Agroyannis B, Fourtounas C, Tzanatos H, Kapetanaki A, Dalamangas A, Vlahakos D V
Department of Nephrology, Aretaieion University Hospital, Athens, Greece.
Int J Artif Organs. 2003 Feb;26(2):135-8. doi: 10.1177/039139880302600207.
The aim of this study was to verify if the degree of pre-HD acidosis and its correction post-HD is related to body fluid expansion during the interdialytic period. Twelve uremic patients without major problems, with stable hematocrit, with regular and similar HD-session characteristics, but widely varying amounts of body fluid expansion in the interdialytic period were included. Blood samples were collected from arterial line pre- and post-HD, anaerobically in heparinized syringes, for determination of HCO3-, pH and PaCO2 (radiometer Copenhagen ABL 300 Acid-Base Laboratory), in two similar HD-sessions for each patient (12 patients, 24 HD-sessions). The percentage (%) of body weight gain in the interdialytic period was also estimated. For each patient, the mean value of parameters studied in the two HD-sessions was used for the evaluation of findings. According to mean values (+/-SD) of HCO3-, pH and PaCO2 Pre-HD (18.26+/-1.99 mmol/L, 7.31+/-0.03, 36.27+/-2.5 mmHg respectively) and post-HD (26.37+/-1.7, 7.43+/-0.03, 38.43+/-2.10 respectively) patients are acidotic pre-HD and slightly alkalemic post-HD. Correlation between the percentage (%) of interdialytic body weight gain (IBWG) and the values of HCO3-, pH and PaCO2, Pre-HD (r=-0.814, p<0.001; r=-0.931, p<0.001; r=0, 100 NS; respectively) and post-HD (r=-0.958, p<0.001; r=-0.937, p<0.001; r=-0.504 NS; respectively) indicates a significant and negative relationship of IBWG% with HCO3- and pH pre- and post-HD, but not with PCO2. In conclusion, the negative relationship of IBWG% with HCO3- and pH pre- and post-HD indicates that the body fluid expansion during the interdialytic period contributes to a dilutional acidosis pre-HD, but not to a contraction alkalosis post-HD, by the elimination of fluid during the HD-session.
本研究的目的是验证血液透析前酸中毒的程度及其血液透析后的纠正情况是否与透析间期的体液潴留有关。纳入了12例无重大问题、血细胞比容稳定、血液透析治疗特征规律且相似，但透析间期体液潴留量差异较大的尿毒症患者。在每次血液透析治疗的前后，通过动脉穿刺采集血样，将血样注入肝素化注射器中并进行厌氧处理，以测定HCO3-、pH和PaCO2（使用丹麦Radiometer公司的ABL 300酸碱分析仪），每位患者进行两次相似的血液透析治疗（共12例患者，24次血液透析治疗）。同时评估患者在透析间期体重增加的百分比（%）。对于每位患者，采用两次血液透析治疗中所研究参数的平均值来评估结果。根据血液透析前和透析后HCO3-、pH和PaCO2的平均值（±标准差）（透析前分别为18.26±1.99 mmol/L、7.31±0.03、36.27±2.5 mmHg；透析后分别为26.37±1.7、7.43±0.03、3８.43±2.10），患者在血液透析前呈酸中毒，透析后呈轻度碱中毒。透析间期体重增加百分比（IBWG）与血液透析前HCO3-、pH和PaCO2值之间的相关性（r分别为-0.814，p<0.001；r为-0.931，p<0.001；r为0.100，无统计学意义）以及与血液透析后HCO3-、pH和PaCO2值之间的相关性（r分别为-0.958，p<0.001；r为-0.937，p<0.001；r为-0.504，无统计学意义）表明，IBWG%与血液透析前后的HCO3-和pH呈显著负相关，但与PCO2无关。总之，IBWG%与血液透析前后HCO3-和pH的负相关关系表明，透析间期的体液潴留导致了血液透析前的稀释性酸中毒，但在血液透析过程中通过超滤脱水后，并未导致收缩性碱中毒。
