EXPERIMENTAL DIALYSIS DISEQUILIBRIUM SYNDROME - PREVENTION WITH GLYCEROL
EXPERIMENTAL DIALYSIS DISEQUILIBRIUM SYNDROME - PREVENTION WITH GLYCEROL
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DOI：
10.1038/ki.1978.119
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发表时间：
1978-01-01
影响因子：
19.6
通讯作者：
GUISADO, R
中科院分区：
文献类型：
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作者：
ARIEFF, AI;LAZAROWITZ, VC;GUISADO, R
接受血液透析治疗的肾衰竭患者可能会出现以头痛、烦躁、恶心和呕吐为特征的临床综合征，并可能进展为癫痫发作和昏迷。这种综合征的实验模型称为透析不平衡综合征 (DDS)，可以通过对尿毒症犬进行快速血液透析（BUN [血尿氮]，200 mg/dl；肌酐，11 mg/dl）来诱导。在实验模型中，接受快速透析治疗的狗出现了脑-血浆渗透压梯度，导致脑水肿。脑脊液 (CSF) 和大脑皮层细胞内 pH (pHi) 的 pH 值也下降，并且脑电图异常。脑水肿的特征是大脑皮质组织中渗透压含量增加。渗透压含量的增加与大脑中钠、钾、氯、尿素或乳酸的保留无关，而是由于未确定的溶质（特异渗透压）所致。当通过向透析液中添加甘露醇（血浆甘露醇，26 mM）来改进透析时，没有发生脑水肿，并且防止了脑pHi的下降。然而，脑电图仍然异常，脑脊液 pH 值下降。当透析液中添加甘油（血浆甘油，26 mM）进行透析时，未发生脑水肿，脑 pHi 和脑脊液 pH 正常，脑电图改善至正常。用透析液中的甘露醇或甘油进行透析后，大脑中不存在特有渗透压。消除大脑 pHi 的下降似乎可以阻止大脑皮层特有渗透压的形成。因此，透析液中添加甘露醇可部分预防 DDS。然而，甘油不仅阻止了 DDS 的所有表现，而且使脑电图恢复到正常模式。甘油可能是预防人类 DDS 的有用药物。
Patients with renal failure being treated with hemodialysis may develop a clinical syndrome characterized by headache, restlessness, nausea and emesis, which may progress to seizures and coma. An experimental model of this syndrome, called dialysis disequilibrium syndrome (DDS), can be induced by rapid hemodialysis of uremic dogs (BUN [blood urinary nitrogen], 200 mg/dl; creatinine, 11 mg/dl). In the experimental model, dogs treated with rapid dialysis developed a brain-to-plasma osmotic gradient which resulted in cerebral edema. There was also a fall in both pH of cerebrospinal fluid (CSF) and intracellular pH (pHi) of cerebral cortex and an abnormal EEG. The cerebral edema was characterized by an increased osmole content in cerebral cortex tissue. The increased osmole content was not related to retention in brain of Na, K, Cl, urea or lactate, but was due to undetermined solute (idiogenic osmoles). When dialysis was modified by the addition of mannitol to the dialysate (plasma mannitol, 26 mM), brain edema did not occur, and the fall in brain pHi was prevented. The EEG, however, remained abnormal and the pH of CSF fell. When dialysis was modified by adding glycerol to the dialysate (plasma glycerol, 26 mM), brain edema did not occur, brain pHi and the pH of CSF were normal and the EEG improved towards normal. After dialysis with either mannitol or glycerol in the dialysate, idiogenic osmoles were not present in the brain. Eliminating the fall in brain pHi appeared to prevent the formation of idiogenic osmoles by cerebral cortex. Thus, DDS was partially prevented by mannitol added to the dialysate. Glycerol, however, not only prevented all the manifestation of DDS but also restored the EEG to a normal pattern. Glycerol may be a useful agent for prevention of DDS in man.