快速血液透析对心肺功能影响的实验研究

Experimental study on the effect of rapid hemodialysis on cardiac and pulmonary function

目的 探讨快速血液透析对心肺功能的影响及其发生机制。方法 采用急性肾功能衰竭的动物模型 ,观察快速血液透析对心功能、肺血管压力指标、肺组织水含量和肺组织学的影响。结果 快速血液透析使血浆尿素氮水平迅速下降 ,形成肺 /血浆浓度梯度 ,使肺组织水含量明显增加 ,形成肺淤血、肺水肿。透析后肺血管压力参数PAP、PCWP、RAP、RVP、TPRI、CVP逐渐增高 (P <0 .0 5 ) ,显示肺血管阻力增加和肺瘀血。心脏指数 (SI)和每博指数 (CI)下降 (P <0 .0 5 )显示心功能下降 ;肺水肿指数和肺干湿比值均提示肺含水量增多 ,透析后犬肺部X线和组织病理检查显示肺瘀血。结论 快速血液透析引起的血浆尿素氮快速下降可以导致肺淤血、肺水肿 ,其机制主要是尿素反向渗透效应。

Objectives To explore the effect and the underlying mechanisms of rapid hemodialysis on cardiac and pulmonary function. Methods Water content in the lung tissue, indexes of pulmonary vascular pressure, and pathological changes of lung tissue were evaluated after hemodialysis in animals with experimental acute renal failure. Results Plasma levels of urea nitrogen, creatinine and osmotic pressure were decreased rapidly and significantly after rapid hemodialysis, and consequently an increase of water content in lung lead to pulmonary congestion a nd edema.There were also statistically significant changes(P<0.05) among pre and posthemodialysis as for RAP (10.80±3.08)mmHg vs (17.90±4.89)mm Hg, PCWP(-1.30±1.95)mmHg vs (17.90±4.46)mmHg, RVP(7.10±2.85) mmHg vs (18.3 2±3.95)mmHg, PAP (10.80±3.08)mmHg vs (17.90±4.89)mmHg, CVP(0.50±1.65)cmH 2O vs (1.3 0±2.00) cmH2O),TPRI (2.25±0.37)u·m2 vs (2.83±0.63)u·m2) and CI (5.21±0. 92)L/min vs (3.89±0.93)L/min, SI(0.041±0.009)L/min vs (0.025±0.007) L/min). Pu lmonary congestion was evidenced with chest X-ray photography, determ ination of water content of the lung tissue, index of pulmonary edema and patho logical examination of the lung. Conclusions The result of the study suggest that, the rapid he modialysis can induce pulmonary congestion and edema and acute heart failure in ARF patients. Its underlying mechanism might be associated with reverse urea e ffect which is due to the formation of lung/plasma osmotic gradient, and ultimat ely water in plasma permeating into lung tissue.