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肾科住院医师可通过肺部超声和血液透析患者下腔静脉测量来确定液体状态:单中心观察性研究。

A nephrology trainee can define the fluid status through lung ultrasonography and inferior vena cava measurements in hemodialysis patients: an observational study in a single center.

机构信息

Department of Nephrology, Papageorgiou General Hospital, Thessaloniki, Greece.

Medical School, Democritus University of Thrace, Alexandroupolis, Greece.

出版信息

J Ultrasound. 2024 Dec;27(4):887-894. doi: 10.1007/s40477-024-00903-x. Epub 2024 Jun 12.

Abstract

AIMS

The determination of ideal weight in hemodialysis patients remains a common problem. The use of Lung Ultrasound (LUS) is an emerging method of assessing the hydric status of hemodialysis patients. LUS combined with Inferior Vena Cava (IVC) ultrasonography can define the fluid status in hemodialysis patients.

METHODS

This study included 68 hemodialysis patients from the Dialysis Unit of Papageorgiou General Hospital in Thessaloniki. The patients underwent lung and IVC ultrasound 30 min before and after the end of the dialysis session by a nephrology trainee. Patients' ideal weight was modified based on daily clinical practice rather than ultrasound findings. The presence of B lines and ultrasound findings of the IVC were evaluated.

RESULTS

The average B line score was 11.53 ± 5.02 before dialysis and became 5.57 ± 3.14 after the session. The average diameter of the IVC was 14.266 ± 0.846 mm before dialysis and 12.328 ± 0.879 mm after the session. The patients were categorized based on the magnitude of overhydration and the findings were evaluated. In addition, findings after the session showed a statistically significant correlation between the b line score and the diameter of the IVC adjusted for the body surface area. (p = 0.009 < 0.05).

CONCLUSIONS

A high rate of hyperhydration was detected before the dialysis session (25%). While it is the first study conducted by a nephrology trainee highlighting that it is a feasible technique. Intervention studies should be carried out in the future to draw more precise conclusions.

摘要

目的

确定血液透析患者的理想体重仍然是一个常见问题。肺部超声(LUS)的使用是评估血液透析患者水合状态的一种新兴方法。LUS 结合下腔静脉(IVC)超声可以定义血液透析患者的液体状态。

方法

这项研究包括来自塞萨洛尼基 Papageorgiou 综合医院透析科的 68 名血液透析患者。由一名肾病学学员在透析结束前 30 分钟和结束后对患者进行肺部和 IVC 超声检查。根据日常临床实践而不是超声检查结果来调整患者的理想体重。评估 B 线的存在和 IVC 的超声表现。

结果

透析前平均 B 线评分为 11.53±5.02,透析后降至 5.57±3.14。透析前 IVC 的平均直径为 14.266±0.846mm,透析后为 12.328±0.879mm。根据脱水过多的程度对患者进行分类,并评估结果。此外,透析后发现 B 线评分与调整体表面积后的 IVC 直径之间存在统计学显著相关性(p=0.009<0.05)。

结论

在透析前(25%)检测到高比例的过度水化。虽然这是由一名肾病学学员进行的首次研究,强调了这是一种可行的技术。但未来应开展干预性研究,以得出更精确的结论。

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