Alfakir Maria, Moammar Mahmoud Q, Ali Muhammad I, Alhatem Eid, Curran Ryan D, Saoud Rani M, Chandran Chandra, Khan M Anees, Debari Vincent A
Department of Medicine, School of Health and Medical Sciences, Seton Hall University, South Orange, NJ 07079, USA.
Ann Clin Lab Sci. 2011 Fall;41(4):315-20.
Little is known about the effect of hemodialysis (HD) on gas exchange in subjects with chronic obstructive pulmonary disease (COPD). The purpose of this study was to examine blood gases and pH in COPD patients undergoing HD with bicarbonate dialysate. We studied thirteen subjects with COPD and thirteen controls (CON). All were dialyzed for 4 hrs against a bicarbonate HD solution. Blood gases, pH and HCO(3) (-) were initially analyzed (t(0)) and, during HD, at 30 min (t(0.5)), 1 hr (t(1)) and 4 hrs (t(4)). At t(0), a statistically significant difference was observed for PO(2) (CON: 84.7±3.60, COPD: 72.19±4.92; p<0.001). For the first hr, PO(2) decreased, and at t(1), oxygen was required for 6 COPD subjects. By t(4), there was no significant difference in PO(2) between groups. The alveolar-arterial gradient (ΔA-a) remained different between groups (P<0.001, all times), with increasing ΔA-a for both groups up to t(1) and decreasing over the remaining 3 hr. For both groups, at t(4), ΔA-a was higher than at t(0) (p<0.001). For PCO(2), both groups demonstrated increases from t(0) to t(1) (p=0.0004), with COPD having PCO(2) higher than CON at t(0.5) and t(1) (p<0.05 for both); by t(4), PCO(2) levels decreased to nearly the same as at t(0). Over the 4 hr treatment, HCO(3) (-) and pH increased significantly for both groups; however no significant difference was observed between COPD and CON. Markedly increased ΔA-a is observed during HD in some COPD patients. COPD patients retain more CO(2). However, the effect of HCO(3) (-) leads to mild metabolic alkalosis at t(4).
关于血液透析（HD）对慢性阻塞性肺疾病（COPD）患者气体交换的影响，目前所知甚少。本研究的目的是检测接受碳酸氢盐透析液进行血液透析的COPD患者的血气和pH值。我们研究了13名COPD患者和13名对照组（CON）。所有患者均使用碳酸氢盐血液透析液进行4小时的透析。在透析开始时（t(0)）以及透析过程中的30分钟（t(0.5)）、1小时（t(1)）和4小时（t(4)）对血气、pH值和HCO(3) (-)进行分析。在t(0)时，两组的PO(2)存在统计学显著差异（CON：84.7±3.60，COPD：72.19±4.92；p<0.001）。在最初的1小时内，PO(2)下降，在t(1)时，6名COPD患者需要吸氧。到t(4)时，两组之间的PO(2)没有显著差异。两组之间的肺泡-动脉氧分压差（ΔA-a）仍然存在差异（所有时间点P<0.001），两组的ΔA-a在t(1)之前均升高，在随后的3小时内下降。对于两组，在t(4)时，ΔA-a高于t(0)时（p<0.001）。对于PCO(2)，两组从t(0)到t(1)均升高（p=0.0004），在t(0.5)和t(1)时COPD患者的PCO(2)高于CON组（两者均p<0.05）；到t(4)时，PCO(2)水平下降至与t(0)时几乎相同。在4小时的治疗过程中，两组的HCO(3) (-)和pH值均显著升高；然而，COPD组和CON组之间未观察到显著差异。在血液透析期间，一些COPD患者观察到ΔA-a显著增加。COPD患者潴留更多的CO(2)。然而，HCO(3) (-)的作用在t(4)时导致轻度代谢性碱中毒。
