肺超声评估维持性血液透析患者容量状态的应用价值

Application value of pulmonary ultrasound in evaluating volume status in patients undergoing maintenance hemodialysis

目的探讨肺超声评估维持性血液透析患者容量状态的临床应用价值。方法选取于我院行常规血液透析治疗的患者48例,检测透析前后下腔静脉相关参数、超声心动图参数及肺超声参数,比较其差异。分析B线数量及其变化值与透析前后一般资料和超声心动图参数的相关性;应用多元线性回归分析B线数量及其变化值的独立预测因子。结果维持性血液透析患者透析后体质量、收缩压、舒张压、下腔静脉吸气末直径、下腔静脉呼气末直径、左室舒张末期内径(LVEDD)、左室收缩末期内径(LVESD)、二尖瓣舒张早期血流频谱峰值速度(E)、二尖瓣舒张晚期血流频谱峰值速度(A)、室间隔侧二尖瓣环舒张早期运动峰值速度(e)、E/e、B线数量均明显低于透析前,透析后下腔静脉塌陷率、左室射血分数(LVEF)均明显高于透析前,差异均有统计学意义(均P<0.05)。相关性分析显示,B线数量与透析前左房前后径(LAD)和E、透析前后LVEF和E/e均相关(均P<0.05);B线数量变化值与减少体质量、透析前LVEF、透析前后LAD、透析后E/e均相关(均P<0.05)。多元线性回归分析显示,透析前LVEF、透析前后E/e均为B线数量的独立预测因子(均P<0.05);减少体质量、透析前LVEF、透析后E/e均为B线数量变化值的独立预测因子(均P<0.05)。结论肺超声可动态监测维持性血液透析患者容量变化情况,准确评估透析治疗效果,具有较好的临床应用价值。

Objective To investigate the clinical application value of pulmonary ultrasound in evaluating volume status in patients undergoing maintenance hemodialysis.Methods A total of 48 patients received routine hemodialysis treatment in our hospital were selected.The parameters related to inferior vena cava,echocardiography and pulmonary ultrasound were detected before and after dialysis,and the differences were analyzed.The correlation between the number and change of B-line,general data and echocardiographic parameters before and after dialysis were analyzed.The independent predictors of the number and change of B-line were analyzed by multiple linear regressions.ResultsThe body weight,systolic pressure,diastolic pressure,end inspiratory diameter of inferior vena cava,end expiratory diameter of inferior vena cava,left ventricular end diastolic diameter(LVEDD),left ventricular end systolic diameter(LVESD),peak velocity of early and late diastolic mitral valve(E,A),early diastolic peak velecity of mitral annulus(e),E/e and the B line number of maintenance hemodialysis patients after dialysis were significantly lower than those before dialysis,the collapse rate of inferior vena cava and left ventricular ejection fraction(LVEF)after dialysis were significantly higher than those before dialysis(all P<0.05).Correlation analysis showed that the number of B-line was correlated with left atrial anterior posterior diameter(LAD),E before dialysis,LVEF and E/e before and after dialysis(all P<0.05).The change of B-line number was correlated with decreased body weight,LVEF before dialysis,LAD before and after dialysis,and E/e after dialysis(all P<0.05).Multiple linear regression analysis showed that LVEF before dialysis and E/e before and after dialysis were independent predictors of the number of B lines(all P<0.05).Decreased body weight,LVEF before dialysis and E/e after dialysis were independent predictors of change of B-line number(all P<0.05).Conclusion Pulmonary ultrasound can dynamically monitor the volume changes of maintenance hemodialysis patients and effectively evaluate the effect of dialysis treatment,which has good clinical application value.