Schilling H, Lehmann H, Hampl H
Artif Organs. 1985 Feb;9(1):17-21. doi: 10.1111/j.1525-1594.1985.tb04341.x.
Eight stable patients on maintenance hemodialysis were studied while undergoing (a) acetate hemodialysis with a sequential dialysate sodium concentration from 147 to 137 mEq/L (SNa-HDA) and (b) bicarbonate hemodialysis with a constant dialysate sodium concentration of 140 mEq/L (HDB). Circulatory behavior was observed during both of these methods, and both were found to allow a high volume removal. However, as a consequence of the high sodium load during SNa-HDA, volume was shifted from the extra- to the intravascular space. This stabilizing effect on the circulation disappeared with the sequential decrease of dialysate sodium concentration (despite a constant plasma sodium concentration (despite a constant plasma sodium concentration of approximately 140 mEq/L), which was concomitant with a significant decline of the mean arterial blood pressure and an inadequate compensation of the metabolic acidosis. In contrast, a better circulatory response to comparable volume removal was found during HDB, expressed by a stable mean arterial blood pressure in the presence of well-balanced arterial acid-base values.
对8名维持性血液透析稳定的患者进行了研究，期间他们接受了：(a) 醋酸盐血液透析，透析液钠浓度从147降至137 mEq/L（SNa-HDA）；(b) 碳酸氢盐血液透析，透析液钠浓度恒定为140 mEq/L（HDB）。在这两种方法实施过程中均观察到循环行为，且二者均能实现大量液体清除。然而，由于SNa-HDA期间钠负荷较高，液体从血管外间隙转移至血管内间隙。随着透析液钠浓度的逐步降低，这种对循环的稳定作用消失（尽管血浆钠浓度恒定（约为140 mEq/L）），这同时伴随着平均动脉血压显著下降以及代谢性酸中毒未得到充分代偿。相比之下，在HDB期间发现对等量液体清除有更好的循环反应，表现为在动脉酸碱值平衡良好的情况下平均动脉血压稳定。
