Bouffard Y, Tissot S, Delafosse B, Viale J P, Annat G, Bertrand O, Motin J
Service d'Anesthésie-Réanimation, Hôpital Edouard Herriot, Hospices Civils de Lyon, France.
Kidney Int. 1993 May;43(5):1086-90. doi: 10.1038/ki.1993.152.
This study was conducted in eight acute renal failure patients undergoing mechanical ventilation to test if the addition of glucose in the dialysate prevents metabolic and hormonal changes induced by hemodialysis. Hemodialysis was performed with a bicarbonate dialysate, a polyacrilonitrile membrane and a continuous heparinization. Two four-hour hemodialysis sessions were performed in each patient: one without glucose (GFD) and one with glucose (GD) in the dialysate at a concentration close to each patient's initial plasma glucose concentration. Oxygen consumption and carbon dioxide elimination, glucose insulin, aceto-acetate and free fatty acids were measured before, during and after the sessions. Oxygen consumption and carbon dioxide elimination were measured with a system using a mass spectrometer. Hemodynamic state and temperature remained constant. Before hemodialysis, respiratory quotient (RQ) values were the same in both groups. There was no change in RQ during GD. There was a decrease in RQ during GFD. Glucose and insulin concentrations decreased during GFD and remained unchanged during GD. Aceto-acetate concentration remained constant under both conditions. Free fatty acids concentration increased to the same extent during GD and GFD. The authors conclude that the addition of glucose in the dialysate prevents the decrease in RQ induced by hemodialysis. This effect is most likely related to a decreased mobilization of non-glucidic fuels.
本研究对8例接受机械通气的急性肾衰竭患者进行，以测试在透析液中添加葡萄糖是否能预防血液透析引起的代谢和激素变化。采用碳酸氢盐透析液、聚丙烯腈膜和持续肝素化进行血液透析。每位患者进行两次4小时的血液透析：一次透析液中不添加葡萄糖（GFD），另一次透析液中添加葡萄糖（GD），葡萄糖浓度接近每位患者的初始血浆葡萄糖浓度。在透析前、透析期间和透析后测量耗氧量、二氧化碳排出量、葡萄糖、胰岛素、乙酰乙酸和游离脂肪酸。使用质谱仪系统测量耗氧量和二氧化碳排出量。血流动力学状态和体温保持恒定。血液透析前，两组的呼吸商（RQ）值相同。在GD期间RQ没有变化。在GFD期间RQ降低。在GFD期间葡萄糖和胰岛素浓度降低，在GD期间保持不变。在两种情况下乙酰乙酸浓度均保持恒定。在GD和GFD期间游离脂肪酸浓度升高幅度相同。作者得出结论，在透析液中添加葡萄糖可预防血液透析引起的RQ降低。这种作用很可能与非糖质燃料动员减少有关。
