Leunissen K M, Kouw P, Kooman J P, Cheriex E C, deVries P M, Donker A J, van Hooff J P
Department of Nephrology, University Hospital Maastricht, The Netherlands.
Kidney Int Suppl. 1993 Jun;41:S50-6.
In this paper, several newly developed techniques for the estimation of the fluid status in hemodialysis patients were reviewed. Whereas echography of the inferior caval vein and the measurement of ANP and cGMP levels merely provide information about the intravascular volume, conductivity measurements are able to detect changes in the extracellular and intracellular compartments without being able to differentiate between the intravascular and interstitial fluid spaces. Echography of the inferior caval vein as a tool to assess over- and underhydration has been successfully validated against objective standards as right atrial pressure, total blood volume and the change in hemodynamic parameters during dialysis. Conductivity measurements were significantly related to vena cava measurements before and after dialysis. Whereas ANP levels were significantly related to the vena cava diameter before dialysis, in another group of patients, only a significant relation between the vena cava diameter and cGMP was observed in patients with normal left atrial hemodynamics, whereas they were not in patients with a dilated left atrium. Furthermore, in normovolemic patients with mitral insufficiency, ANP levels after dialysis remained increased compared to patients without mitral insufficiency, suggesting that, in addition to volume expansion, also altered left atrial hemodynamics influence the release of cGMP and ANP. Conductivity measurements and ANP before and after dialysis were not related, whereas only cGMP after dialysis was significantly related to conductivity measurements. ANP and cGMP were not related to the change in hemodynamic parameters during dialysis, questioning their reliability in the assessment of underhydration.
本文综述了几种新开发的用于评估血液透析患者体液状态的技术。下腔静脉超声检查以及心房钠尿肽（ANP）和环磷酸鸟苷（cGMP）水平的测量仅能提供血管内容量的信息，而电导率测量能够检测细胞外和细胞内间隙的变化，但无法区分血管内和组织间隙的液体空间。下腔静脉超声检查作为评估水合过多和水合不足的工具，已根据诸如右心房压力、总血容量以及透析期间血流动力学参数变化等客观标准成功得到验证。透析前后的电导率测量与腔静脉测量值显著相关。虽然透析前ANP水平与腔静脉直径显著相关，但在另一组患者中，仅在左心房血流动力学正常的患者中观察到腔静脉直径与cGMP之间存在显著关系，而左心房扩大的患者则未观察到这种关系。此外，在患有二尖瓣关闭不全的血容量正常患者中，与无二尖瓣关闭不全的患者相比，透析后的ANP水平仍然升高，这表明除了容量扩张外，左心房血流动力学改变也会影响cGMP和ANP的释放。透析前后的电导率测量与ANP无关，而仅透析后的cGMP与电导率测量显著相关。ANP和cGMP与透析期间血流动力学参数的变化无关，这对它们在评估水合不足方面的可靠性提出了质疑。
