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首页> 外文期刊>Critical care : >Microcirculatory changes and skeletal muscle oxygenation measured at rest by non-infrared spectroscopy in patients with and without diabetes undergoing haemodialysis
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Microcirculatory changes and skeletal muscle oxygenation measured at rest by non-infrared spectroscopy in patients with and without diabetes undergoing haemodialysis

机译：用非红外光谱法对患有和不患有糖尿病的糖尿病患者进行血液透析时的微循环变化和骨骼肌氧合作用

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IntroductionHaemodialysis has direct and indirect effects on skin and muscle microcirculatory regulation that are severe enough to worsen tolerance to physical exercise and muscle asthenia in patients undergoing dialysis, thus compromising patients' quality of life and increasing the risk of mortality. In diabetes these circumstances are further complicated, leading to an approximately sixfold increase in the incidence of critical limb ischaemia and amputation. Our aim in this study was to investigate in vivo whether haemodialysis induces major changes in skeletal muscle oxygenation and blood flow, microvascular compliance and tissue metabolic rate in patients with and without diabetes.MethodsThe study included 20 consecutive patients with and without diabetes undergoing haemodialysis at Sant Andrea University Hospital, Rome from March to April 2007. Near-infrared spectroscopy (NIRS) quantitative measurements of tissue haemoglobin concentrations in oxygenated [HbO2] and deoxygenated forms [HHb] were obtained in the calf once hourly for 4 hours during dialysis. Consecutive venous occlusions allowed one to obtain muscular blood flow (mBF), microvascular compliance and muscle oxygen consumption (mVO2). The tissue oxygen saturation (StO2) and content (CtO2) as well as the microvascular bed volume were derived from the haemoglobin concentration. Nonparametric tests were used to compare data within each group and among the groups and with a group of 22 matched healthy controls.ResultsThe total haemoglobin concentration and [HHb] increased significantly during dialysis in patients without and with diabetes. Only in patients with diabetes, dialysis involved a [HbO2], CtO2 and increase but left mVO2 unchanged. Multiple regression StO2 analysis disclosed a significant direct correlation of StO2 with HbO2 and an inverse correlation with mVO2. Dialysis increased mBF only in diabetic patients. Microvascular compliance decreased rapidly and significantly during the first hour of dialysis in both groups.ConclusionsOur NIRS findings suggest that haemodialysis in subjects at rest brings about major changes in skeletal muscle oxygenation, blood flow, microvascular compliance and tissue metabolic rate. These changes differ in patients with and without diabetes. In all patients haemodialysis induces changes in tissue haemoglobin concentrations and microvascular compliance, whereas in patients with diabetes it alters tissue blood flow, tissue oxygenation (CtO2, [HbO2]) and the metabolic rate (mVO2). In these patients the mVO2 is correlated to the blood supply. The effects of haemodialysis on cell damage remain to be clarified. The absence of StO2 changes is probably linked to an opposite [HbO2] and mVO2 pattern.
机译：简介血液透析对皮肤和肌肉的微循环调节具有直接和间接的影响，严重到足以使接受透析的患者对体育锻炼和肌肉衰弱的耐受性降低，从而损害患者的生活质量并增加死亡风险。在糖尿病中，这些情况更加复杂，导致严重肢体缺血和截肢的发生率增加约六倍。本研究的目的是在体内研究血液透析是否会导致糖尿病患者和非糖尿病患者的骨骼肌氧合和血流量，微血管顺应性以及组织代谢率发生重大变化。罗马安德里亚大学医院（Andrea University Hospital），罗马，从2007年3月至4月。在透析过程中，每小时从小腿中每小时一次获得小牛中含氧[HbO2]和脱氧形式[HHb]中组织血红蛋白浓度的近红外光谱（NIRS）定量测量。连续静脉阻塞使人可以获得肌肉血流量（mBF），微血管顺应性和肌肉耗氧量（mVO2）。组织血氧饱和度（StO2）和含量（CtO2）以及微血管床体积均来自血红蛋白浓度。使用非参数测试比较各组之间以及各组之间以及与22位匹配的健康对照组之间的数据。结果在无糖尿病和无糖尿病患者的透析过程中，总血红蛋白浓度和[HHb]显着增加。仅在糖尿病患者中，透析涉及[HbO2]，CtO2和升高，但mVO2保持不变。多元回归StO2分析揭示了StO2与HbO2的显着直接相关性与与mVO2的反相关性。透析仅在糖尿病患者中增加mBF。两组在透析的第一小时内，微血管顺应性迅速且显着下降。结论我们的NIRS结果表明，静息受试者的血液透析会引起骨骼肌氧合，血流，微血管顺应性和组织代谢率发生重大变化。这些变化在有和没有糖尿病的患者中有所不同。在所有患者中，血液透析都会引起组织血红蛋白浓度和微血管顺应性的变化，而在糖尿病患者中，血液透析会改变组织的血流量，组织氧合（CtO2，[HbO2]）和代谢率（mVO2）。在这些患者中，mVO2与血液供应相关。血液透析对细胞损伤的影响尚待阐明。没有StO2变化可能与[HbO2]和mVO2模式相反。

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