Prencipe Michele, D'Amelio Alessandro, Aucella Filippo, Granata Antonio, Fiorini Fulvio
U.O.C. Nefrologia e Dialisi, Ospedale Casa Sollievo della Sofferenza', San Giovanni Rotondo, Foggia, Italy.
G Ital Nefrol. 2012 Nov-Dec;29 Suppl 57:S58-64.
The achievement of a normal hydration state is one of the major targets of hemodialysis. It is based on the estimation of ''dry weight'', which corresponds to the normal body fluid content. Even though the concept of dry weight in hemodialysis patients is clinically undisputed, it is not always easy to achieve in this population. Assessment of the hydration state by clinical examination is imprecise and often unreliable. Measurement of the inferior vena cava (IVC) diameter has been shown to reflect individual fluid status. The relationship between the variation of the IVC diameter before and after the hemodialysis session and weight loss has been investigated. Measurement of the IVC diameter by ultrasound is considered a valid measure of the hydration state and can be routinely used in hemodialysis patients. Moreover, a relationship between IVC diameter, respiratory activity and the hydration state, evaluated by considering both plasma volume and central venous pressure, has been demonstrated. In conclusion, assessment of the hydration state based on blood pressure and central venous pressure can be considered reliable only in patients without signs of heart failure.
达到正常的水合状态是血液透析的主要目标之一。这基于对“干体重”的估计，干体重对应于正常的体液含量。尽管血液透析患者的干体重概念在临床上并无争议，但在这一人群中实现并不总是容易的。通过临床检查评估水合状态不准确且往往不可靠。下腔静脉（IVC）直径的测量已被证明可反映个体的液体状态。已经研究了血液透析疗程前后IVC直径变化与体重减轻之间的关系。通过超声测量IVC直径被认为是评估水合状态的有效方法，可常规用于血液透析患者。此外，通过同时考虑血浆容量和中心静脉压评估，已证明IVC直径、呼吸活动与水合状态之间存在关联。总之，仅在没有心力衰竭迹象的患者中，基于血压和中心静脉压评估水合状态才可被认为是可靠的。
