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題名 | Arterial Oxygenation is Unchanged during Hemodialysis in Patients Mechanically Ventilated in Assist-Control Mode:接受輔助/控制模式機械通氣病人在血液透析時動脈血氧和作用並無改變 |
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作者 | 蔡熒煌; 黃崇旂; 林孟志; 陳濘宏; 張玉珍; 李政輝; Tsai, Ying-huang; Huang, Chung-chi; Lin, Meng-chih; Chen, Ning-hung; Chang, Yu-jhen; Lee, Cheng-huei; |
期刊 | 臺灣醫學會雜誌 |
出版日期 | 19980200 |
卷期 | 97:2 1998.02[民87.02] |
頁次 | 頁90-96 |
分類號 | 415.816 |
語文 | eng |
關鍵詞 | 輔助/控制模式機械通氣病人; 血液透析; 動脈血氧和作用; Hemodialysis; Bicarbonate dialysate; Mechanical ventilation; APACHE Ⅲ; |
英文摘要 | Dialysis-induced hypoxemia can occur in spontaneously breathing renal failure patients but whether it occurs during bicarbonate hemodialysis in critically ill patients receiving mechanical ventilation in assist-control mode is not clear. Twenty-one patients admitted to the medical intensive care unit who required mechanical ventilation and hemodialysis with the use of a cuprammonium dialyzer were enrolled and 25 sessions of hemodialysis wre performed. Arterial blood gas, white blood cell count, minute ventilation, respiratory rate, and blood pressure were measured before dialysis (time 0) and at 15, 30, 60, 120, 180, and 240 minutes thereafter. The white blood cell count dropped immediately and reached the nadir 15 minutes after hemodialysis began. Thereafter, it recovered and overshot the predialysis value at the end of dialysis. The serum HCO �婀� concentration increased progressively after dialysis began and resulted in significant metabolic alkalosis. The P(A-a)O �� was not aggravated and minute ventilation was not depressed by rapid metabolic alkalosis under mechanical ventilatory support. The PaO �� remained stable throughout hemodialysis. No significant hypoxemia occurred in groups of varying predialysis cardiopulmonary dysfunction. These findings suggest that in renal failure patients ventilated in assist-control mode, 1)hypoventilation and accompanying hypoxemia did not occur during bicarbonate (35 mEq/L) dialysis, despite significant metabolic alkalosis; and 2)patients with hihger Acute Physiologic and Chronic Health Evaluation (APACHE) Ⅲ scores and P (A-a) O �� levels were not more prone to dialysisinduced hypoxemia. |
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