Daul A E, Schäfers R F, Wenzel R R, Loew H, Windeck R, Philipp T
Abteilung für Nieren- und Hochdruckkrankheiten, Zentrum für Innere Medizin, Universität Essen.
Dtsch Med Wochenschr. 1994 Sep 23;119(38):1263-9. doi: 10.1055/s-2008-1058831.
A retrospective study was undertaken of 14 patients (eleven men, three women; mean age 52 [33-68] years in whom haemolysis had occurred during chronic haemodialysis (n = 12) or haemofiltration (n = 2). The haemolysis was of mechanical cause in eight patients, by an osmotic mechanism in one, and of unknown cause in five. Cardinal symptoms were nausea in 14 patients, abdominal pain in nine, vomiting in eight and raised blood pressure in ten. The plasma was discoloured in all patients and there was also an increase in free haemoglobin (110-2400 mg/dl) and (or) lactate dehydrogenase (311-7403 U/l). In all of eleven patients in whom it was measured the activity of serum amylase and (or) lipase was more than doubled (to 73-2400 U/l and 473-16,740 U/l, respectively). All patients were treated symptomatically, three had a blood exchange, two others plasma separation. Eight patients recovered within a few days, but necrotizing pancreatitis developed in six, three of whom died while two had permanent sequelae. This series shows that dialysis-induced acute haemolysis can cause life-threatening pancreatitis. Narrowings within the extracorporeal circuit, not always recognized in current dialysis equipment, are the most frequent cause of the mechanical haemolysis.
对14例患者进行了一项回顾性研究（11例男性，3例女性；平均年龄52岁[33 - 68岁]），这些患者在慢性血液透析（n = 12）或血液滤过（n = 2）过程中发生了溶血。8例患者的溶血是机械性原因导致，1例是渗透机制导致，5例原因不明。主要症状为14例患者出现恶心，9例出现腹痛，8例出现呕吐，10例血压升高。所有患者的血浆均变色，游离血红蛋白（110 - 2400 mg/dl）和（或）乳酸脱氢酶（311 - 7403 U/l）也升高。在测量的11例患者中，血清淀粉酶和（或）脂肪酶的活性均增加了一倍以上（分别升至73 - 2400 U/l和473 - 16,740 U/l）。所有患者均接受了对症治疗，3例进行了换血，另外2例进行了血浆分离。8例患者在数天内康复，但6例发生了坏死性胰腺炎，其中3例死亡，2例有永久性后遗症。该系列研究表明，透析引起的急性溶血可导致危及生命的胰腺炎。体外循环内的狭窄是机械性溶血最常见的原因，目前的透析设备并不总能识别出这种狭窄。
