肾综合征出血热患者血液透析前后的血液流变性及甲襞微循环变化

Hemorheologic and nailfold microcirculatory changes after haemodialysis in patients with hemorrhagic fever with renal syndrome

目的 探讨肾综合征出血热 (HFRS)合并急性肾功衰竭 (ARF)患者血液透析 (HD)前后的血液流变性及甲襞微循环的变化规律 .方法 采用瑞典 Gambro公司生产的 AK-10型血液透析机治疗患者 45例 ,血液流变学及甲襞微循环指标分别采用成都仪器厂的 NXE- 1型锥板式粘度计和徐州光学仪器厂的 MX- 75 3B微循环显微镜检测 ,所得数据按田牛氏综合定量评价方法 ,计算综合加权积分值 .结果 HD前后患者血中 BUN,Cr均有明显下降 (P<0 .0 1) ,β2 - MG及血清钾也有下降 (P<0 .0 5 ) ;全血粘度随切变率的增加而降低 ,HCT明显升高 ,红细胞聚集指数 (RAI)、红细胞刚性指数(IR)、血沉 (ESR)、血沉方程 K值 (K)、红细胞电泳时间(EET)均有显著变化 (P<0 .0 1) ,Casson屈服值亦有显著差异 (P<0 .0 5 ) ;甲襞微循环评价指标中 ,微血管形态及微血流流态均有明显好转 ,总积分值变化明显 (P<0 .0 1) .结论 HD治疗前后患者肾功能障碍及电解质紊乱均有明显好转 ,血液流变学及甲襞微循环指标获得显著改善 ,但仍有 6 0 .0 %以上的指标未达到正常标准 .

AIM To investigate the changes of hemorheologyand nailfold mircrocirculation after haemodialysis in hemorrhagic fever with renal syndrome (HFRS) complicated with acute renal failure (ARF). METHODS Indexes of hemorheology and nailfold microcirculation of 45 cases treated with haemodialysis were mearsured using cone and plate viscometer and microcirculation microscope, and analyzed by the Tian-Niu's comprehensive quantitative evaluation method. RESULTS Quantity of serum BUN, Cr decreased significantly as compared with that of pre-haemodialysis ( P < 0.01 ); β 2-MG, K + also decreased ( P <0.05); blood viscosity decreased with the elevation of the rate of shear. Statistical significance was also found in the hemorheologic indexes, such as RAI, IR, ESR, K +, EET and Casson yield stress. Microvessel morphological characteristics and blood flow shape were greatly improved ( P <0.01). CONCLUSION After haemodialysis, renal failure and electrolytical turbulence might obviously be corrected, and indexes of hemorheology and nailfold microcirculation, accordingly, can be significantly improved, but more than 60% index may remain abnormal.