Brennan J Matthew, Ronan Adam, Goonewardena Sascha, Blair John E A, Hammes Mary, Shah Dipak, Vasaiwala Samip, Kirkpatrick James N, Spencer Kirk T
Department of Internal Medicine, University of Chicago, Chicago, IL 60637, USA.
Clin J Am Soc Nephrol. 2006 Jul;1(4):749-53. doi: 10.2215/CJN.00310106. Epub 2006 May 24.
Accurate intravascular volume assessment is critical in the treatment of patients who receive chronic hemodialysis (HD) therapy. Clinically assessed dry weight is a poor surrogate of intravascular volume; however, ultrasound assessment of the inferior vena cava (IVC) is an effective tool for volume management. This study sought to determine the feasibility of using operators with limited ultrasound experience to assess IVC dimensions using hand-carried ultrasounds (HCU) in the outpatient clinical setting. The IVC was assessed in 89 consecutive patients at two outpatient clinics before and after HD. Intradialytic IVC was recorded during episodes of hypotension, chest pain, or cramping. High-quality IVC images were obtained in 79 of 89 patients. Despite that 89% of patients presented at or above dry weight, 39% of these patients were hypovolemic by HCU. Of the 75% of patients who left HD at or below goal weight, 10% were still hypervolemic by HCU standards. Hypovolemic patients had more episodes of chest pain and cramping (33 versus 14%, P = 0.06) and more episodes of hypotension (22 versus 3%, P = 0.02). The clinic with a higher prevalence of predialysis hypovolemia had significantly more intradialytic adverse events (58 versus 27%; P = 0.01). HCU measurement of the IVC is a feasible option for rapid assessment of intravascular volume status in an outpatient dialysis setting by operators with limited formal training in echocardiography. There is a poor relationship between dry weight goals and IVC collapsibility. Practice variation in the maintenance of volume status is correlated with significant differences in intradialysis adverse events.
准确评估血管内容量对于接受慢性血液透析（HD）治疗的患者至关重要。临床评估的干体重并不能很好地代表血管内容量；然而，超声评估下腔静脉（IVC）是一种有效的容量管理工具。本研究旨在确定在门诊临床环境中，让超声经验有限的操作人员使用便携式超声（HCU）评估IVC尺寸的可行性。在两家门诊诊所，对89例连续患者在HD治疗前后进行IVC评估。在低血压、胸痛或痉挛发作期间记录透析过程中的IVC情况。89例患者中有79例获得了高质量的IVC图像。尽管89%的患者就诊时体重达到或超过干体重，但其中39%的患者通过HCU评估为血容量不足。在以目标体重或低于目标体重结束HD治疗的患者中，按照HCU标准，仍有10%的患者血容量过多。血容量不足的患者胸痛和痉挛发作更频繁（33%对14%，P = 0.06），低血压发作也更频繁（22%对3%，P = 0.02）。透析前血容量不足患病率较高的诊所透析过程中的不良事件明显更多（58%对27%；P =
