论文部分内容阅读
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 the level of urinary N acetyl-D-glucosaminidase (NAG) and the morphology of proximal tubule in renal tissue biopsy specimens after hemodialysis treatment of patients with acute renal failure And ultrastructure changes under electron microscopy to investigate the effect of ultrafiltration dehydration on proximal convoluted tubules. Methods: The changes of blood pressure, heart rate and blood volume in 6 patients with acute renal failure during hemodialysis and ultrafiltration dehydration were monitored. The blood pressure, heart rate and blood volume were monitored before dialysis for 0-1h, immediately after the dialysis, on the first day after the dialysis, Respectively urine test NAG, of which 4 cases were carried out after 4 to 6 dialysis renal biopsy. Results: The mean volume of blood pressure decreased during the dialysis in 6 patients (6.9 ± 3.1)%. There was no significant change in mean arterial pressure (MAP) and heart rate between the two groups. Urinary NAG in 6 patients immediately after the dialysis was higher than that before the dialysis. There was no change with time, nor was there any significant correlation with the decreasing rate of blood volume. Renal biopsy light microscopy and electron microscopy found no significant renal tubular lesions of fresh lesions. CONCLUSIONS: In the course of hemodialysis of patients with acute renal failure, appropriate dewatering of ultrafiltration does not cause significant changes in blood pressure and poor perfusion of the kidneys. Although urease NAG is elevated, it does not result in a histological new tubular damage.