Malik Jan, Kudlicka Jaroslav, Lachmanova Jana, Valerianova Anna, Rocinova Katarina, Bartkova Magdalena, Tesar Vladimir
3rd Department of Internal Medicine, General University Hospital, First Faculty of Medicine, Charles University, Prague - Czech Republic.
Department of Nephrology, General University Hospital, First Faculty of Medicine, Charles University, Prague - Czech Republic.
J Vasc Access. 2017 Jan 18;18(1):47-51. doi: 10.5301/jva.5000630. Epub 2016 Nov 22.
Cognitive deficit is a common problem in end-stage renal disease (ESRD) patients. Ultrafiltration and hemodialysis lead to profound hemodynamic changes. The aim of this pilot study was to describe brain and hand oxygenation values in ESRD patients and their changes during hemodialysis.
Twenty-seven patients treated by chronic hemodialysis and 17 controls patients of the same age were included in the study. Regional saturation of oxygen (SrO2) was measured at the brain frontal lobe and at the hand with dialysis access using the INVOS 5100C. In 17 of ESRD patients, SrO2 was also monitored throughout hemodialysis. Finger systolic blood pressure and basic hemodialysis and laboratory data were collected.
Dialysis patients had lower brain and also hand SrO2 values at rest (51.5 ± 10.9 vs. 68 ± 7%, p<0.0001 and 55 ± 16 vs. 66 ± 8%, p = 0.03, respectively). Both values further decreased during the first 35 minutes of hemodialysis (brain SrO2 to 47 ± 8%, p<0.0001 and hand to 45 ± 14%, p<0.0001, respectively). The brain SrO2 decrease was related to the ultrafiltration rate, the hand SrO2 decrease to the finger pressure and to blood hemoglobin.
Chronic dialysis patients suffer from tissue ischemia and that even worsens after the beginning of hemodialysis. This observation may contribute to the understanding of cognitive deficit etiology.
认知缺陷是终末期肾病（ESRD）患者的常见问题。超滤和血液透析会导致显著的血流动力学变化。这项初步研究的目的是描述ESRD患者的脑和手部氧合值及其在血液透析期间的变化。
本研究纳入了27例接受慢性血液透析治疗的患者和17例同龄对照患者。使用INVOS 5100C在脑额叶和有透析通路的手部测量局部氧饱和度（SrO2）。在17例ESRD患者中，还在血液透析全过程监测SrO2。收集手指收缩压、基本血液透析和实验室数据。
透析患者静息时脑和手部的SrO2值较低（分别为51.5±10.9 vs. 68±7%，p<0.0001和55±16 vs. 66±8%，p = 0.03）。在血液透析的前35分钟内，这两个值进一步下降（脑SrO2降至47±8%，p<0.0001；手部降至45±14%，p<0.0001）。脑SrO2的下降与超滤率有关，手部SrO2的下降与手指压力和血红蛋白有关。
慢性透析患者存在组织缺血，且在血液透析开始后缺血情况会进一步恶化。这一观察结果可能有助于理解认知缺陷的病因。
