血液透析超滤脱水对急性肾功能衰竭患者近曲小管的影响  

The effect of ultrafiltration on proximal renal tubules in acute renal failure patients underwent hemodialysis

作　　者：王梅[1] 王静艳 王素霞[1] 左力[1] 王海燕[1] 

机构地区：[1]北京医科大学第一医院肾内科,北京100034

出　　处：《北京医科大学学报》2000年第2期152-154,共3页Journal of Peking University(Health Sciences)

基　　金：卫生部临床学科重点项目!(970 2 0 2 1 3)

摘　　要：目的 :观察急性肾功能衰竭患者行血液透析治疗超滤脱水后 ,尿N 乙酰 β D 氨基葡萄糖苷酶 (N acetyl β D glucosaminidase ,NAG)的水平及肾组织活检光镜下近曲小管的组织形态和电镜下超微结构的变化 ,探讨超滤脱水对近曲小管的影响。方法 :6例急性肾功能衰竭患者在血液透析超滤脱水过程中 ,监测血压、心率及血容量的变化 ;首次透析前 0～ 1h、透后即刻、透后第 1天清晨、第 2天清晨分别留尿检测NAG ,其中 4例在进行了 4～ 6次透析后进行了肾活检。结果 :6例患者透析过程中平均血容量下降 (6 .9± 3.1) % ,透中与透前比较 ,平均动脉压 (meanarterialpressure,MAP)、心率均无显著变化。透后即刻 6例患者尿NAG均较透前升高 ,尚无随时间变化的规律 ,与血容量的下降率亦无明显相关。肾穿刺活检光镜及电镜下未发现明显肾小管损伤的新鲜病变。结论 :急性肾衰患者血液透析过程中 ,合适的超滤脱水量不会引起血压的显著变化及肾脏的灌注不良 ,尽管有尿酶NAG的升高 ,但并未造成肾小管组织学上新的损伤。Objective: To observe if ultrafiltration during hemodialysis adds damage to proximal renal tubules in acute renal failure(ARF) patients. Methods: Blood pressure, heart rate and change of intravascular volume were deteced during hemodialysis(HD). Urinary N acetyl β D glucosaminidase(NAG) was tested just prior to initiation of the patient' s first HD, 0 1 h immediately after HD, an the second morning and the third. Urine flow was measured the day before and after HD. After 4 6 times of HD, 4 of them underwent renal biopsy. Results: Mean intravascular volume decreased (6.9± 3.1 )% during HD, but no significant difference was found in mean arterial pressure(MAP) and heart rate between pre HD and during HD. Urinary NAG increased at 0 1 h after HD in all patients, but no significant difference compared with the level before HD, also no correlation was found with reduction rate of intravascular volume. Urine flow was reduced after HD, but there was no significane difference compared with that before HD. No fresh proximal renal tubular damage was observed. Conclusion: Temperate ultrafiltration rate would not cause hypotention and hypoperfusion in kidney and apparent structural injury in renal tubules.( J Beijing Med Univ, 2000,32:152 154 )

关 键 词：血液透析 肾功能衰竭 急性 超滤脱水 

分 类 号：R692.5[医药卫生—泌尿科学] R459.5[医药卫生—外科学]