下腔静脉直径变化评估连续血液净化治疗前后容量状态

Volume Assessment Using Inferior Vena Cava Diameter changes before and after Continuous Blood Purification

目的:应用下腔静脉直径的变化(ΔIVCD)评估多脏器功能障碍综合征(MODS)患者连续血液净化治疗(CBP)24 h前后容量状态。方法:检测32例CBP治疗患者前后血浆BNP水平,并计算CBP治疗前后血浆BNP差值ΔBNP;在呼吸机呼气末床边B超测量下腔静脉直径,计算CBP治疗前后下腔静脉直径差值(ΔIVCD);同时记录CBP治疗后24 h每千克体重实际出量。结果:32例MODS患者CBP治疗后血浆BNP显著下降(156.8±72.5)比(354.2±148)pg/ml(P<0.05);CBP治疗后下腔静脉直径明显减小(1.45±0.56)比(1.98±0.67)cm(P<0.05);24 h实际出量(38.5±11.3)ml/kg;ΔIVCD与实际出量呈正相关,r=0.71,P<0.05,ΔBNP与实际出量呈正相关,r=0.68,P<0.05;ΔIVCD与ΔBNP呈正相关,r=0.72,P<0.05。结论:下腔静脉直径变化能够反映连续血液净化治疗前后容量状态变化,对CBP治疗的液体平衡有指导意义。

Objective To assess the volume status of MODS patients before and after continuous blood purification（CBP） by the changes of inferior vena cava diameter（IVCD）.Methods Plasma BNP Concentration was detected before and after treatment of continuous blood purification of 32 MODS patients,Difference of BNP before and after CBP is ΔBNP;bedside ultrasound exam was performed to measure IVCD in the term of the end expiratory,difference of IVCD before and after CBP isΔIVCD;Actual amount of 24 hours per kilogram of body weight also recorded.Results Concentration of BNP after CBP treatment decreased significantly（156.8＆#177;72.5） vs （354.2＆#177;148） pg/ml in 32 MODS patients（P〈0.05）;CBP significantly reduced the inferior vena cava diameter （1.45＆#177;0.56） vs （1.98＆#177;0.67）cm（P〈0.05）;Actual amount of 24 hours per kilogram of body weight was （38.5＆#177;11.3） ml/kg;It was the positive correlation betweenΔIVCD and the actual amount,r=0.71,P〈0.05;BetweenΔBNP and the actual amount were positively correlated,r=0.68,P〈0.05;BetweenΔIVCD andΔBNP were positively correlated,r=0.72,P〈0.05. Conclusion The variations of inferior vena cava diameter can reflect the capacity of state changes before and after CBP,it is helpful to control volume status of CBP.