年人全麻术中血流动力学影响的临床效果。方法选择50例接受心脏瓣膜置换手术的老年患者,随机分为对照组和观察组。对照组选用芬太尼、顺阿曲库胺和咪达唑仑组合麻醉药;观察组选用舒芬太尼、顺阿曲库胺和依托咪酯组合麻醉药。观察记录两组患者麻醉诱导前后、纵劈胸骨时以及插管后心率(HR)、平均动脉压(MAP)、收缩压(SBP)及舒张压(DBP)的变化。结果麻醉诱导后以及气管插管后相比于麻醉诱导前,观察组中患者HR、MAP、SBP、DBP变化幅度大小均明显低于对照组(P0.05),两组数据的差异具有统计学意义。结论老年患者在心脏不停搏的情况下进行心脏瓣膜置换手术,采取顺阿曲库胺、舒芬太尼以及依托咪酯对患者行麻醉诱导,手术的过程中选用舒芬太尼来维持,对手术中血流动力学的影响较小,值得在临床上广泛应用。     

全麻诱导时丙泊酚滴定给药与传统给药对患者血流动力学的影响

目的：比较丙泊酚全麻诱导时滴定给药和传统给药对患者血流动力学的影响,以探求更安全、合理的麻醉诱导方案。方法：60例美国麻醉医师学会（AmericanSocietyofAnesthesiology,ASA）分级Ⅰ~Ⅱ级、拟气管插管全麻下行择期手术的患者,随机分成2组,每组30例。Ⅰ组为传统给药组,按丙泊酚传统量2mg·kg-1以250mg·min-1的速度静脉泵注;Ⅱ组为滴定给药组,丙泊酚以1mg·kg-1·min-1的速度静脉泵注,滴定至患者镇静警觉（OAA/S）评分1分,改为1mg·kg-1·h-1维持。2组均在泵注丙泊酚的同时,给予芬太尼4μg·kg-1以注射泵注入。传统组给丙泊酚后1min、滴定组入睡后给予顺阿曲库铵2mg·kg-1静推,4min后行气管插管。记录诱导插管期间各个时点的收缩压（SBP）、舒张压（DBP）、平均血压（MBP）、心率（HR）和脉搏氧饱和度（SpO2）。记录血压下降超过30%的例数。术后第2d询问患者对插管过程是否有记忆。结果：2组均在一次试插即完成气管插管,术后随访均对插管过程无记忆。Ⅱ组SBP和MBP在给药后1min、3min及DBP在给药后1min下降幅度均较Ⅰ组小（P<0.01）。Ⅱ组血压下降超过30％的例数较Ⅰ组少（P<0.01）。结论：和传统的给药方法相比,全麻诱导时丙泊酚滴定给药既能满足气管插管所需要的麻醉深度,又能避免血流动力学的剧烈波动。     

持续输注艾司洛尔对食管癌手术病人血液动力学的影响

目的 观察持续输注艾司洛尔对食管癌手术病人血液动力学的影响.方法 60例择期行开胸食管癌根治术患者,随机分为A,B,C 3组.B组,C组患者术中持续静脉泵注盐酸艾司洛尔注射液,B组的泵注速度为30?g·kg-1·min-1,C组的泵注速度为50?g·kg-1·min-1.A,B,C 3组均在插管和拔管前5min缓慢静注艾司洛尔0.5mg/kg.分别记录3组患者入室后10min(T0)、插管时(T1)、切皮时(T2)、手术开始后30min(T3)、手术开始后60min(T4)和拔管时(T5)的血液动力学指标并计算心率收缩压乘积(RPP).记录各组患者手术时间,术中失血量,补液量和尿量.结果 A组HR、SBP和RPP在T1 、T5与T0比较升高明显(P<0.05).A组HR和RPP在T1～T5与C组比较差异有统计学意义 (P<0.05),A组HR和RPP高于C组.A组SBP在T1、T5与C组比较有统计学差异(P<0.05),A组SBP在T1、T5高于C组.结论 艾司洛尔50?g·kg-1·min-1持续输注并在插管和拔管前静注0.5mg/kg能够降低插管和拔管刺激引起的血液动力学波动.     

