Nette Robert W, Ie Eric H Y, Vletter Wim B, Krams Rob, Weimar Willem, Zietse Robert
Erasmus MC, Department of Internal Medicine, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
Nephrol Dial Transplant. 2006 May;21(5):1305-11. doi: 10.1093/ndt/gfk070. Epub 2006 Jan 31.
Hypotension during haemodialysis results from an inadequate cardiovascular response to ultrafiltration-induced hypovolaemia. It has been suggested that plasma volume could be increased as a result of systemic vasoconstriction.
We studied the effect of a norepinephrine (NOR) infusion (30 min), compared with no infusion, on relative blood volume (RBV) in six haemodialysis patients. During infusion we measured RBV, systolic blood pressure (SAP), heart rate (HR), stroke volume index (SI), total peripheral resistance (TPRI), ejection fraction (EF), inferior vena cava diameter (VCD) and core temperature.
At the end of the NOR infusion, we observed a significant increase in TPRI (47+/-47% vs 4+/-17%; P<0.01) and SAP (27+/-12% vs 0+/-8%; P<0.01). Norepinephrine-induced vasoconstriction resulted in a significant decrease in RBV (-9+/-3% vs 0+/-1%; P<0.01). No significant changes were seen in SI (-4+/-21% vs 0+/-8%), HR (-5+/-19% vs -4+/-5%), EF (7+/-14% vs -2+/-10%), VCD or temperature.
We conclude that norepinephrine-induced vasoconstriction results in a decrease in RBV. This indicates that improved haemodynamic stability during haemodialysis through vasoconstriction can be accompanied by a decrease in RBV and that part of the variability in blood volume may be due to changes in arterial tone. Such changes must be taken into account if RBV measurements are used to improve the haemodynamic tolerance of dialysis.
血液透析期间的低血压是由于心血管系统对超滤引起的血容量减少反应不足所致。有人提出，全身血管收缩可能会导致血浆量增加。
我们研究了去甲肾上腺素（NOR）输注（30分钟）与不输注相比，对6例血液透析患者相对血容量（RBV）的影响。在输注过程中，我们测量了RBV、收缩压（SAP）、心率（HR）、每搏量指数（SI）、总外周阻力（TPRI）、射血分数（EF）、下腔静脉直径（VCD）和核心温度。
在NOR输注结束时，我们观察到TPRI显著增加（47±47%对4±17%；P<0.01）和SAP显著增加（27±12%对0±8%；P<0.01）。去甲肾上腺素诱导的血管收缩导致RBV显著降低（-9±3%对0±1%；P<0.01）。SI（-4±21%对0±8%）、HR（-5±19%对-4±5%）、EF（7±14%对-2±10%）、VCD或温度均无显著变化。
我们得出结论，去甲肾上腺素诱导的血管收缩导致RBV降低。这表明，通过血管收缩改善血液透析期间的血流动力学稳定性可能伴随着RBV的降低，并且血容量的部分变异性可能归因于动脉张力的变化。如果使用RBV测量来改善透析的血流动力学耐受性，则必须考虑到这些变化。
