超声评估慢性肾功能衰竭合并高血压病的维持性血液透析患者容量状态的价值

Ultrasonic evaluation of maintenance dialysis patients with chronic renal failure and hypertension

目的探讨超声评价慢性肾功能衰竭(以下简称肾衰)合并高血压病的维持性血液透析患者容量状态的临床应用价值。方法选取我院拟接受维持性血液透析治疗的慢性肾衰合并高血压病患者56例,根据CT测量的心胸比分为容量过负荷(心胸比>0.55)组24例和容量正常(心胸比≤0.55)组32例,均于透析治疗前行床旁超声测量下腔静脉内径(D-IVC),并计算下腔静脉随呼吸变异度(V-IVC),比较两组间各指标的差异。绘制受试者工作特征(ROC)曲线评价各指标对容量状态的预测价值。分析呼气末下腔静脉内径(D-IVCe)、V-IVC与心胸比的相关性。结果与容量正常组比较,容量过负荷组D-IVCe升高、V-IVC降低,差异均有统计学意义(P=0.005、0.010)。ROC曲线分析显示,分别以D-IVCe 17.7 mm和V-IVC 30%为截断值,其预测容量过负荷的敏感性分别为58.3%和81.3%,特异性分别为81.2%和58.3%,曲线下面积分别为0.719(95%可信区间0.584~0.855)和0.696(95%可信区间0.554~0.838)。相关性分析显示,心胸比与D-IVCe呈正相关(r=0.607,P<0.05),与V-IVC呈负相关(r=-0.585,P<0.05)。结论应用超声评估慢性肾衰合并高血压病的维持性血液透析患者的容量状态有重要的临床价值。

Objective To explore the clinical application value of ultrasound in evaluating the volume state of maintenance dialysis patients with chronic renal function failure(herein referred to as renal failure)and hypertension.Methods Totally 56 cases of chronic renal failure and hypertension planned to receive maintenance dialysis in our hospital were included.They were divided into volume overload group 24 cases(cardiothoracic ratio>0.55)and normal volume group32 cases(cardiothoracic ratio≤0.55)according to cardiothoracic ratio measured by CT.The diameter of inferior vena cava(D-IVC)was dynamically monitored by bedside ultrasound before dialysis treatment,and the variability of inferior vena cava(V-IVC)with respiration was calculated,the differences of parameters between the two groups were compared.The receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of each index on capacity state,and the correlation between the inner diameter of D-IVC at the end of expiratory(D-IVCe),V-IVC,and CT cardiothoracic ratio was analyzed.ResultsD-IVCe of parameters was increased and V-IVC decreased in volume overload group compared with volume normal group,and the difference were statistically significant(P=0.005,0.010).The ROC curve analysis showed that taking D-IVCe 17.7 mm and V-IVC 30%as the cut-off values,the sensitivity of predicting volume overload were 58.3%and 81.3%,and the specificity were 81.2%and 58.3%,respectively.The areas under ROC curve were 0.719(95%CI 0.584~0.855)and 0.696(95%CI 0.554~0.838).The correlation analysis showed that the cardio-thoracic ratio was positively correlated with D-IVCe(r=0.607,P<0.05),and negatively correlated with V-IVC(r=-0.585,P<0.05).Conclusion Ultrasound has a good evaluation value for the volume state of maintenance dialysis patients with chronic renal failure and hypertension.