超声引导C7星状神经节阻滞对全麻围拔管期血流动力学的影响

目的:观察超声引导C7星状神经节阻滞对全麻患者围拔管期血流动力学的影响。方法:选择胸腹部择期手术患者(ASA分级Ⅰ或Ⅱ级)60例,随机分为A、B、C 3组,每组20例(随机数字表法)。术前选择气管插管全身麻醉,诱导方式为快诱导,术中机械通气。A、B组手术结束时分别给予左、右侧超声引导C7星状神经节阻滞后停麻药送PACU,C组手术结束后无操作再停麻药送PACU。术毕患者符合拔管指征时边吸痰边拔除气管插管。记录出手术室前(基础值,T0)、拔管时(T1)、拔管后5 min(T2)的收缩期动脉血压(SBP)、舒张期动脉血压(DBP)、心率(HR)。同时,对A、B两组行星状神经节阻滞后出现霍纳综合征的例数以及相关并发症(声音嘶哑、神经血管损伤等)的发生情况进行观察记录。结果:与A、B组相比,C组患者在T1、T2时点(较T0时点来看)的SBP、DBP明显增高,HR明显加快(P<0.05)。A、B组星状神经节阻滞后均出现霍纳综合征,暂未发现相关并发症。结论:超声引导C7星状神经节阻滞在胸腹部择期手术患者全麻拔管时可有效减轻拔管过程中的心血管反应,且超声引导C7入路星状神经节阻滞兼具了安全性和有效性(成功率高、并发症少)。     

BWYJ的降压作用及对血流动力学的影响

目的：观察萘哌地尔衍生物(BWYJ)对正常血压及实验性高血压模型大鼠血压的影响，采用麻醉猫观察其对血流动力学的影响，并探讨其降压机制。方法：采用肾动脉双肾双夹(2K2C)法制作大鼠肾血管性高血压模型，分别对正常及高血压大鼠静脉和口服给药，观察血压的变化；利用麻醉开胸猫测定血流动力学各项指标的变化；采用侧脑室给药、猫在体瞬膜神经肌肉标本和肾上腺素的翻转实验探讨BWYJ的降压作用机制。     

小剂量艾司洛尔对丙泊酚麻醉诱导静脉注射疼痛的影响

目的 研究小剂量艾司洛尔对丙泊酚麻醉诱导静脉注射疼痛的影响.方法 选择2007年6月至2008年3月全身麻醉下行择期手术的患者80例,随机分为对照组(A组)和艾司洛尔组(B组),每组40例.A组进行常规麻醉诱导,B组先静脉注射艾司洛尔0.5 mg/kg,30 s后再进行常规麻醉诱导.采用4分制对两组的丙泊酚注射痛进行评分,比较麻醉前、诱导完毕、气管插管完成即刻、气管捅管后2、4、6、8与10 min的血压和心率变化及诱导期间注射痛的发生率.结果 两组麻醉前和诱导期间各时点血压和心率的变化差异无统计学意义(均P>0.05).诱导期间丙泊酚总的注射疼痛发生率A组为65%(26/40),B组为23%(9140)(P<0.01).其中重度疼痛发生率A组为20%(8/40),B组为3%(1/40)(P<0.05);而轻度和中度疼痛发生率两组间差异无统计学意义(P>0.05).结论 小剂量艾司洛尔可减轻丙泊酚麻醉诱导的静脉注射疼痛.     

Comparison of the variability of the onset and recovery from neuromuscular blockade with cisatracurium versus rocuronium in elderly patients under total intravenous anesthesia

This study was designed to compare the variability of the onset and offset of the effect of two neuromuscular blocking drugs with different elimination pathways in adult and elderly patients during total intravenous anesthesia (TIVA). After Ethics Committee approval and patients'' informed consent, the drugs were compared in 40 adult and 40 elderly patients scheduled for elective surgery under TIVA with tracheal intubation who were randomized to receive a single bolus dose of 0.15 mg/kg cisatracurium or 0.9 mg/kg rocuronium. The time of onset of maximum depression, duration of action, and recovery index time were measured and recorded for each patient and variability is reported as means ± standard deviation. Time of onset was significantly shorter for rocuronium than cisatracurium for the adult and elderly groups (P = 0.000), but the variability of cisatracurium was significantly greater compared with rocuronium for the same age groups (93.25 vs 37.01 s in the adult group and 64.56 vs 33.75 s in the elderly group; P = 0.000). The duration of the effect in the elderly group receiving rocuronium was significantly longer than in the elderly group receiving cisatracurium, and the variability of the duration was significantly greater in the rocuronium group than in the cisatracurium group. Mean time of recovery was significantly longer for the elderly group receiving rocuronium than for the elderly group receiving cisatracurium (P = 0.022), and variability was also greater (P = 0.002). Both drugs favored good intubating conditions. In conclusion, cisatracurium showed less variability in these parameters than rocuronium, especially in the elderly, a fact that may be of particular clinical interest.     

