Hirszel P, Maher J F, Tempel G E, Mengel C E
J Lab Clin Med. 1975 Jun;85(6):978-86.
Ten patients underwent 4 study hemodialyses, one with standard dialysis conditions, one with an isophosphate dialysate, one with simultaneous ammonium chloride loading, and other, after pretreatment, with sodium bicarbonate. Measurement of hemoglobin oxygen affinity (P-50), erythrocyte 2,3-DPG, blood-gasses, and serum chemistries revealed biochemically effective hemodialyses and slight changes in oxygen transport parameters. The P-50 (in vivo) values decreased slightly but significantly (p greater than 0.05) with dialysis. When corrected to pH 7.4, eliminating the Bohr effect, P-50 increased (p greater than 0.05). With unmodified dialysis elevated values of 2,3-DPG (in comparison to normal) decreased, a change that did not correlate with delta-p-50, delta-serum phosphate, or delta-serum creatinine. With standard and isophosphate dialyses Po-2 decreased significantly. The decrease correlated with delta-hydrogen ion concentration and did not occur with dialyses designed to maintain pH constant. Thus, hemodialysis influences many factors that affect oxygen transport in different and counterbalancing directions. These changes are not totally explained by alterations in 2,3-DPG, pH or serum phosphate. Maintenance of acidosis or hyperphosphatemia during dialysis is not recommended.
10名患者接受了4次研究性血液透析，一次采用标准透析条件，一次采用等磷酸盐透析液，一次同时进行氯化铵负荷试验，另一次在预处理后采用碳酸氢钠。对血红蛋白氧亲和力（P-50）、红细胞2,3-二磷酸甘油酸（2,3-DPG）、血气和血清化学指标的测量显示，血液透析具有生化有效性，且氧转运参数有轻微变化。透析时，P-50（体内）值略有下降但具有显著性（p＞0.05）。校正至pH 7.4以消除波尔效应后，P-50升高（p＞0.05）。在未改良的透析中，升高的2,3-DPG值（与正常相比）下降，这一变化与δ-P-50、δ-血清磷酸盐或δ-血清肌酐无关。采用标准透析和等磷酸盐透析时，氧分压（Po-2）显著下降。这种下降与δ-氢离子浓度相关，而在旨在维持pH恒定的透析中未出现。因此，血液透析会影响许多以不同且相互抵消的方向影响氧转运的因素。这些变化不能完全由2,3-DPG、pH或血清磷酸盐的改变来解释。不建议在透析期间维持酸中毒或高磷血症。
