Ghasemi Asghar, Shafiee Morteza, Rowghani Karim
Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shaheed Beheshti University of Medical Sciences, Tehran, Iran.
Saudi J Kidney Dis Transpl. 2008 May;19(3):378-83.
To investigate the effect of cool dialysis on hemodynamic parameters and serum nitric oxide levels in diabetic patients, we studied 20 old (mean age 63.3 +/- 7.5) chronic hemodialysis diabetics who were dialyzed twice, once using cool and once using standard (37 degrees C) temperature dialysate solution. During the study, all the dialysis conditions were maintained the same except cooling the dialysate from 37 degrees C to 35 degrees C. Hemodynamic parameters including SBP, DBP, and HR were measured hourly. Oral temperature was measured before and after dialysis. Serum urea and nitric oxide metabolites were determined before and after hemodialysis. Systolic, diastolic, and mean arterial pressure decreased significantly during standard temperature compared to cool dialysis. Maximum decrease of systolic, diastolic, and mean arterial pressure was observed during the third hour of dia-lysis and the magnitude of decrease was 18, 17, and 14 percent for standard temperature and 6, 1, and 4 percent for cool dialysis, respectively. Heart rate did not differ significantly between the two study groups. Compared to the pre dialysis levels of serum nitric oxide metabolites, the post dialysis levels decreased significantly with cool and standard temperature dialysate (59 +/- 5 vs. 37 +/- 4, and 63 +/- 7 vs. 41 +/- 5, micromol/L respectively, P< 0.01). Cool dialysis could decrease episodes of hypotension and stabilized hemodynamic parameters in diabetic patients. Probably other mechanisms than increased serum nitric oxide levels may be involved in hemodialysis hypotension in this group of patients.
为研究低温透析对糖尿病患者血流动力学参数及血清一氧化氮水平的影响，我们对20例老年（平均年龄63.3±7.5岁）慢性血液透析糖尿病患者进行了研究，这些患者接受两次透析，一次使用低温透析液，一次使用标准（37℃）温度的透析液。在研究过程中，除了将透析液温度从37℃降至35℃外，所有透析条件均保持相同。每小时测量包括收缩压（SBP）、舒张压（DBP）和心率（HR）在内的血流动力学参数。透析前后测量口腔温度。测定血液透析前后的血清尿素和一氧化氮代谢产物。与低温透析相比，标准温度透析期间收缩压、舒张压和平均动脉压显著下降。在透析的第三小时观察到收缩压、舒张压和平均动脉压的最大降幅，标准温度透析时降幅分别为18%、17%和14%，低温透析时降幅分别为6%、1%和4%。两组研究对象的心率差异无统计学意义。与透析前血清一氧化氮代谢产物水平相比，低温和标准温度透析液透析后水平均显著下降（分别为59±5与37±4，以及63±7与41±5，微摩尔/升，P<0.01）。低温透析可减少糖尿病患者的低血压发作并稳定血流动力学参数。在这组患者的血液透析低血压中，可能涉及血清一氧化氮水平升高以外的其他机制。
