vtioВестник трансплантологии и искусственных органовRussian Journal of Transplantology and Artificial Organs1995-1191Academician V.I.Shumakov National Medical Research Center of Transplantology and Artificial Organs", Ministry of Health of the Russian Federation10.15825/1995-1191-2012-4-59-64vtio-218Research ArticleИмплантаты и искусственные органыImplants and Artificial OrgansУПРАВЛЕНИЕ ТЕРМАЛЬНЫМ БАЛАНСОМ С ЦЕЛЬЮ ПРОФИЛАКТИКИ ИНТРАДИАЛИЗНОЙ ГИПОТЕНЗИИTERMAL BALANCE MANAGEMENT FOR INTRADIALYSIS HYPOTENSION PREVENTIONСтроковА. Г.StrokovA. G.ПозЯ. Л.PozY. L.КрышинК. Н.KryshinK. N.ФГБУ «ФНЦ трансплантологии и искусственных органов имени академика В.И. Шумакова» Минздрава России, ГБОУ ВПО «Первый МГМУ имени И.М. Сеченова», кафедра трансплантологии и искусственных органов, г. МоскваРоссияAcademician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs, I.M. Sechenov First Moscow State Medical University, Department of transplantology and artificial organsRussian Federation201229052014144ВЕСТНИК ТРАНСПЛАНТОЛОГИИ И ИСКУССТВЕННЫХ ОРГАНОВ том XIV No 4–20125964Copyright © Строков А.Г., Поз Я.Л., Крышин К.Н., 20122012Строков А.Г., Поз Я.Л., Крышин К.Н.Strokov A.G., Poz Y.L., Kryshin K.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.transpl.ru/vtio/article/view/218

Одной из причин интрадиализной артериальной гипотензии (ИАГ) является неадекватная перифери- ческая вазоконстрикция (ПВК) на фоне гиповолемии. Охлаждение крови в экстракорпоральном кон- туре (ЭК) способно стабилизировать гемодинамику. В данном исследовании прецизионный контроль температурного баланса осуществляли при помощи монитора температуры крови Blood Temperature Monitor (Fresenius Medical Care, Германия). При использовании стандартной (36,5 °С)(СД) и низкой (35 °С) (НД) температуры диализата (ТД) температура крови на входе в ЭК (ТКЭК) росла даже при НД (36,2 ± 0,3 °С/36,5 ± 0,3°С, р < 0,05), хотя этот рост был значимо меньшим, чем при СД (36,3 ± 0,4 °С/37,1 ± 0,3 °С, р < 0,01). При термонейтральном диализе (ТНД) была выявлена корреляция повышения ТКЭК и величины ультрафильтрации (УФ) (r = 0,66; р < 0,05). Сохранение стабильной ТКЭК при изотермическом диализе (ИТД) требовало постоянного снижения ТД вплоть до 34,9 ± 0,2°С. При ИТД частота ИАГ сни- жалась с 36,2 ± 1,1% до 11,3 ± 4,6%. Выводы. 1. Основным механизмом повышения температуры тела в процессе ГД является снижение теплоотдачи на фоне ПВК, связанной с УФ. 2. Низкотемпературный ГД эффективен для профилактики ИАГ. 3. ИТД является оптимальным вариантом НТД. 

Intradialytic hypotension (IDH) remains an important cause of morbidity and mortality in chronic hemodialysis (HD) patients and can be ameliorated by low temperature HD. Biofeed-back temperature-control device BTM® (Fresenius Medical Care, Germany) was used for precision temperature measurement and to deliver isothermic (ITD) or thermoneutral (TND) dialysis. At stage one 24 stable dialysis patients were studied in terms of inlet blood temperature (IBT) variation during sessions with normal (36,5 °С-ND) and cold dialysate (35 °С-CD). IBT was increasing in both cases however the increase was significantly lower in CD. At stage two, 18 patients underwent programmed cooling during two ITD and two TND sessions. In TND high correlation (r = 0.66; р < 0.05) was observed between IBT increase and ultrafiltration rate. Keeping IBT stable during ITD required cons- tant decrease of dialysate temperature to 34.9 ± 0.2 °С at the end of session. At stage three, 19 IDH-prone patients were displaced from regular dialysis program to ITD. As a result,the decrease overall rate of IDH from 36.2 ± 1.1% to 11.3 ± 4,6% was observed. Conclusions: 1. The main mechanism of body temperature raise during HD is heat retention secondary to the compensatory response to loss of plasma volume, resulting in increase of the total peripheral resistance. 2. CD is effective for IDH prevention. 3. ITD is the optimal version of CD. 

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The authors declare that there are no conflicts of interest present.