Katzarski K S, Nisell J, Randmaa I, Danielsson A, Freyschuss U, Bergström J
Department of Clinical Science, Huddinge University Hospital, Karolinska Institute, Stockholm, Sweden.
Am J Kidney Dis. 1997 Oct;30(4):459-65. doi: 10.1016/s0272-6386(97)90302-4.
The utility of measurement of the inferior vena cava diameter (IVCD) with ultrasound for the assessment of fluid status and posthemodialysis dry weight was studied in 35 hemodialysis (HD) patients, 17 with and 18 without hypertension. In 17 patients (group A), IVCD was measured before and 35 to 40 minutes after HD, pre-HD blood volume (BV) was measured with radiolabeled albumin and post-HD BV was calculated from the change in hematocrit. In 18 patients (group B), IVCD was measured repeatedly during HD and 2 hours after HD. Changes in BV were recorded by monitoring of the hematocrit "on line." Body weight, blood pressure (BP), BV, and IVCD decreased in the entire population. In group A, BV was significantly larger in the hypertensive patients than in the normotensive patients, and it was correlated with the mean BP before and after HD. In the whole population, IVCD was larger in the hypertensive than in the normotensive patients before and after HD. These results confirm that extracellular fluid overload plays an important role in the pathogenesis of dialysis-associated hypertension. In group B, BV and IVCD decreased in parallel during HD and increased during 2 hours after HD due to refilling of the intravascular space, indicating that changes in IVCD reflect changes in BV. In 8 patients studied twice, IVCD increased much more after a 3-hour HD session than after a 6-hour session. At the end of HD, several patients had IVCD below the reference range but IVCD increased during the following 1 to 2 hours, in some patients to values above the reference range. IVCD measured at the end or shortly after HD may therefore be misleading in assessing dry weight.
在35例血液透析（HD）患者中研究了超声测量下腔静脉直径（IVCD）对评估液体状态和血液透析后干体重的作用，其中17例有高血压，18例无高血压。在17例患者（A组）中，在HD前和HD后35至40分钟测量IVCD，用放射性标记白蛋白测量HD前血容量（BV），并根据血细胞比容的变化计算HD后BV。在18例患者（B组）中，在HD期间和HD后2小时重复测量IVCD。通过“在线”监测血细胞比容记录BV的变化。整个人群的体重、血压（BP）、BV和IVCD均下降。在A组中，高血压患者的BV显著大于血压正常的患者，并且它与HD前后的平均BP相关。在整个人群中，HD前后高血压患者的IVCD大于血压正常的患者。这些结果证实细胞外液超负荷在透析相关性高血压的发病机制中起重要作用。在B组中，HD期间BV和IVCD平行下降，HD后2小时由于血管内空间的再充盈而增加，表明IVCD的变化反映了BV的变化。在8例接受两次研究的患者中，3小时HD疗程后IVCD的增加比6小时疗程后更多。在HD结束时，一些患者的IVCD低于参考范围，但在接下来的1至2小时内IVCD增加，在一些患者中升至高于参考范围的值。因此，在HD结束时或结束后不久测量的IVCD在评估干体重时可能会产生误导。
