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首页> 外文期刊>Artificial Organs >Changes in Vascular Tone Occur Early During Hemodialysis Treatments Independently of Volume Reduction
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Changes in Vascular Tone Occur Early During Hemodialysis Treatments Independently of Volume Reduction

机译：血液透析治疗早期血管紧张的变化与体积减少无关

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摘要

Hypotension commonly occurs during hemodialysis (HD). Hypotension can result from an absolute reduction in plasma volume following excessive ultrafiltration or from a reduction in vascular tone. We hypothesized that changes in vascular tone could occur during dialysis. Aortic pulse wave velocity (aPWV) was measured in 197 HD patients, mean age 63.3 +/- 16.6 years, 62% male, 49% diabetic, during a single HD session. aPWV did not change (9.6 +/- 2.2 vs. 9.6 +/- 2.2m/s) with HD. Systolic blood pressure (SBP) declined from 151 +/- 31 to 147 +/- 32 after 20min and to 140 +/- 36mmHg on completion of HD (P<0.05), with an ultrafiltration volume of 2.2 +/- 0.9L over a 3.9 +/- 0.4h HD session. Aortic SBP declined from 154 +/- 32 to 146 +/- 29 after 20min and 143 +/- 35 at the end of HD, P<0.001. Aortic augmentation index (Aortic Aix) decreased from 65% (52-79%) to 36.7% (23.3-52.9%) by 20min and to 34.3 (15.1-49.1%) on completion of HD (P<0.05), and brachial augmentation index (brachial Aix) from 5.7% (-25.2 to 27.5%) to -1.9% (-2.2 to 30.1%) and -6.6% (-44 to 22.7%), respectively, P<0.05. Diastolic reflection area (DRA) increased from 36.7 (27.9-46.3) to 40.4 (32.2-51) after 20min and 47.1 (34.2-60.5) on completion of HD, P<0.05. We report changes in arterial tone within 20min of starting HD, when minimal ultrafiltration has occurred, suggesting that volume changes may not be the only predisposing cause of intradialytic hypotension. The combination of a fall in SBP and a rise in DRA would suggest a reduction in coronary blood flow in keeping with reports of myocardial stunning during HD.
机译：低血压通常发生在血液透析（HD）期间。低血压可能是由于过度超滤后血浆容量的绝对减少或血管张力的降低引起的。我们假设透析过程中可能发生血管张力的变化。在一次HD期间，对197名HD患者进行了主动脉脉搏波速度（aPWV）测量，平均年龄63.3 +/- 16.6岁，男性为62％，糖尿病为49％。 HD的aPWV不变（9.6 +/- 2.2 vs. 9.6 +/- 2.2m / s）。收缩压（SBP）在20分钟后从151 +/- 31降至147 +/- 32，在HD完成时降至140 +/- 36mmHg（P <0.05），超滤量为2.2 +/- 0.9L 3.9 +/- 0.4h HD会话。主动脉SBP在20分钟后从154 +/- 32下降到146 +/- 29，在HD结束时下降到143 +/- 35，P <0.001。 HD（P <0.05）和肱动脉完全扩张完成20分钟后，主动脉扩张指数（Aortic Aix）从65％（52-79％）降至36.7％（23.3-52.9％），降至34.3（15.1-49.1％）指数（肱Aix）分别从5.7％（-25.2至27.5％）至-1.9％（-2.2至30.1％）和-6.6％（-44至22.7％），P <0.05。舒张反射面积（DRA）在20分钟后从36.7（27.9-46.3）增加到40.4（32.2-51），在HD结束时从47.1（34.2-60.5）增加，P <0.05。我们报道在开始HD的20分钟内发生最小超滤时动脉张力发生变化，这表明体积变化可能不是透析内低血压的唯一诱因。 SBP下降和DRA上升相结合，表明冠状动脉血流量减少，与HD期间心肌电击的报道一致。

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