Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients
Hemodialysis causes severe orthostatic reduction in cerebral blood flow velocity in diabetic patients
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DOI：
10.1016/s0272-6386(99)70016-8
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发表时间：
1999-12-01
影响因子：
13.2
通讯作者：
Fujishima, M
中科院分区：
文献类型：
--
作者：
Ishida, I;Hirakata, H;Fujishima, M
在接受血液透析（HD）的糖尿病患者中，体位性低血压是一个严重的问题。为了评估DM患者直立时的脑循环，我们使用经颅多普勒超声检查了DM患者（6名男性，2名女性，年龄57 +/- 3岁[平均-/+ SEM]； HD持续时间47 +/- 27个月）在碳酸氢盐HD前后60度仰卧5分钟时大脑中动脉（VMCA）平均血流速度的变化。研究结果与在HD患者非糖尿病(non-DM; 12人,5名妇女,年龄、47 + / - 3年,高清持续时间、82 + / - 23个月),意味着血压(MBP)在仰卧位,比容(Hct),血浆纤维蛋白原和体积的液体被高清两组之间没有显著差异(MBP, 106 + / - 6和103 + / - 4毫米汞柱,Hct, 26% + / - 1%和28% + / - 1%,纤维蛋白原,355 + / - 37和357 + / - 27 mg / dL,液体,2.5 + / - 0.2和2.3 + / - 0.2 L)。比较HD前后两组倾斜时VMCA的变化百分比（%VMCA）。在HD之前，只有DM患者的MBP在倾斜时明显下降到93 +/- 5 mm Hg， DM患者的MBP下降程度为-13 +/- 2 mm Hg，非DM患者的MBP下降程度为-2 +/- 2 mm Hg (P < 0.01)， VMCA在倾斜时同样下降；DM, -12% + / - 3%,非DM, -12% + / - 2%,高清后;糖尿病患者的MBP下降了36 +/- 7 mm Hg，明显大于HD前。两组HD后VMCA均下降，DM组VMCA %（-32% +/- 5%）显著高于HD前（P < 0.01），非DM组VMCA % （-13% +/- 2%, P < 0.01）与HD后两组MBP倾斜变化率百分比呈正相关（DM, r = 0.87, P < 0.01；非DM， r = 0.61, P < 0.01）。我们的研究结果显示，尽管两组患者低血压水平不同，但HD前两组患者的等量倾斜时脑血流速度明显下降，而HD后DM患者的脑血流速度下降和MBP下降更为明显。因此，直立可引起HD后血流动力学介导的脑损伤，特别是糖尿病患者。(C) 1999年由国家肾脏基金会，Inc。
Orthostatic hypotension is a serious problem in patients with diabetes mellitus (DM) undergoing hemodialysis (HD). To evaluate cerebral circulation during orthostasis in patients with DM, we examined changes in mean blood flow velocity in the middle cerebral artery (VMCA) during 60 degrees head-up tilt for 5 minutes in patients with DM (six men, two women; age, 57 +/- 3 years [mean -/+ SEM]; HD duration, 47 +/- 27 months) before and after bicarbonate HD by using transcranial Doppler sonography. The findings were compared with those in HD patients without diabetes (non-DM; 12 men, 5 women; age, 47 +/- 3 years; HD duration, 82 +/- 23 months), Mean blood pressure (MBP) in the supine position, hematocrit (Hct), plasma fibrinogen, and volume of fluid removed by HD were not significantly different between the two groups (MBP, 106 +/- 6 versus 103 +/- 4 mm Hg; Hct, 26% +/- 1% versus 28% +/- 1%; fibrinogen, 355 +/- 37 versus 357 +/- 27 mg/dL; fluid, 2.5 +/- 0.2 versus 2.3 +/- 0.2 L). Percentage of change in VMCA (%VMCA) during tilt was compared between the groups before and after HD. Before HD, MBP decreased significantly to 93 +/- 5 mm Hg during tilt only in patients with DM, The degree of MBP reduction was -13 +/- 2 mm Hg in DM and -2 +/- 2 mm Hg in non-DM patients (P < 0.01), %VMCA equally decreased during tilt; DM, -12% +/- 3%, and non DM, -12% +/- 2%, After HD; MBP decreased by 36 +/- 7 mm Hg in patients with DM, which was significantly greater than before HD. VMCA also decreased In both groups after HD, and %VMCA in DM (-32% +/- 5%) was significantly greater than before HD (P < 0.01) and in non-DM patients (-13% +/- 2%; P < 0.01), %VMCA positively correlated with the percentage of change ratio of MBP during tilt in both groups after HD (DM, r = 0.87, P < 0.01; non-DM, r = 0.61, P < 0.01). Our results showed a significant decrease in cerebral blood flow velocity during tilt of equal magnitude in both groups before HD despite differences in the level of hypotension, whereas reduction in cerebral blood flow velocity and decrease in MBP were more marked in DM after HD. Orthostasis could thus cause hemodynamically mediated brain damage after HD, especially in patients with DM. (C) 1999 by the National Kidney Foundation, Inc.