| 摘要: |
| 目的探究下腔静脉（IVC）超声指标对接受维持性透析的慢性肾衰竭合并高血压患者的容量状态评估价值。方法纳入我院肾内科拟接受维持性透析治疗的慢性肾衰竭合并高血压的患者56例，根据CT心胸比值将患者分为容量过负荷组和容量正常组，于透析治疗前使用床旁超声动态监测下腔静脉内径（D-IVC），并计算下腔静脉随呼吸变异度（V-IVC）。观察并分析两组间各指标的差异。通过受试者工作特征（ROC）曲线评价各指标对容量状态的预测价值。并将呼气末下腔静脉内径（D-IVCe）、V-IVC分别与CT心胸比进行相关性分析。结果容量过负荷组较容量正常组具有较高的D-IVCe（P=0.005）和较低的V-IVC（P=0.01）。以D-IVCe和V-IVC分别取17.7mm和30%为阈值，预测容量过负荷的敏感度为58.3%和81.3%，特异度为81.2%和58.3%，ROC曲线下面积分别为0.719（95%CI:0.584~0.855）和0.696（95%CI:0.554~0.838）。相关性分析显示，CT心胸比与D-IVCe呈正相关性（r=0.607），与V-IVC呈负相关性（r=-0.585）。结论下腔静脉超声指标对慢性肾衰竭合并高血压的维持性透析患者容量状态有较好的评估价值。 |
| 关键词: 下腔静脉 容量状态 超声 心胸比 慢性肾衰竭 |
| DOI： |
| 投稿时间：2020-11-15修订日期：2021-12-24 |
| 基金项目:河北省医学科学研究课题计划项目(No. 20200714)；河北省科技计划项目(No.152777137) |
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| The value of inferior vena cava ultrasound in evaluating the volume state of maintenance dialysis patients with chronic renal failure and hypertension |
| WANG Ze-kai,LONG Ling,ZHAO Peng,ZHAO Haotian,NIU Kai,LIU Bing |
| (HEBEI GENERAL HOSPITAL) |
| Abstract: |
| Objective: To explore the value of inferior vena cava(IVC) in evaluating the volume state of chronic renal failure and hypertensionpatients undergoing maintenance dialysis. Methods: 56 cases of chronic renal failure and hypertensionwere included in the department of Nephrology of our hospital. Patients were divided into volume overload group and normal volume group according to CT cardiothoracic ratio. The diameter of inferior vena cava(D-IVC) was dynamically monitored by bedside ultrasound before dialysis treatment, and the variation of inferior vena cava(V-IVC) was calculated. To observe and analyze the differences between the two groups. The predictive value of each index to volume state was evaluated by ReceiverSoperatingScharacteristic(ROC) curve, and the correlation between End expiratory of D-IVC(D-IVCe) and CT cardiothoracic ratio was analyzed. Results there were higher D-IVCe(P=0.005) and lower V-IVC(P=0.01) in volume overload group than in volume normal group. The threshold values of D-IVCe and V-IVC were 17.7mm and 30%, respectively. The sensitivity, specificity were 58.3% and 81.3%, 81.2% and 58.3%, respectively. The area under ROC curve was 0.719(95%CI:0.584-0.855) and 0.696(95%CI:0.554-0.838). According to the correlation analysis, there was a positive correlation between D-IVCe and CT cardiothoracic ratio(r=0.607), and a negative correlation between V-IVC and CT cardiothoracic ratio(r=-0.585). Conclusion: the ultrasonic index of inferior vena cava has a better evaluation value for the volume state of patients with chronic renal failureand maintenance dialysis. |
| Key words: inferior vena cava volume status ultrasound cardiothoracic ratio chronic renal failure |
