超声测量下腔静脉对维持性血液透析患者血压、透析充分性和生活质量的影响

Effect of inferior vena cava measurement by ultrasound on blood pressure,dialysis adequacy,and quality of life in patients with maintenance hemodialysis

目的探讨超声测量下腔静脉对维持性血液透析患者血压、透析充分性和生活质量的影响。方法将60例维持性血液透析患者随机分为对照组和研究组,每组30例。对照组采用传统方法调整干体重,研究组在对照组的基础上根据超声测量下腔静脉的结果调整患者干体重。比较两组患者干预前后透析相关性低血压(IDH)发生率、透析前血压、透析中最低血压、实验室指标水平和生活质量。结果干预后,研究组患者的IDH发生率低于对照组,透析前收缩压、平均动脉压均低于干预前及对照组(均P<0.05);研究组尿素清除指数(Kt/V)高于干预前及对照组,N-末端脑钠肽前体水平较干预前降低(均P<0.05);研究组36项健康调查简表总体健康维度、生理功能维度和生理综合得分均较干预前升高(均P<0.05)。结论将超声测量下腔静脉应用于维持性血液透析患者的容量管理,可以提升容量管理效果,降低IDH发生率,提高透析充分性。

Objective To explore the effect of inferior vena cava measurement by ultrasound on blood pressure,dialysis adequacy,and quality of life in patients with maintenance hemodialysis.Methods A total of 60 patients with maintenance hemodialysis were randomly assigned to control group or research group,with 30 cases in each group.The control group received conventional method to adjust dry body weight,based on which the research group adjusted dry body weight of patients according to the measurement results of inferior vena cava by ultrasound.The pre-and post-intervention incidence rate of intradialytic hypotension(IDH),pre-dialysis blood pressure,minimum blood pressure during dialysis,levels of laboratory indices,and quality of life were compared between the two groups.Results After intervention,the research group exhibited a lower incidence rate of IDH compared to the control group,and decreased pre-dialysis systolic pressure,mean artery pressure as compared with before intervention and the control group(all P<0.05).The research group depicted a higher urea clearance index(Kt/V)compared with before intervention and the control group;furthermore,the research group interpreted a decreased level of N-terminal pro-B-type natriuretic peptide as compared with before intervention(all P<0.05).The research group yielded elevated scores of total health dimension,physiological function dimension,and physiological comprehension in 36-Item Short-From Health Survey compared to before intervention(all P<0.05).Conclusion The application of ultrasound measurement of inferior vena cava to the volume management of patients with maintenance hemodialysis can improve the effect of volume management,decrease the incidence rate of IDH,and increase the adequacy of dialysis.