Naik R B, Mathias C J, Reid J L, Warren D J
Am J Nephrol. 1985;5(2):96-102. doi: 10.1159/000166913.
The mechanisms of hypotension during haemodialysis were investigated by studying cardiovascular reflexes, body fluid volumes, and osmolality in 11 patients with renal failure before and after haemodialysis and in 17 normal subjects before and after furosemide diuresis. Blood pressure and heart rate responses to tests of autonomic nervous function were unaffected in either group except that in the patients, head-up tilt after haemodialysis caused a fall in blood pressure. This was associated with a greater fall in cardiac output than before haemodialysis but with a similar rise in peripheral vascular resistance. Resting plasma noradrenaline levels were higher than normal, and the rise in plasma noradrenaline levels in response to tilt was unaffected by haemodialysis. Plasma renin activity rose in response to head-up tilt in normal subjects, but not in patients either before or after haemodialysis. Our studies indicate that changes in plasma potassium and osmolality or the possible peripheral circulatory effects of acetate do not impair the regulation of the circulation in response to haemodialysis. Haemodialysis does not reduce plasma noradrenaline levels. Impaired myocardial function in response to fluid depletion or unresponsiveness of the renin-angiotensin system may contribute to haemodialysis hypotension.
通过研究11例肾衰竭患者血液透析前后以及17例正常受试者速尿利尿前后的心血管反射、体液容量和渗透压，对血液透析期间低血压的机制进行了研究。除患者在血液透析后进行头高位倾斜会导致血压下降外，两组对自主神经功能测试的血压和心率反应均未受影响。这与血液透析前相比心输出量下降幅度更大，但外周血管阻力升高幅度相似有关。静息血浆去甲肾上腺素水平高于正常，头高位倾斜引起的血浆去甲肾上腺素水平升高不受血液透析影响。正常受试者头高位倾斜时血浆肾素活性升高，但患者血液透析前后均未升高。我们的研究表明，血浆钾和渗透压的变化或醋酸盐可能的外周循环效应不会损害血液透析时的循环调节。血液透析不会降低血浆去甲肾上腺素水平。对液体消耗的心肌功能受损或肾素 - 血管紧张素系统无反应可能导致血液透析低血压。
