Jiang Chuan, Patel Satyam, Moses Andrew, DeVita Maria V, Michelis Michael F
Department of Medicine, Division of Nephrology, Lenox Hill Hospital/Northwell Health, 100 East 77th Street, New York, NY, 10075, USA.
Department of Medicine, Lenox Hill Hospital/Northwell Health, 100 East 77th Street, New York, NY, 10075, USA.
Int Urol Nephrol. 2017 Dec;49(12):2223-2230. doi: 10.1007/s11255-017-1709-5. Epub 2017 Oct 3.
The use of lung ultrasound (LUS) to identify extravascular lung water has received increasing acceptance. Sonographic B-lines, discrete vertical lines that originate from the pleura, represent pulmonary edema and are correlated with the accumulation of fluid. The goal of this study was to evaluate the utility of LUS to determine the accuracy of prescribed dry weight (DW) in chronic hemodialysis (HD) patients and to ascertain the adequacy of fluid removal.
LUS was scheduled to be performed pre- and post-HD in 20 patients. The HD prescription and DW challenge were done independent of the results of the LUS. The presence of B-lines was tabulated and compared to the intradialytic ultrafiltration parameters.
Of the 20 patients, 3 did not exhibit B-lines at the first dialysis session. In regard to the other 17 patients, B-lines disappeared in 7 patients at the end of the HD session (mean B-lines 4.2-0). One patient was 0.3 kg away from the prescribed dry weight, but the 6 patients were a mean of 1.7 kg below DW. Of the remaining 10 patients, eight decreased but did not eliminate the B-lines (mean B-lines 15.5-3.8) and were a mean of 3.8 kg below DW post-HD. Two patients who exhibited more cardiac insufficiency than initially recognized could not reach DW or eliminate the B-lines. Eight patients who had residual B-lines at the end of the first HD session had their DW re-estimated and had a second session. Two were able to eliminate the B-lines (mean 2.5-0) and reached a mean of 1.2 kg below DW. Six did not eliminate the B-lines (mean 11.5-4.2) but were able to reach a mean of 0.6 kg below DW. Correlation analysis showed a statistically significant correlation (P < 0.05) between the intradialytic percent change in B-lines and the percent change in total body weight (r = 0.40) and ultrafiltration rate (r = 0.33). Seven of 10 patients with clear chest X-rays pre-HD exhibited B-lines.
This study supports the hypothesis that reduction in B-lines during HD can provide accurate information regarding changes in pulmonary fluid content. Further, LUS is a valuable diagnostic tool for recognizing both the adequacy of fluid removal and the occurrence of error in the estimation of dry weight by usual clinical parameters.
使用肺部超声（LUS）识别血管外肺水越来越受到认可。超声B线是起源于胸膜的离散垂直线，代表肺水肿，与液体蓄积相关。本研究的目的是评估LUS在确定慢性血液透析（HD）患者规定干体重（DW）准确性及确定液体清除充分性方面的效用。
计划对20例患者在HD前后进行LUS检查。HD处方和DW挑战的进行与LUS结果无关。记录B线的存在情况，并与透析期间超滤参数进行比较。
20例患者中，3例在首次透析时未出现B线。对于其他17例患者，7例在HD结束时B线消失（平均B线从4.2降至0）。1例患者与规定干体重相差0.3 kg，但另外6例患者平均比DW低1.7 kg。其余10例患者中，8例B线减少但未消除（平均B线从15.5降至3.8），HD后平均比DW低3.8 kg。2例表现出比最初认识到的更严重心功能不全的患者未能达到DW或消除B线。8例在首次HD结束时仍有残余B线的患者重新估计了DW并进行了第二次透析。2例能够消除B线（平均从2.5降至0），比DW平均低1.2 kg。6例未消除B线（平均从11.5降至4.2），但能够比DW平均低0.6 kg。相关性分析显示，透析期间B线的百分比变化与总体重的百分比变化（r = 0.40）和超滤率（r = 0.33）之间存在统计学显著相关性（P < 0.05）。HD前胸部X线清晰的10例患者中有7例出现B线。
本研究支持以下假设，即HD期间B线的减少可提供有关肺内液体含量变化的准确信息。此外，LUS是一种有价值的诊断工具，可用于识别液体清除的充分性以及通过常规临床参数估计干体重时的误差情况。
