采用静脉碳酸氢盐缓冲的再循环透析（RD）（透析液20至40升）——血液滤过（HF）的替代方法。

Recirculation dialysis (RD) (20 to 40 liters of dialysate) with venous bicarbonate buffering - an alternative procedure to hemofiltration (HF).

作者信息

Hampl H, Fisher C, Resa I, Paeprer H, Kessel M

出版信息

Int J Artif Organs. 1979 Sep;2(5):235-42.

Abstract

We report about a dialysis procedure, the circulation stability of which is comparable to hemofiltration treatment. Hemodynamic parameters were measured invasively and different procedures were compared for each patient. In RD and HF significant reduction in cardiac output (HF: --20%, RD: --21.5%), stroke volume (HF: --20%, RD: --17%), pulmonary artery pressure (HF: --57%, RD: --45:6%) and plasma volume (HF: --12%, RD: --15%) were found. Blood pressure and heart rate (HF: --1%, RD: --3%) remained stable despite the high utrafiltration rate. Peripheral resistance rose significantly (HF: + 20%, RD: + 25.9%). Compared with HG, the most important advantage during RD is the improved tolerance to treatment without typical hemodialysis-induced symptoms. In comparison to that, we found under conventional dialysis an inadequate increase in peripheral resistance (HD: + 6.1%). A following strong compensatory hyperventilation with drop in PCO2 was paralleled with typical symptoms like nausea and headache. Because of resttriction of this compensatory mechanism, hypotension and arrhythmia will be induced of the following peripheral tissue perfusion and central acidosis.

摘要

我们报告了一种透析程序，其循环稳定性与血液滤过治疗相当。对血流动力学参数进行了有创测量，并对每位患者的不同程序进行了比较。在血液滤过（HF）和重复性透析（RD）中，发现心输出量（HF：-20%，RD：-21.5%）、每搏输出量（HF：-20%，RD：-17%）、肺动脉压（HF：-57%，RD：-45.6%）和血浆量（HF：-12%，RD：-15%）均显著降低。尽管超滤率很高，但血压和心率（HF：-1%，RD：-3%）保持稳定。外周阻力显著升高（HF：+20%，RD：+25.9%）。与血液滤过（HG）相比，重复性透析（RD）最重要的优势在于对治疗的耐受性提高，且无典型的血液透析诱导症状。相比之下，我们发现在传统透析下外周阻力增加不足（HD：+6.1%）。随后强烈的代偿性过度通气伴PCO2下降，并伴有恶心和头痛等典型症状。由于这种代偿机制受限，随后会因外周组织灌注和中枢性酸中毒而诱发低血压和心律失常。