van Kuijk W H, Luik A J, de Leeuw P W, van Hooff J P, Nieman F H, Habets H M, Leunissen K M
Department of Nephrology, University Hospital Maastricht, The Netherlands.
Nephrol Dial Transplant. 1995 Oct;10(10):1852-8.
The present study was performed to assess the role of the extracorporeal blood temperature in the disparate cardiovascular response between isolated ultrafiltration and combined ultrafiltration-haemodialysis.
In twelve stable dialysis patients (21-77 years), blood pressure and heart rate (Finapres) as well as forearm vascular resistance and venous tone (strain-gauge plethysmography) were measured during 1-h isolated ultrafiltration and 1-h combined ultrafiltration-haemodialysis (bicarbonate, sodium 141 mmol/l) at a fixed ultrafiltration rate of 0.91 l/h. The sequence of both treatment modalities was randomly defined within each patient. Serving as his or her own control, each patient was studied at two different dialysate temperatures: 37.5 and 35.0 degrees C.
At a dialysate temperature of 35.0 degrees C extracorporeal blood cooling during combined ultrafiltration-haemodialysis was comparable to isolated ultrafiltration. The cardiovascular response in isolated ultrafiltration was characterized by a significant increase in both forearm vascular resistance and venous tone, while heart rate even decreased. As a result, blood pressure remained unchanged or even increased. In contrast, during combined ultrafiltration-haemodialysis at a dialysate temperature of 37.5 degrees C the increase in forearm vascular resistance was only small and insignificant, while venous tone decreased significantly. Heart rate tended to increase. Combined ultrafiltration-haemodialysis at a dialysate temperature of 35.0 degrees C was also associated with a small increase in forearm vascular resistance. However, venous tone remained stable while heart rate decreased. At both dialysate temperatures, blood pressure was well maintained.
We conclude that differences in cardiovascular reactivity between isolated ultrafiltration and combined ultrafiltration-haemodialysis are only partially explained by differences in the extracorporeal blood temperature. In addition, especially venous reactivity is improved by lowering the dialysate temperature.
本研究旨在评估体外血液温度在单纯超滤与超滤 - 血液透析联合治疗时不同心血管反应中的作用。
对12例稳定的透析患者（年龄21 - 77岁），在以0.91升/小时的固定超滤速率进行1小时单纯超滤和1小时超滤 - 血液透析联合治疗（碳酸氢盐，钠浓度141 mmol/l）期间，测量血压和心率（Finapres）以及前臂血管阻力和静脉张力（应变片体积描记法）。每种治疗方式的顺序在每位患者体内随机确定。每位患者在两种不同的透析液温度下进行研究，即37.5℃和35.0℃，以自身作为对照。
在透析液温度为35.0℃时，超滤 - 血液透析联合治疗期间的体外血液冷却与单纯超滤相当。单纯超滤时的心血管反应表现为前臂血管阻力和静脉张力均显著增加，而心率甚至下降。结果，血压保持不变甚至升高。相比之下，在透析液温度为37.5℃的超滤 - 血液透析联合治疗期间，前臂血管阻力的增加很小且不显著，而静脉张力显著下降。心率有增加趋势。在透析液温度为35.0℃的超滤 - 血液透析联合治疗也与前臂血管阻力的小幅增加有关。然而，静脉张力保持稳定，而心率下降。在两种透析液温度下，血压均维持良好。
我们得出结论，单纯超滤与超滤 - 血液透析联合治疗之间心血管反应性的差异仅部分由体外血液温度的差异所解释。此外，降低透析液温度尤其能改善静脉反应性。
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