Wehle B, Asaba H, Castenfors J, Gunnarsson B, Bergström J
Proc Eur Dial Transplant Assoc. 1981;18:153-9.
Haemodynamic studies were made in eight patients before and during isovolaemic dialysis with five different dialysis solutions which varied with regard to concentration of sodium, acetate, bicarbonate and urea. Low sodium (133mmol/L) in the dialysate induced a fall in blood pressure both with and without urea removal, but no significant fall in peripheral vascular resistance. Acetate in the dialysate at higher sodium concentration (140mmol/L) resulted in peripheral vasodilation but no fall in blood pressure due to a compensatory increase in heart rate and cardiac output. We conclude that a fall in plasma tonicity (sodium) is the most important pathogenetic factor in dialysis associated hypotension; fall in total osmolality (mainly urea) is of no importance and acetate vasodilation can be compensated for haemodynamically provided that tonicity is kept stable.
对8例患者在使用五种不同透析液进行等容透析前及透析过程中进行了血流动力学研究，这五种透析液在钠、醋酸盐、碳酸氢盐和尿素浓度方面有所不同。透析液中低钠（133mmol/L）无论有无尿素清除均导致血压下降，但外周血管阻力无显著下降。较高钠浓度（140mmol/L）的透析液中的醋酸盐导致外周血管舒张，但由于心率和心输出量的代偿性增加，血压未下降。我们得出结论，血浆张力（钠）下降是透析相关性低血压最重要的发病因素；总渗透压（主要是尿素）下降无关紧要，并且只要张力保持稳定，醋酸盐血管舒张在血流动力学上可得到代偿。
