肺超声技术在血液透析患者容量评估中的临床应用

Clinical application of lung ultrasound in volume assessment of hemodialysis patients

目的探讨肺超声B线在血液透析患者容量状态评估中的应用价值。方法选取2022年1月至2023年6月该院透析中心93例维持性血液透析患者,使用超声分别测量透析前后B线数量、下腔静脉直径(IVCD),比较透析前后两者的变化,并分析透析前后B线数量与IVCD的相关性。同时选取其中62例合并高血压患者,分别采用传统临床评估法和肺超声B线评估法以调整透析干体重,比较2组患者透析后B线数量、干体重下降程度、血压、透析低血压发生率的差异。结果透析后B线数量及IVCD、体重均低于透析前,差异有统计学意义(P<0.05);透析前B线数量与IVCD呈正相关(r=0.536,P<0.05)。相比传统评估组,肺超声B线组患者的血压下降程度、干体重下降幅度更大,透析低血压发生率更低,差异均有统计学意义(P<0.05)。结论在血液透析患者中,应用肺超声B线检测进行容量评估具有较好的临床价值。

Objective To explore the application value of lung ultrasound B-line in the assessment of volume status in hemodialysis patients.Methods A total of 93 maintenance hemodialysis patients in the dialysis center of our hospital from January 2022 to June 2023 were selected.Ultrasound was used to measure the number of B-lines and inferior vena cava diameter(IVCD)before and after dialysis.The changes of the two before and after dialysis were compared,and the correlation between the number of B-lines and IVCD before and after dialysis was analyzed.At the same time,62 patients with hypertension were selected,and the traditional clinical evaluation method and lung ultrasound B-line evaluation method were used to adjust the dry weight of dialysis.The number of B-lines,the degree of dry weight loss,blood pressure and the incidence of dialysis hypotension were compared between the two groups.Results The number of B-lines,IVCD and body weight after dialysis were lower than those before dialysis,and the differences were statistically significant(P<0.05).The number of B-lines before dialysis was positively correlated with IVCD(r=0.536,P<0.05).Compared with the traditional evaluation group,the degree of blood pressure decline and dry weight loss in the lung ultrasound B-line group were greater,and the incidence of dialysis hypotension was lower,the differences were statistically significant(P<0.05).Conclusion In hemodialysis patients,the application of lung ultrasound B-line detection for volume assessment has good clinical value.