Body temperature regulation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription?
Body temperature regulation during hemodialysis in long-term patients: is it time to change dialysate temperature prescription?
复制标题
长期患者血液透析期间的体温调节：是时候改变透析液温度处方了吗？
DOI：
10.1053/j.ajkd.2004.03.036
复制
发表时间：
2004
期刊：
影响因子：
--
通讯作者：
Johnson,JohnM
中科院分区：
文献类型：
--
作者：
Pérgola,PabloE;Habiba,NusrathM;Johnson,JohnM
在血液透析过程中，透析液温度的变化可能会升高或降低体温，因为血液与透析液处于热平衡状态返回患者体内。即使透析液温度等于从鼓膜、口腔或腋窝测得的患者体温，也可能导致患者体温升高，导致皮肤血管舒张以及心血管不稳定和低血压的可能性。通过适当调节透析液温度可以防止这种有害的循环。将透析液温度从37°C降低到34-35.5°C改善了许多血液透析患者的心血管稳定性。连续监测血液温度允许医生预先改变透析液温度，因为体温的微小变化可能会对心血管产生巨大影响。例如，只有0.3°C到0.8°C将皮肤血管舒张的阈值与颤抖的阈值分开。建议对血液透析程序进行改进，使用能够连续监测动脉和静脉血液温度并自动调节透析液温度的器械，使患者而非透析液保持等温。不太理想的解决方案似乎是（1）监测动脉和静脉温度，同时手动调节透析液温度以维持动脉温度，（以及因此身体）温度稳定性;（2）监测外周温度（口腔、鼓膜），并调节透析液温度以保持体温恒定;（3）所有患者常规使用透析液温度<37.0°C，除非禁忌。
During hemodialysis procedures, changes in the dialysate temperature can raise or lower body temperature because the blood is returned to the patient in thermal equilibrium with the dialysate. Even a dialysate temperature equal to the patient’s body temperature as measured from the tympanic membrane, oral cavity, or axilla can result in an increase in the patient’s body temperature, leading to cutaneous vasodilation and the potential for cardiovascular instability and hypotension. This deleterious cycle of events can be prevented by suitably adjusting the dialysate temperature. Lowering the dialysate temperature from 37°C to 34–35.5°C has improved the cardiovascular stability of many hemodialysis patients. Continuous monitoring of blood temperature allows the practitioner to make preemptive changes in dialysate temperature because a small change in body temperature can have enormous cardiovascular implications. For example, only 0.3°C to 0.8°C separates the thresholds for skin vasodilation from that for shivering. A suggested improvement in the hemodialysis procedure is to use devices that allow continuous monitoring of arterial and venous blood temperatures and adjust the dialysate temperature automatically, keeping the patient, not the dialysate, isothermic. Less optimal solutions appear to be (1) to monitor arterial and venous temperatures while manually adjusting the dialysate temperature to maintain arterial (and hence body) temperature stability; (2) to monitor peripheral temperatures (oral, tympanic) at regular intervals and adjust dialysate temperature to maintain the body temperature constant; (3) routinely use a dialysate temperature <37.0°C in all patients unless contraindicated.