下腔静脉直径测量判断血透患者体液容量状态

目的 :探讨下腔静脉直径 (VCD)对体液容量状态判断的临床应用价值。方法 :对 6 4例体液容量过多者(血液透析患者透析前 )和 71例体液容量正常者 (正常人组 ) ,用二维超声测量其呼气末下腔静脉直径 (VCD E) ,并计算其呼吸衰减指数 (CI)。结果 :( 1)体液容量正常者VCD E为 ( 10 6 9± 2 18)mm ,CI( 2 6 2 4± 6 34) % ;体液容量过多者VCD E为 ( 13 78± 2 95 )mm ,CI( 19 2 8± 6 2 4) % ,二者差异有显著性 (P <0 .0 1)。 ( 2 )血液透析患者透析前后VCD E改变与透析超滤量呈直线相关 ( r=0 .380 ,P <0 .0 1) ,二者比值为 ( 2 0± 1 2 )mm·kg- 1 。 ( 3)用VCD作诊断试验 ,受试者运筹特性 (ROC)曲线显示 ,体液容量过多的判断值宜为VCD E≥ 13 0mm ,其敏感性为 87% ,特异性为 87 5 %。结论 :血液透析患者透析后VCD E应控制在 ( 10 7± 2 2 )mm ,以达到干体重状态 ;超声检测下腔静脉直径简便、可靠 ,对体液容量状态判断具有临床应用价值

Measurement of the inferior vena cava diameter for estimating fluid status in hemodialysis patients

Objective:To investigate the clinical application of inferior vena cava diameter (VCD)for estimating fluid status. Methods: VCD were measured during the expiratory phase (VCDE) in 64 patients before hemodialysis (hypervolemia) and 71 normovolemia cases by ultrasonography, meanwhile collapsibility index (CI) were calculated. Results: (1) VCDE was (10.69±2.18) mm, CI was (26.24±6.34)% in normovolemic group; and (13.78±2.95) mm, (19.28±6.24%) in hypervolemic group respectively. There were significant differences in both (P<0.01). (2) Change of VCDE between preand postdialysis was related with the amount of ultrafiltraiton during hemodialysis (r=0.38,P<0.01). The ratio was (2.0±1.2) mm·kg -1 . (3)By using VCDE to estimate hypervolemia, receiver operating charactersitic (ROC) curve shoued if VCDE≥13.0 mm, the sensitivity was 87.0% and the specificity was 87.5%. Conlusion: VCDE in postdialysis patients would approach (10.7±2.2) mm, which could be interpreted as being close to the dry weight. Thus VCD appears to be a valuable tool in estimating fluid status.