Sharma Ashima, Sharma Ashok, Gahlot Sushila, Prasher Pawan Kumar
MD. Senior Resident, Department of Physiology, Indira Gandhi Medical College, Shimla, India.
MD. Professor, Department of Medicine, Indira Gandhi Medical College, Shimla, India.
Sao Paulo Med J. 2017 Nov-Dec;135(6):568-572. doi: 10.1590/1516-3180.2017.0179150817.
The aim here was to study acute effects of hemodialysis among end-stage renal disease (ESRD) patients.
Prospective study in tertiary-level care center.
Fifty ESRD patients undergoing hemodialysis were studied. Spirometric pulmonary function tests were performed before and after four-hour hemodialysis sessions.
The patients' average age was 45.8 ± 10.0 years; 64% were males and 64% had normal body mass index. Anemia (94%) and hypoalbuminemia (72%) were common. Diabetes mellitus (68%), hypertension (34%) and coronary artery disease (18%) were major comorbidities. Forty-five patients (90%) had been on hemodialysis for six months to three years. The patients' pre-dialysis mean forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) were below normal: 45.8 ± 24.9% and 43.5 ± 25.9% of predicted, respectively. After hemodialysis, these increased significantly, to 51.1 ± 23.4% and 49.3 ± 25.5% of predicted, respectively (P < 0.01). The increase in mean FEV1/FVC, from 97.8 ± 20.8% to 99.3 ± 20.1% of predicted, was not significant (P > 0.05). The pre-dialysis mean forced expiratory flow 25-75% was 50.1 ± 31% and increased significantly, to 56.3 ± 31.6% of predicted (P < 0.05). The mean peak expiratory flow was below normal (43.8 ± 30.7%) and increased significantly, to 49.1 ± 29.9% of predicted (P < 0.05). Males and females showed similar directions of change after hemodialysis.
Pulmonary function abnormalities are common among ESRD patients. Comparison of pre and post-hemodialysis parameters showed significant improvements, but normal predicted values were still not achieved.
本研究旨在探讨血液透析对终末期肾病（ESRD）患者的急性影响。
在三级医疗中心进行的前瞻性研究。
对50例接受血液透析的ESRD患者进行研究。在4小时血液透析疗程前后进行肺量计肺功能测试。
患者的平均年龄为45.8±10.0岁；64%为男性，64%的患者体重指数正常。贫血（94%）和低白蛋白血症（72%）较为常见。糖尿病（68%）、高血压（34%）和冠状动脉疾病（18%）是主要的合并症。45例患者（90%）已接受血液透析6个月至3年。患者透析前的平均用力肺活量（FVC）和1秒用力呼气量（FEV1）低于正常水平：分别为预测值的45.8±24.9%和43.5±25.9%。血液透析后，这些指标显著增加，分别为预测值的51.1±23.4%和49.3±25.5%（P<0.01）。平均FEV1/FVC从预测值的97.8±20.8%增加到99.3±20.1%，差异无统计学意义（P>0.05）。透析前平均用力呼气流量25%-75%为50.1±31%，显著增加至预测值的56.3±31.6%（P<0.05）。平均呼气峰值流量低于正常水平（43.8±30.7%），显著增加至预测值的49.1±29.9%（P<0.05）。血液透析后，男性和女性的变化趋势相似。
肺功能异常在ESRD患者中很常见。透析前后参数比较显示有显著改善，但仍未达到正常预测值。
