关键词: 血液透析, 失衡综合征, 肺水肿

Abstract:

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. 

Key words: Disequilibrium syndrome, Pulmonary edema 