Kooman J P, van der Sande F M, Leunissen K M
Academisch Ziekenhuis, afd. Interne Geneeskunde, Maastricht.
Ned Tijdschr Geneeskd. 1999 Oct 23;143(43):2137-40.
Hypotensive periods occur frequently during a haemodialysis session. The pathogenesis of intradialytic hypotension is multifactorial. The initiating factor is a decline in blood volume. Important contributory factors are inadequate vascular reactivity during haemodialysis and structural cardiovascular abnormalities. Compared with 'standard' haemodialysis, vascular reactivity is clearly increased during isolated ultrafiltration, haemodialysis with lowered fluid temperature (e.g. 36 degrees C), and haemofiltration. The single most important factor explaining these differences in vascular response is the thermal energy balance during the various treatment modalities. With a critical reduction of cardiac filling, the Bezold-Jarish reflex may occur, leading to paradoxical vasodilation and bradycardia.
血液透析过程中低血压期频繁发生。透析中低血压的发病机制是多因素的。起始因素是血容量下降。重要的促成因素是血液透析期间血管反应性不足和结构性心血管异常。与“标准”血液透析相比，在单纯超滤、降低液体温度（如36摄氏度）的血液透析和血液滤过过程中，血管反应性明显增加。解释这些血管反应差异的唯一最重要因素是各种治疗方式下的热能平衡。随着心脏充盈的严重减少，可能会发生贝佐尔德-贾里什反射，导致反常性血管扩张和心动过缓。