Effects of conventional vs high-dose rocuronium on the QTc interval during anesthesia induction and intubation in patients undergoing coronary artery surgery: a randomized,double-blind,parallel trial

Myocardial ischemia, as well as the induction agents used in anesthesia, may cause corrected QT interval (QTc) prolongation. The objective of this randomized, double-blind trial was to determine the effects of high- vs conventional-dose bolus rocuronium on QTc duration and the incidence of dysrhythmias following anesthesia induction and intubation. Fifty patients about to undergo coronary artery surgery were randomly allocated to receive conventional-dose (0.6 mg/kg, group C, n=25) or high-dose (1.2 mg/kg, group H, n=25) rocuronium after induction with etomidate and fentanyl. QTc, heart rate, and mean arterial pressure were recorded before induction (T0), after induction (T1), after rocuronium (just before laryngoscopy; T2), 2 min after intubation (T3), and 5 min after intubation (T4). The occurrence of dysrhythmias was recorded. In both groups, QTc was significantly longer at T3 than at baseline [475 vs 429 ms in group C (P=0.001), and 459 vs 434 ms in group H (P=0.005)]. The incidence of dysrhythmias in group C (28%) and in group H (24%) was similar. The QTc after high-dose rocuronium was not significantly longer than after conventional-dose rocuronium in patients about to undergo coronary artery surgery who were induced with etomidate and fentanyl. In both groups, compared with baseline, QTc was most prolonged at 2 min after intubation, suggesting that QTc prolongation may be due to the nociceptive stimulus of intubation.     

艾司洛尔和乌拉地尔对拔管期心血管反应及心率变异性的影响

目的 观察全麻患者拔管前静注艾司洛尔或乌拉地尔对心血管反应及心率变异性的影响。方法 60例手术患者随机平均分成3组，Ⅰ组为对照组，Ⅱ组为艾司洛尔组，Ⅲ组为乌拉地尔组；分别观察拔管前、拔管后1、3、5、7、9min，3组的收缩压（SP）、舒张压（DP）、心率（HR）、心率变并性（HRV）。结果Ⅰ组SP、DP、HR拔管后1、3min升高（P〈0．05）；Ⅱ组HR拔管后5、7、9min均显著下降（P〈0．01），SP、DP均无显著性差异；Ⅲ组HR拔管后1、3、5min显著升高（P〈0．01），SP、DP拔管后1min下降（P〈0．05）。结论 艾司洛尔、乌拉地尔均可减轻拔菅引起的心血管反应，但不能阻止拔管时交感神经活性增强；乌拉地尔对于单纯血压升高的患者拔管有利，艾司洛尔对于心率增加的患者有利。     

Dehydration,hemodynamics and fluid volume optimization after induction of general anesthesia

OBJECTIVES:Fluid volume optimization guided by stroke volume measurements reduces complications of colorectal and high-risk surgeries. We studied whether dehydration or a strong hemodynamic response to general anesthesia increases the probability of fluid responsiveness before surgery begins.METHODS:Cardiac output, stroke volume, central venous pressure and arterial pressures were measured in 111 patients before general anesthesia (baseline), after induction and stepwise after three bolus infusions of 3 ml/kg of 6% hydroxyethyl starch 130/0.4 (n = 86) or Ringer''s lactate (n = 25). A subgroup of 30 patients who received starch were preloaded with 500 ml of Ringer''s lactate. Blood volume changes were estimated from the hemoglobin concentration and dehydration was estimated from evidence of renal water conservation in urine samples.RESULTS:Induction of anesthesia decreased the stroke volume to 62% of baseline (mean); administration of fluids restored this value to 84% (starch) and 68% (Ringer''s). The optimized stroke volume index was clustered around 35-40 ml/m²/beat. Additional fluid boluses increased the stroke volume by ≥10% (a sign of fluid responsiveness) in patients with dehydration, as suggested by a low cardiac index and central venous pressure at baseline and by high urinary osmolality, creatinine concentration and specific gravity. Preloading and the hemodynamic response to induction did not correlate with fluid responsiveness. The blood volume expanded 2.3 (starch) and 1.8 (Ringer''s) times over the infused volume.CONCLUSIONS:Fluid volume optimization did not induce a hyperkinetic state but ameliorated the decrease in stroke volume caused by anesthesia. Dehydration, but not the hemodynamic response to the induction, was correlated with fluid responsiveness.     

