Coli U, Landini S, Lucatello S, Fracasso A, Morachiello P, Righetto F, Scanferla F, Onesti G, Bazzato G
Trans Am Soc Artif Intern Organs. 1983;29:71-5.
Vascular instability represents the most frequent intradialytic complication of uremic patients. Catecholamine impairment, changes in plasma sodium or osmolality and, more recently, temperature (T) of dialysate have been proposed to explain this phenomenon. In order to evaluate the role of T in hemodynamic stability, we studied the effect of cooling dialysate in 5 patients (3 m, 2 f), who often experienced hypotension during dialytic sessions. Dialysate T was lowered, leading to a body T decrease of 1.5 degrees C, measured by a thermistor in the pulmonary artery. Ultrafiltration was kept constant during both "warm" (W) and "cold" (C) hemodialysis (HD). Systemic and pulmonary hemodynamic parameters were studied by thermodilution technique. The evaluation was performed in the same patients during W-HD and C-HD with the same dialysate composition. MAP showed a significant reduction during the first hour under both dialysis conditions. Subsequently a further decrease of MAP was observed in W-HD, while it remained stable in C-HD. CI and SI demonstrated similar trends, whereas HR showed no major changes. TPRI appeared significantly higher during C-HD compared to W-HD, with no clinical symptoms of hypotension. Similarly pulmonary parameters resulted in a better cardiovascular stability during C-HD. Our hemodynamic study confirms the important role played by T on intradialytic vascular stability and may explain the better control observed during hemofiltration compared to standard W-HD.
血管不稳定是尿毒症患者透析期间最常见的并发症。儿茶酚胺功能障碍、血浆钠或渗透压的变化，以及最近提出的透析液温度（T）被用来解释这一现象。为了评估温度在血流动力学稳定性中的作用，我们研究了降低透析液温度对5例患者（3例男性，2例女性）的影响，这些患者在透析过程中经常出现低血压。透析液温度降低，导致肺动脉内热敏电阻测得的体温下降1.5摄氏度。在“温热”（W）和“冷”（C）血液透析（HD）过程中，超滤量保持恒定。通过热稀释技术研究全身和肺血流动力学参数。在相同透析液成分的情况下，对同一组患者在W-HD和C-HD期间进行评估。在两种透析条件下的第一个小时内，平均动脉压（MAP）均显著降低。随后，在W-HD中观察到MAP进一步下降，而在C-HD中保持稳定。心脏指数（CI）和每搏指数（SI）表现出相似的趋势，而心率（HR）没有明显变化。与W-HD相比，C-HD期间的外周阻力指数（TPRI）显著升高，且无低血压的临床症状。同样，肺参数在C-HD期间显示出更好的心血管稳定性。我们的血流动力学研究证实了温度在透析期间血管稳定性中所起的重要作用，并可能解释了与标准W-HD相比，血液滤过期间观察到的更好的控制效果。
