Cirit M, Akçiçek F, Terzioğlu E, Soydaş C, Ok E, Ozbaşli C F, Başçi A, Mees E J
Division of Nephrology, Ege University School of Medicine, Bornova, Izmir, Turkey.
Nephrol Dial Transplant. 1995;10(8):1417-20.
In some hypertensive haemodialysis (HD) patients, blood pressure rises further during ultrafiltration (UF). We investigated seven such patients, who were not responsive to hypotensive drugs, including converting enzyme inhibitors. All had marked cardiac dilatation, but most were non-oedematous. They were treated with repeated intense UF while monitoring cardiac function by echocardiography. After a variable time period they all became (near) normotensive without medication. Mean systolic and diastolic blood pressure decreased by 46 +/- 18 and 22 +/- 9 mmHg respectively while bodyweight decreased by a mean of 6.7 +/- 3.0 kg. Plasma volume decreased by 22%, and mean albumin increased from 3.9 +/- 0.3 to 4.2 +/- 0.3 g/dl. Cardiothoracic index decreased from a 0.56 +/- 0.02 to 0.45 +/- 0.03. Mitral and tricuspid insufficiency was present in four patients and improved or disappeared in all of them. Diameters of the inferior vena cava, left atrium, and end systolic and diastolic left ventricle markedly decreased in all patients. Ejection fraction increased, but remained subnormal in some patients, while cardiac output increased in five and decreased in two patients. We conclude that paradoxical blood pressure rise with UF usually occurs in the presence overhydration and cardiac dilatation and should be treated by intensified UF. The explanation of this phenomenon remains speculative.
在一些高血压血液透析（HD）患者中，超滤（UF）过程中血压会进一步升高。我们对7例此类患者进行了研究，他们对包括转换酶抑制剂在内的降压药物均无反应。所有患者均有明显的心脏扩大，但大多数无水肿。在通过超声心动图监测心脏功能的同时，对他们进行反复强化超滤治疗。经过不同时间段后，他们在未用药的情况下均（接近）血压正常。平均收缩压和舒张压分别下降了46±18 mmHg和22±9 mmHg，而体重平均下降了6.7±3.0 kg。血浆容量下降了22%，平均白蛋白从3.9±0.3 g/dl增加到4.2±0.3 g/dl。心胸指数从0.56±0.02降至0.45±0.03。4例患者存在二尖瓣和三尖瓣关闭不全，所有患者的此类情况均有所改善或消失。所有患者的下腔静脉、左心房以及左心室收缩末期和舒张末期直径均明显减小。射血分数增加，但部分患者仍低于正常水平，5例患者的心输出量增加，2例患者的心输出量减少。我们得出结论，超滤时出现的反常血压升高通常发生在水过多和心脏扩大的情况下，应通过强化超滤进行治疗。这种现象的解释仍属推测。