The effect of anesthesia on hemodynamics and renal function in the rat

Although many renal physiologic studies in the rat have utilized pentobarbital anesthetized animals, there has been no systematic evaluation of the effects of barbiturate anesthesia on renal function. We therefore compared systemic hemodynamic and renal function parameters in conscious (C) and pentobarbital anesthetized (A) rats. Cardiac index and renal blood flow as assessed by microspheres were greater in C rats while systemic and renal vascular resistance were less in C rats. Although basal glomerular filtration rate was similar in both groups of animals, glomerular filtration rate following hypotonic volume expansion was greater in C than A rats. During hypotonic volume expansion, distal delivery as estimated by the sum of free water and sodium clearances was greater in C rats. In contrast, function of the distal nephron as assessed by maximum fractional free water clearance during hypotonic volume expansion and by solute free water reabsorption at maximum levels of osmolar clearance were comparable in C and A rats. Collecting duct water permeability as assessed by the response to exogenous vasopressin was similar in C and A rats. Following an exogenous sodium chloride load, C rats excreted 16% more of the sodium. No differences in measured whole blood or plasma volume were present when C and A rats were compared.We conclude that pentobarbital does not impair basal glomerular filtration rate, distal nephron function or the water permeability response of the collecting duct. Pentobarbital does result in alterations in systemic and renal hemodynamics which may contribute to the failure of A rats to normally excrete a saline load.     

胃癌根治术中腹腔热化疗对血流动力学的影响

目的:观察胃癌根治手术中进行腹腔热化疗对血流动力学的影响。方法:择期年龄31-75岁胃癌根治手术病人26例,在手术切除癌肿准备关腹前行低渗腹腔热化疗。记录热化疗前和热化疗过程中血流动力学指标并分析。结果:心率(HR)显著增快,至化疗结束后又显著减慢。过程中平均动脉压(MAP)显著下降,结束后恢复到热灌洗前水平。总外周阻力指数(SVRI)由(1830±362)降至(1340±270)dyn·s·cm^－5·m^－2,平均肺动脉压(MPAP)、肺动脉楔压(PAWP)均较热化疗前显著增高,化疗结束即恢复正常。结论:热化疗可引起体温上升及继发一系列血流动力学变化。     

Comedications and potential drug-drug interactions with direct-acting antivirals in hepatitis C patients on hemodialysis

Background/AimsDirect‐acting antivirals (DAAs) have been approved for hepatitis C virus (HCV) treatment in patients with end-stage renal disease (ESRD) on hemodialysis. Nevertheless, the complicated comedications and their potential drug-drug interactions (DDIs) with DAAs might limit clinical practice in this special population.MethodsThe number, class, and characteristics of comedications and their potential DDIs with five DAA regimens were analyzed among HCV-viremic patients from 23 hemodialysis centers in Taiwan.ResultsOf 2,015 hemodialysis patients screened in 2019, 169 patients seropositive for HCV RNA were enrolled (mean age, 65.6 years; median duration of hemodialysis, 5.8 years). All patients received at least one comedication (median number, 6; mean class number, 3.4). The most common comedication classes were ESRD-associated medications (94.1%), cardiovascular drugs (69.8%) and antidiabetic drugs (43.2%). ESRD-associated medications were excluded from DDI analysis. Sofosbuvir/velpatasvir/voxilaprevir had the highest frequency of potential contraindicated DDIs (red, 5.6%), followed by glecaprevir/pibrentasvir (4.0%), sofosbuvir/ledipasvir (1.3%), sofosbuvir/velpatasvir (1.3%), and elbasvir/grazoprevir (0.3%). For potentially significant DDIs (orange, requiring close monitoring or dose adjustments), sofosbuvir/velpatasvir/voxilaprevir had the highest frequency (19.9%), followed by sofosbuvir/ledipasvir (18.2%), glecaprevir/pibrentasvir (12.6%), sofosbuvir/velpatasvir (12.6%), and elbasvir/grazoprevir (7.3%). Overall, lipid-lowering agents were the most common comedication class with red-category DDIs to all DAA regimens (n=62), followed by cardiovascular agents (n=15), and central nervous system agents (n=10).ConclusionsHCV-viremic patients on hemodialysis had a very high prevalence of comedications with a broad spectrum, which had varied DDIs with currently available DAA regimens. Elbasvir/grazoprevir had the fewest potential DDIs, and sofosbuvir/velpatasvir/voxilaprevir had the most potential DDIs.     

Effects of plasmapheresis on renal hemodynamics and sodium excretion in dogs

Summary Acute plasmapheresis in dogs reduces plasma protein concentration, without significantly altering plasma volume, glomerular filtration rate and plasma sodium concentration.The effects of acute hypoproteinemia on renal circulation is variable. In some cases, the renal plasma flow is not modified, while in others it is markedly decreased, leading to a rise in filtration fraction. The hemodynamic changes are observed in experiments inducing marked protein depletion.Acute hypoproteinemia increases sodium excretion exclusively in experiments where plasmapheresis has not reduced kidney irrigation.The lack of plasma volume expansion in the natriuretic animals cancels the necessity of postulating the secretion of some unknown natriuretic hormone to explain the decreased tubular reabsorption of sodium. The explanation of saline diuresis should be sought within the kidney itself, and the fall in peritubular oncotic pressure, occurring after plasmapheresis or during massive saline loading, offers an alternative explanation, which appears simpler and more rational.