Igarashi H, Kioi S, Gejyo F, Arakawa M
Nephron. 1985;41(1):62-9. doi: 10.1159/000183548.
This study was undertaken to evaluate the effects of membrane-related complement activation and dialysate composition on dialysis-associated hypoxemia. Seven chronic hemodialysis patients were hemodialyzed 3 times sequentially with the following three combinations; Cuprophan membrane with acetate dialysate, polymethylmethacrylate (PMMA) membrane with acetate dialysate, and PMMA membrane with bicarbonate dialysate. During dialysis with acetate dialysate, the pulmonary diffusing capacity (DLco) at 30 min after the start of dialysis was decreased to 88% (p less than 0.01) of the predialysis value with PMMA and to 79% (p less than 0.01) with Cuprophan, and the degree of DLco on PMMA membrane was different from that on Cuprophan (p less than 0.01). The degree of leukopenia with PMMA was less than that with Cuprophan. However, the fall in DLco did not alter the alveolar-arterial O2 tension gradient. Although the changes in transcutaneous PO2 (tcPO2) were not constant in all three combinations, a distinct fall in tcPO2 was observed in the first half of dialysis with acetate dialysate. During dialysis with acetate dialysate but not with bicarbonate, the extracorporeal dialyzer removed an average of 60 ml/min of CO2, and the respiratory quotient dropped from a mean predialysis value of 0.86 to 0.59 (p less than 0.001). The arterial CO2 tension was not significantly changed throughout dialysis, but the alveolar ventilation decreased significantly in proportion to the fall in carbon dioxide output. The arterial tension fell from a control level of 91 +/- 6 to 77 +/- 8 mm Hg (p less than 0.01) in 30 min. It is concluded that, in spite of a fall in DLco, dialysis-induced hypoxemia in this group of patients on maintenance dialysis is caused by CO2 loss via the dialyzer, resulting in reflex hypoventilation.
本研究旨在评估与膜相关的补体激活及透析液成分对透析相关低氧血症的影响。7例慢性血液透析患者依次采用以下三种组合进行3次血液透析：铜仿膜与醋酸盐透析液、聚甲基丙烯酸甲酯（PMMA）膜与醋酸盐透析液、PMMA膜与碳酸氢盐透析液。在使用醋酸盐透析液进行透析期间，透析开始30分钟时，PMMA膜组的肺弥散功能（DLco）降至透析前值的88%（p<0.01），铜仿膜组降至79%（p<0.01），且PMMA膜上的DLco程度与铜仿膜不同（p<0.01）。PMMA膜组的白细胞减少程度低于铜仿膜组。然而，DLco的下降并未改变肺泡-动脉血氧分压差。尽管在所有三种组合中经皮氧分压（tcPO2）的变化并不恒定，但在使用醋酸盐透析液透析的前半段观察到tcPO2明显下降。在使用醋酸盐透析液而非碳酸氢盐透析期间，体外透析器平均每分钟清除60 ml的二氧化碳，呼吸商从透析前的平均0.86降至0.59（p<0.001）。整个透析过程中动脉血二氧化碳分压无明显变化，但肺泡通气量随二氧化碳排出量的下降而显著降低。动脉血氧分压在30分钟内从对照水平的91±6降至77±8 mmHg（p<0.01）。结论是，尽管DLco下降，但维持性透析的这组患者中，透析诱导的低氧血症是由透析器导致的二氧化碳丢失引起的，从而导致反射性通气不足。
