床旁肺部超声对尿毒症血液透析合并心衰患者容量状态的评估

Evaluation value of bedside lung ultrasound on volume status in patients with uremia and heart failure after hemodialysis

目的探讨床旁肺部超声对尿毒症血液透析合并心衰患者容量状态的评估价值。方法选取2018年1月~2022年12月于我院行血液透析合并心力衰竭患者56例。分析患者透析前后的床旁肺部超声B线数量与下腔静脉(IVC)内径、左室射血分数(LVEF)以及体质量的关系。结果相关性分析显示透析前B线数量与IVC内径、体质量相关,且呈正相关(IVC内径:r=0.285,P<0.05,体质量:r=0.369,P<0.05);透析前B线数量与LVEF相关,且呈负相关(LVEF:r=-0.417,P<0.05)。透析后,B线数量与IVC内径不相关(P>0.05),但仍与LVEF(r=-0.349,P<0.05)、体质量(r=0.397,P<0.05)相关。多元线性回归分析发现,透析前IVC内径、LVEF、体质量是B线数量的独立预测因子(P<0.05),透析后IVC内径、LVEF、体质量均不是B线数量的独立预测因子(P>0.05)。结论床旁肺部超声用于评估尿毒症血液透析合并心衰患者容量状态具有一定临床价值。

Objective:To investigate the value of bedside pulmonary ultrasound in evaluating the volume status of patients with uremic hemodialysis complicated with heart failure.Methods:A total of 56 patients with uremia with heart failure undergoing hemodialysis in our hospital were enrolled from January 2018 and December 2022.The relationship between the number of bedside ultrasound B-lines and inferior vena cava(IVC)diameter,left ventricular ejection fraction(LVEF),body mass before and after dialysis was analyzed.Results:the Correlation analysis showed thatthe number of B-lines before dialysis was positively correlated with IVC diameter and body mass(IVC diameter:r=0.285,P<0.05,body mass:r=0.369,P<0.05),while negatively correlated with LVEF(LVEF:r=-0.417,P<0.05).After dialysis,the number of B-lines was not correlated with IVC diameter(P>0.05),but was still correlated with LVEF(r=-0.349,P<0.05)and body mass(r=0.397,P<0.05).Multivariate linear regression analysis showed that IVC diameter,LVEF and body mass were independent predictors of the number of B-lines before dialysis(P<0.05),while which after dialysis were not independent predictors(P>0.05).Conclusion:Bedside lung ultrasound has certain clinical evaluation value for volume status in patients with uremia and heart failure after hemodialysis.