Vatazin A V, Kruglov E E, Fomin A M, Suslov V P, Koshelev R V, Iankovoĭ A G, Fominykh N M
Anesteziol Reanimatol. 2002 Mar-Apr(2):60-2.
Central hemodynamics was studied by integral polyrheography in 24 patients with acute renal failure (ARF) during hemofiltration (HF) and in 18 patients with ARF during peritoneal dialysis. All central hemodynamic parameters improved by the end of HF. However stroke volume decreased by 26.6%, stroke index by 24.4%, minute volume by 25.7%, and cardiac index by 24.8% as early as at the moment of extracorporeal contour filling. This was paralleled by an increase of total peripheral vascular resistance from 1321 +/- 124 to 1586 +/- 106 din/(cm*c-5) (by 16.7%). Hence, clear-cut signs of centralization of circulation were seen during the initial period of HF in patients with ARF. Peritoneal dialysis did not lead to centralization of circulation in patients with ARF; moreover, minute heart volume increased by 9% during some stages of the procedure, stroke volume increased significantly (p < 0.05), other parameters increased, but total peripheral vascular resistance was virtually unchanged. After removal of dialysis solution from the abdominal cavity all hemodynamic parameters returned to the initial values. Hence, both hemofiltration and peritoneal dialysis ameliorate the central hemodynamics. However peritoneal dialysis does not involve even temporary centralization of circulation, which has a positive impact on the course of acute tubular necrosis.
采用积分多流变学方法对24例急性肾衰竭（ARF）患者血液滤过（HF）期间及18例ARF患者腹膜透析期间的中心血流动力学进行了研究。血液滤过结束时所有中心血流动力学参数均有所改善。然而，早在体外循环回路充盈时，每搏量就下降了26.6%，每搏指数下降了24.4%，分钟心输出量下降了25.7%，心脏指数下降了24.8%。与此同时，总外周血管阻力从1321±124增加到1586±106达因/（厘米·秒⁻⁵）（增加了16.7%）。因此，急性肾衰竭患者在血液滤过初期出现了明显的循环集中化迹象。腹膜透析并未导致急性肾衰竭患者出现循环集中化；此外，在该过程的某些阶段，分钟心输出量增加了9%，每搏量显著增加（p<0.05），其他参数也增加，但总外周血管阻力基本未变。从腹腔移除透析液后，所有血流动力学参数均恢复到初始值。因此，血液滤过和腹膜透析均可改善中心血流动力学。然而，腹膜透析甚至不会引起循环的暂时集中化，这对急性肾小管坏死的病程有积极影响。
