Annamalai Ishwarya, Balasubramaniam Suhasini, Fernando M Edwin, Srinivasaprasad N D, Suren S, Thirumalvalavan K, Veerakumar A M
Department of Nephrology, Government Stanley Hospital, Chennai, Tamil Nadu, India.
Department of Radiology, Government Stanley Hospital, Chennai, Tamil Nadu, India.
Indian J Nephrol. 2019 Mar-Apr;29(2):102-110. doi: 10.4103/ijn.IJN_78_18.
Dry weight assessment in dialysis patients remains a challenging endeavor owing to the limitations of the available methods for volume assessment. Lung ultrasound is emerging as an invaluable tool to assist in the appropriate assessment and assignment of dry weight. The objectives of this study are (1) to determine the reliability of clinical signs and symptoms for volume assessment, (2) to compare lung ultrasound with High Resolution Computed Tomography (HRCT) chest-A noninvasive gold standard tool for detecting pulmonary congestion and with inferior vena cava diameter (IVCD) - another time-tested volume assessment method, and (3) to analyze if lung ultrasound could detect dialysis induced fluid status variations. The cross-sectional study involves 50 patients on maintenance hemodialysis. Lung ultrasound for B line estimation and ultrasonographic measurement of IVCD performed before and after hemodialysis by a nephrologist trained in ultrasonography. Limited HRCT was obtained just before hemodialysis. Edema, crackles, and dyspnea had a poor sensitivity of 37.9%, 11.5%, and 52.6%, respectively, to detect clinically significant pulmonary congestion by lung ultrasound. A highly significant correlation was obtained between B-line score and HRCT signs of pulmonary congestion ( < 0.001) before dialysis. B lines showed statistically significant reduction with dialysis. The absolute reduction of B lines showed significant correlation with ultrafiltration volume and weight loss. Bedside lung ultrasound appears a sensitive tool for evaluating real-time changes in extravascular lung water and would serve to optimize volume status in dialysis patients.
由于现有容量评估方法存在局限性，透析患者的干体重评估仍然是一项具有挑战性的工作。肺部超声正逐渐成为协助进行适当干体重评估和确定的一项宝贵工具。本研究的目的是：（1）确定用于容量评估的临床体征和症状的可靠性；（2）将肺部超声与胸部高分辨率计算机断层扫描（HRCT）（一种用于检测肺充血的非侵入性金标准工具）以及下腔静脉直径（IVCD）（另一种经过长期验证的容量评估方法）进行比较；（3）分析肺部超声是否能够检测透析引起的液体状态变化。这项横断面研究纳入了50例维持性血液透析患者。由接受过超声检查培训的肾病专家在血液透析前后进行肺部超声检查以评估B线，并对IVCD进行超声测量。在血液透析前即刻进行有限的HRCT检查。水肿、啰音和呼吸困难在通过肺部超声检测临床上显著的肺充血方面，敏感性分别较差，为37.9%、11.5%和52.6%。透析前B线评分与HRCT肺充血征象之间存在高度显著相关性（<0.001）。B线在透析后显示出统计学上的显著降低。B线的绝对降低与超滤量和体重减轻显著相关。床旁肺部超声似乎是评估血管外肺水实时变化的一种敏感工具，有助于优化透析患者的容量状态。
