Tissue ischemia worsens during hemodialysis in end-stage renal disease patients
Tissue ischemia worsens during hemodialysis in end-stage renal disease patients
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DOI：
10.5301/jva.5000630
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发表时间：
2017-01-01
影响因子：
1.9
通讯作者：
Tesar, Vladimir
中科院分区：
文献类型：
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作者：
Malik, Jan;Kudlicka, Jaroslav;Tesar, Vladimir
背景：认知功能障碍是终末期肾病（ESRD）患者的常见问题。超滤和血液透析导致了深刻的血液动力学变化。本试验的目的是描述脑和手氧合值在终末期肾病患者和他们的变化在hemodialys.Methods：27例慢性血液透析治疗和17例对照组患者的同龄人被纳入本研究。使用INVOS 5100 C测量大脑额叶和具有透析通路的手部的局部氧饱和度（SrO 2）。在17例ESRD患者中，在整个血液透析过程中还监测了SrO 2。结果：透析患者在休息时脑和手的SrO 2值较低（分别为51.5 +/- 10.9 vs. 68 +/-7%，p< 0.0001和55 +/- 16 vs. 66 +/-8%，p = 0.03）。在血液透析的前35分钟内，这两个值进一步降低（脑SrO 2分别降至47 +/-8%，p< 0.0001，手SrO 2降至45 +/-14%，p< 0.0001）。脑SrO 2下降与超滤率有关，手SrO 2下降与指压和血红蛋白有关。结论：慢性血液透析患者存在组织缺血，血液透析开始后组织缺血更甚。这一观察结果可能有助于理解认知缺陷的病因。
Background: Cognitive deficit is a common problem in end-stage renal disease (ESRD) patients. Ultrafiltration and hemodialysis lead to profound hemodynamic changes. The aim of this pilot study was to describe brain and hand oxygenation values in ESRD patients and their changes during hemodialysis.Methods: Twenty-seven patients treated by chronic hemodialysis and 17 controls patients of the same age were included in the study. Regional saturation of oxygen (SrO2) was measured at the brain frontal lobe and at the hand with dialysis access using the INVOS 5100C. In 17 of ESRD patients, SrO2 was also monitored throughout hemodialysis. Finger systolic blood pressure and basic hemodialysis and laboratory data were collected.Results: Dialysis patients had lower brain and also hand SrO2 values at rest (51.5 +/- 10.9 vs. 68 +/- 7%, p< 0.0001 and 55 +/- 16 vs. 66 +/- 8%, p = 0.03, respectively). Both values further decreased during the first 35 minutes of hemodialysis (brain SrO2 to 47 +/- 8%, p< 0.0001 and hand to 45 +/- 14%, p< 0.0001, respectively). The brain SrO2 decrease was related to the ultrafiltration rate, the hand SrO2 decrease to the finger pressure and to blood hemoglobin. Conclusions: Chronic dialysis patients suffer from tissue ischemia and that even worsens after the beginning of hemodialysis. This observation may contribute to the understanding of cognitive deficit etiology.