摘要
目的 证明快速透析诱发的失衡综合征 (DDS)伴发肺水肿的发病机制。方法 采急性肾衰竭犬模型 ,评定快速血液透析后血清和脑脊液生化参数、颅内压、肺血管阻力指数、脑 /肺组织干湿比、肺水肿指数和脑与肺组织学变化。结果 透析快速排除尿素氮、肌酐导致DDS ,表现为颅压增高和发生神经系统症状。监测C组ARF狗血流动力学参数 ,显示为透析后肺动脉压 (PAP)、肺毛细血管嵌楔压 (PCWP)、右房压 (RAP)、右室压 (RVP)、中心静脉压 (CVP)增加 ;随透析时间的延长 ,肺血管总阻力 (TPRI)、颅内压增加 ;透析后肺水肿指数增加 ,脑、肺组织干湿比减少以及脑、肺组织学检查均提示脑和肺水肿。D组狗假透析后没有上述变化。结论 实验结果表明血液透析可以诱发肺和脑水肿 ,其发生机制可能是因血浆尿素浓度快速下降有关 ,通过“尿素逆渗透效应”导致血浆 /组织产生渗透梯度 ,使血浆水进入脑和肺组织 ,临床可出现脑水肿、肺水肿等多系统失衡现象。
Objectives The aim of this study was to demonstrate the existence and potential pathogenesis of pulmonary edema accompanied in disequilibrium syndrome induced by rapid hemodialysis. Methods Biochemical parameters of serum and cerebrospinal fluid, Intracranial pressure, indexes of pulmonary vascular pressure, dry/wet ratio of brain and lung tissue, pulmonary edema index and pathological changes of brain and lung tissue were evaluated in dogs with experimental acute renal failure (ARF) after rapid hemodialysis.Results In the experimental model, the rapid removal of plasma urea nitrogen and creatinine by hemodialysis induced DDS, which was characterized by an increased intracranial pressure and development of neuropathic manifestations. The monitoring of a variety of hemodynamic parameters (right atrial pressure, right ventricular pressure, pulmonary artery pressure, pulmonary capillary wedge pressure and central venous pressure) indicated an increase after dialysis, intracranial pressures and pulmonary vascular resistance with increasing dialysis time in group C. There were also an increase in pulmonary edema index and a decrease in dry/wet ratio of lung and brain tissue in group C, ARF animals with dialysis. But there was no changes in group D sham dialysis group. Moreover, pathological examination revealed a edema of lung and brain in dialyzed dogs.Conclusions These results suggest that hemodialysis also may induce edema of brain and lung which appears to be associated with a rapid decrease in plasma urea concentration. The predominate pathogenesis may be due to the 'urea reverse effect' that creates a tissue-plasma osmotic gradient,thereby leading to plasma water permeating into lung and brain tissue.The brain edema and pulmonary edema as well as manifestation of multi-system disequilibrium occurs clinically.
出处
《中国血液净化》
2004年第10期526-531,共6页
Chinese Journal of Blood Purification
关键词
血液透析
失衡综合征
肺水肿
Hemodialysis
Disequilibrium syndrome
Pulmonary edema
