Mandelbaum A, Link A, Wambach G, Ritz E
Sektion Nephrologie, Medizinische Universitätsklinik Heidelberg.
Dtsch Med Wochenschr. 1993 Sep 17;118(37):1309-15. doi: 10.1055/s-2008-1059455.
Vena cava diameter (VCD) was measured by ultrasonography in 10 acutely hypervolemic dialysis patients (6 men, 4 women; mean age 61.3 +/- 15.4 years), results being compared with the level of the central venous pressure (CVP) and, in 39 long-term dialysis patients (18 men, 21 women; mean age 56 +/- 15 years), with the plasma concentration of atrial natriuretic peptide (ANP). In 86 subjects without renal disease (43 men, 43 women; mean age 39.4 +/- 14.6 years) there was a statistically highly significant correlation between the end-expiratory VCD and heart rate (r = -0.63; P < 0.001). These data were used to construct a VCD/heart rate (HR) nomogram. In the ten dialysis patients HR-adjusted VCD correlated significantly at various hydration states (54 measurements) with the CVP (r = 0.72; P < 0.001). The steep slope for the relationship between CVP and VCD showed marked interindividual variations. However, in all patients (except one) with a raised CVP (> 12 cm H2O) the HR-adjusted VCD was above the 95th percentile. In the 39 patients on long-term dialysis (13 with, 25 without predialysis tricuspid regurgitation [TR] there occurred a parallel decrease in VCP and ANP during removal of fluid. In the 25 patients without TR, the fall in ANP concentration and VCD correlated significantly (r = 0.70; P < 0.001). These results indicate that, in patients with renal failure but normal cardiac function, measurement of the VCD by ultrasonography provides an adequate index of hydration.
对10例急性容量过多的透析患者（6例男性，4例女性；平均年龄61.3±15.4岁）进行超声检查测量腔静脉直径（VCD），并将结果与中心静脉压（CVP）水平进行比较；对39例长期透析患者（18例男性，21例女性；平均年龄56±15岁），则将结果与心房利钠肽（ANP）的血浆浓度进行比较。在86例无肾脏疾病的受试者（43例男性，43例女性；平均年龄39.4±14.6岁）中，呼气末VCD与心率之间存在统计学上高度显著的相关性（r = -0.63；P < 0.001）。利用这些数据构建了VCD/心率（HR）列线图。在10例透析患者中，在不同水化状态下（共54次测量），经心率校正的VCD与CVP显著相关（r = 0.72；P < 0.001）。CVP与VCD之间关系的陡峭斜率显示出明显的个体差异。然而，在所有CVP升高（> 12 cm H₂O）的患者中（除1例），经心率校正的VCD高于第95百分位数。在39例长期透析患者中（13例有、25例无透析前三尖瓣反流[TR]），在超滤过程中VCP和ANP出现平行下降。在25例无TR的患者中，ANP浓度下降与VCD显著相关（r = 0.70；P < 0.001）。这些结果表明，在肾功能衰竭但心功能正常的患者中，通过超声检查测量VCD可提供充分的水化指标。
