中国血液净化

中国血液净化 ›› 2018, Vol. 17 ›› Issue (09): 608-612.doi: 10.3969/j.issn.1671-4091.2018.09.007

• 临床研究 • 上一篇    下一篇

肺超声技术在维持性血液透析患者容量评估中的应用

崔琳琳1,汤孟君1,陈揭剑1,叶朝阳2   

  1. 1. 第二军医大学长征医院肾内科 解放军肾脏病研究所
    2. 上海中医药大学曙光医院肾内科
  • 收稿日期:2017-12-04 修回日期:2018-07-10 出版日期:2018-09-12 发布日期:2018-08-24
  • 通讯作者: 叶朝阳 yechaoyang63@126.com E-mail:yechaoyang63@126.com

he role of lung ultrasonography to evaluate overhydration in maintenance hemodialysis patients

  • Received:2017-12-04 Revised:2018-07-10 Online:2018-09-12 Published:2018-08-24

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摘要： 【摘要】目的评价维持性血液透析患者肺超声检查结果与容量及心功能的相关性。方法纳入2014 年7 月～2015 年7 月在上海长征医院血液透析中心门诊及住院的维持性血液透析患者，患者近1 周内接受常规实验室检查，记录其基本资料。透析前后30min 进行肺超声、心脏超声、生物电阻抗等基本检查，获得心脏超声参数、肺超声参数、容量相关指标等。结果依据肺超声检查结果将患者分为3组：轻度肺淤血组、中度肺淤血组和重度肺淤血组，中度及重度彗尾征组患者的心功能较差(c2=25.358，P＜0.001)，多合并下肢水肿(c2=12.217，P=0.002)。透析前后肺超声检查有显著改变(Z=-6.176，P＜0.001)，与透析超滤量呈正相关(r=0.200, P=0.039)，射血分数(β=-87.138，P=0.014)与肺超声检查中彗尾征形成独立相关。肺超声彗尾征评价容量负荷状态的曲线下面积为0.841,95%可信区间为0.758～0.925(P＜0.001)。肺超声判断患者容量超负荷的最佳临界值为12.50 条，诊断的灵敏度为0.688，特异度0.950。结论本研究证实肺超声检查彗尾征的出现与维持性血液透析患者的心功能、容量负荷相关。

关键词: 维持性血液透析, 容量负荷, 彗尾征, 生物电阻抗

Abstract: 【Abstract】Objective The aim of present study was to evaluate the value of lung ultrasonography for the prediction of body fluid volume and heart function. Methods The patients treated in Shanghai Changzheng Hospital during July 2014 to July 2015 were enrolled in this study according to the inclusion criteria. Three different kinds of methods, including lung ultrasonography, bioimpedance spectroscopy and echocardiography, were used to evaluate the prediction value. The examinations were performed 30 minutes before dialysis and after dialysis for 30 minutes. Results Patients were classified into 3 groups according to comet- tail: mild, moderate and severe lung congestion. Compared with the patients in mild and moderate groups, patients in the severe group had worse heart function (c2=25.358, P＜0.001) and edema complication (c2=12.217, P=0.002). A significant reduction of the comet-tail was detected following hemodialysis (Z=-6.176, P＜0.001), and the variation was significantly correlated with ultrafiltration volume (r=0.200, P=0.039). According to the stepwise multiple regression analyses, the ejection fraction (β=-87.138, P=0.014) was an independent element for comet-tail. According to the ROC analysis, lung ultrasonography was highly accurate for the detection of overhydration [AUC: 0.841 (0.758, 0.925)]. Furthermore, the best cut-point of lung comet was 12.5 according to the bioelectrical spectroscopy. Conclusion This study proposes that lung ultrasonography is a potentially reliable method for the estimation of fluid overload and heart failure.

Key words: Maintenance hemodialysis, overhydration, comet-tail, bioelectrical impedance