血液透析时的低氧血症

The hypoxemia during the time of hemodialysis

研究目的探讨血液透析时低氧血症(HXA)的原因及防治措施。研究方法终末肾衰维持性血液透析(HD)患者14例(男女各7例)。HD5h/次,2次/周。透析液醋酸盐含量35mmol/L,或碳酸盐含量35mmol/L。所有患者先行醋酸盐透析(AD),后随机选7例同时吸氧,2～3L/min(AD+O_2组),再随机抽6例改用碳酸盐透析(BD)。每次HD第1、2和5小时分别从血路动脉端取血1ml,测PO_2及PCO_2。结果和结论 AD整个过程存在HXA,第1小时最明显。同时吸氧或改用BD则可避免HXA。PO_2与PCO_2呈显著正相关(r=0.74,P<0.05)。同步监测透析器前后血气发现,AD透析器后PCO_2、HCO_3^-显著下降(P<0.01),BD透析器后PCO_2、HCO_3^-反而上升(P<0.05)。提示AD时HXA与CO_2大量从透析器丢失有关。

Objective To search for the reasons and preventive methods of hypoxemia (HXA) during the time of hemodialysis. Methods There are 14 patients (7 males and 7 females) with terminal renal failure who are carried out hemodialysis (HD). HD 5h every time, two times in a week. The acetate content in dialysate is 35 mmol / L, and the carbonate 35 mmol / L too. At first, acetate dialysis (AD) was carried out in all of the patients. The second, oxygen inhalation (2L- 3L / min) in 7 patients who were randomly selected from all of the patients, At last, carbonate dialysis (BD) instead of AD was carried out in 6 patients who were randomly selected from all the patients. Every time HD of 1st , 2nd and 5th, 1ml blood was drown respectively from the end of artery of blood pass so that PO2 and PCO2will be tested. Results and Conclusions HXA exists in the course of AD and ti's clearest at the first hour. Oxygen inhalation or BD instead of AD can avoid HXA. There is positive correlation between PO2and PCO2(r = 0.74, P<0.05). Sychronizing surveillance of blood gas in front of and behind dialyzer shows that PCO2 and HCO3- are obviously decreased behind AD dialyzer (P<0.01) and increased behind BD dialyzer (P<0.05). It's suggested that the HXA during the time of HD should be related to loss of CO2 from dialyzer.