Department of Anesthesiology, University Medical Centre of the Johannes Gutenberg-University Mainz, Langenbeckstr 1, 55131 Mainz, Germany.
Can J Anaesth. 2013 Jun;60(6):564-9. doi: 10.1007/s12630-013-9912-z. Epub 2013 Mar 28.
In chronic renal failure, intermittent hemodialysis decreases cerebral blood flow velocity (CBFV); however, in critically ill patients with acute renal failure, the effect of continuous venovenous hemodialysis (CVVHD) on CBFV and cerebrovascular autoregulation (AR) is unknown. Therefore, a study was undertaken to investigate the potential effect of CVVHD on CBFV and AR in patients with acute renal failure.
This cohort study investigated 20 patients with acute renal failure who required CVVHD. In these patients, the CBFV and index of AR (Mx) were measured using transcranial Doppler before and during CVVHD.
The median Mx values at baseline were 0.33 [interquartile range (IQR): 0.02-0.55], and during CVVHD, they were 0.20 [0.07-0.40]. The differences in Mx (CVVHD--baseline) was (median [IQR]) -0.015 [-0.19-0.05], 95% confidence interval (CI) -0.16 to 0.05. The Mx was > 0.3 in 11/20 patients at baseline measurement. Six of these patients recovered to Mx < 0.3 during CVVHD. The CBFV was (median [IQR]) 47 [36-59] cm · sec(-1) at baseline and 49 [36-66] cm · sec(-1) during CVVHD. The difference of CBFV was 0.0 [-4 - 2.7], 95% CI -2.5 to 4.2.
Compared with patients with intermittent hemodialysis, CVVHD did not influence CBFV and AR in critically ill patients with acute renal failure, possibly due to lower extracorporeal blood flow, slower change of plasma osmolarity, and a lower fluid extraction rate. In a subgroup of patients with sepsis, the AR was impaired at baseline in more than half of the patients, and this was reversed during CVVHD. The trial was registered at ClinicalTrials.gov ID: NCT01376531.
在慢性肾衰竭患者中，间歇性血液透析会降低脑血流速度（CBFV）；然而，在患有急性肾衰竭的危重症患者中，连续静脉-静脉血液透析（CVVHD）对 CBFV 和脑血管自动调节（AR）的影响尚不清楚。因此，进行了一项研究，以调查 CVVHD 对急性肾衰竭患者 CBFV 和 AR 的潜在影响。
这项队列研究调查了 20 名需要 CVVHD 的急性肾衰竭患者。在这些患者中，使用经颅多普勒在 CVVHD 之前和期间测量 CBFV 和 AR 指数（Mx）。
基线时的中位数 Mx 值为 0.33 [四分位距（IQR）：0.02-0.55]，而在 CVVHD 期间为 0.20 [0.07-0.40]。Mx 的差异（CVVHD-基线）为（中位数 [IQR]）-0.015 [-0.19-0.05]，95%置信区间（CI）-0.16 至 0.05。20 名患者中有 11 名在基线测量时的 Mx 值>0.3。其中 6 名患者在 CVVHD 期间恢复到 Mx<0.3。CBFV 的中位数（IQR）为 47 [36-59] cm·sec(-1) ，CVVHD 期间为 49 [36-66] cm·sec(-1)。CBFV 的差异为 0.0 [-4-2.7]，95%CI-2.5 至 4.2。
与间歇性血液透析患者相比，CVVHD 对急性肾衰竭危重症患者的 CBFV 和 AR 没有影响，这可能是由于体外血流较低、血浆渗透压变化较慢以及液体提取率较低所致。在一个脓毒症亚组中，超过一半的患者在基线时 AR 受损，而在 CVVHD 期间则得到了逆转。该试验在 ClinicalTrials.gov 注册号为 NCT01376531。
