线性可调碳酸氢根离子血液透析对血气的影响

Effects of linear regulating bicarbonate ion hemodiotysis on blood gas

目的 观察不同浓度的碳酸氢根离子透析液对维持性血液透析患者血气的影响。方法 对我院32例维持性血液透析患者分别以普通碳酸氢盐透析液(HCO3-34mmol/L)和从高至低的线性可调碳酸氢根离子透析液(HCO3-从38mmol/L渐降至34mmol/L)各透析三个月,开始及三个月结束时分别查透析前、后血气分析、BUN、Scr、K+、Na+、CL-、Ca2+及心电图,并记录患者的不适反应。结果 普通碳酸氢盐透析初始和三个月时患者的血气无明显改变(P>0.05),使用线性可调碳酸氢根离子透析三个月后其透析前、透析后的BEe(b)、BE(ect)明显改善,两者比较相差显著(P<0.01),而pH、HCO3-、PO2、PCO2则无明显改变(P>0.0 5)。两种方法患者的透析前、透析后心电图、BUN、Scr的清除效果和不适反应发生率无显著差异(P>0.05)。结论 应用线性可调碳酸氢根离子透析液进行血液透析,使患者在治疗期间得到了足够的碱储,在清除毒素的同时,可有效纠正患者的细胞内、外代谢性酸中毒。至透析结束时,透析液HCO3-浓度渐降至常规的34mmol/L,避免了患者透析结束时可能出现的碱中毒和低氧血症。

Objective To observe the effects of different bicarbonate ion concentration dialysate on hemodialysis patients blood gas. Methods Thirty - two maintenance hemodialysis patients were treated for 3 months respectively with common bicarbonate dialysate (HCO3- 34mmol/L) and linear regulating bicarbonate ion dialysate in which the HCO3- concentration decreased from 38mmol/L to 34mmol/L in 3 months. They were also examined the blood gas、BUN、Scr、K+、Na+、C1-、Ca2 + and electrocardiogram before and after hemodialysis, and they were also recorded the side effections during the treatment. Results The blood gas of the patients treated with common bicarbonate dialysate had no significant changes at beginning and 3 months later (P > 0. 05). While treated with the patients BE(b)、BE(ect) before and after hemodialysis had significantly improved ( P < 0.01) with the treatment of linear regulating bicarbonate ion dialysate, but pH、HCO3-、PO2、PCO2 had no significant changes (P > 0.05). Conclusion With the linear regulating bicarbonate hemodialysis, the patients can obtain enough HCO3- . While eliminating the metabolic waste materials, it can effectively correct the patients' acidosis. When the hemodialysis finished, the HCO3- concentration in dialysate may decline gradually to common 34mmol/L. Therefore it avoided the alkalosis and hypoxemia that the patients may be occured after hemodialysis.