Brunois J P, Toupance O, Vistelle R, Choisy H, Chanard J
Nephrologie. 1984;5(1):27-31.
Symptomatic hypotension and other symptoms of the so-called dialytic desiquilibrium syndrome have been related to alterations of body fluid osmolality and distribution. Fluid removal from the intracellular compartment can be achieved by manipulating the sodium dialysate (NaD). The extracellular fluid volume ( EFCV ) was measured with inulin and/or 35SO = 4. Total body water changes were calculated in terms of fluid substraction induced by dialysis. They were monitored in 12 patients on hemodialysis with a highly permeable membrane and a careful monitoring of ultrafiltration. NaD was maintained constant throughout the session and was comprised between 140 and 170 mmol/l. Below 150 mmol/l NaD, ECFV was reduced more than the weight loss, indicating concomitant intracellular water loading. Conversely, over 150 mmol/l NaD weight loss resulted from extracellular and cellular water. We conclude: 1) transcellular water shift during dialysis is dependent of sodium dialysate; 2) net cellular water-shift was obtained for NaD higher than 150 mmol/l; 3) at least two compartments for water distribution should be taken into account for sodium modeling.
症状性低血压及所谓透析失衡综合征的其他症状与体液渗透压及分布的改变有关。通过调整透析液钠浓度（NaD）可实现细胞内液的脱水。用菊粉和/或35SO₄测量细胞外液量（EFCV）。根据透析引起的液体减少量计算总体水的变化。对12例使用高通透性膜进行血液透析且严格监测超滤的患者进行了监测。透析过程中NaD保持恒定，范围在140至170 mmol/L之间。当NaD低于150 mmol/L时，ECFV的减少超过体重减轻，表明伴有细胞内水负荷增加。相反，当NaD超过150 mmol/L时，体重减轻源于细胞外液和细胞内液的丢失。我们得出以下结论：1）透析过程中的跨细胞水转移取决于透析液钠浓度；2）当NaD高于150 mmol/L时可实现净细胞水转移；3）在进行钠模型构建时，至少应考虑两个水分布区间。
