维持性血液透析患者肺超声和腔静脉指标评估容量状况。

Mujtaba Z Al-Saray, Ala Ali
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摘要

背景:容量超载在终末期肾脏疾病(ESKD)和透析患者中很常见。因此,需要客观的工具来检测这种体积过剩。护理点超声(POCUS)是一种目标导向的床边检查,以回答这样一个特定的诊断问题。方法:于2022年2月1日至5月31日招募伊拉克成年血液透析患者100例。记录主要临床、透析资料和处方。肾科医生在本周最后一次透析后进行了POCUS检查。此外,进行胸部超声检查以检测b线和胸腔积液。下腔静脉参数包括下腔静脉(IVC)直径和溃散指数。结果:研究组平均年龄51.48±14.6岁,男性占53%。平均透析期体重增加2.74±1.15 Kg。下肢水肿和胸腔积液分别占33%和27%。47%的患者在肺超声上有>3个b线,范围为12。结论:伊拉克维持性血液透析患者存在容量超载,需要采取适当的干预措施进行检测和透析管理。POCUS是一种有用且易于执行的评估体积状态的技术。
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Lung Ultrasound and Caval Indices to Assess Volume Status in Maintenance Hemodialysis Patients.

Background: Volume overload is common in end stage kidney disease (ESKD) and dialysis patients. Hence, the need for objective tools to detect such volume excess. Point of care ultrasound (POCUS) is a goal-directed, bedside examination to answer such a specific diagnostic question. Methods: One hundred Iraqi adult hemodialysis patients were recruited from February 1 to May 31, 2022. Primary clinical, dialysis data, and prescriptions were recorded. A nephrologist performed a POCUS examination after the last dialysis session of the week. In addition, an ultrasound examination of the chest was performed to detect B-lines and pleural effusion. Caval parameters included inferior vena cava (IVC) diameter and collapsibility index. Results: The mean age of the study group was 51.48 ± 14.6 years, with 53% males. The mean interdialytic weight gain was 2.74 ± 1.15 Kg. Lower limb edema and pleural effusion were present in 33% and 27%, respectively. Forty-seven percent of patients had >3 B-lines on lung ultrasound with a range of 12. Forty-three percent of patients had an IVC diameter of >2 cm, and 93% had <50% IVC collapsibility. In total, 97% of patients had evidence of excess volume by ultrasound criteria. IVC collapsibility index was the most prevalent sign of excess volume (93%). Patients without lower limb edema and pleural effusion had positive B-lines in 38.8% and 38.3%, an IVC diameter >2 cm in 46.2% and 38.3%, and IVC collapsibility <50% in 89.5% and 95.8% respectively. Conclusion: Iraqi maintenance hemodialysis patients are volume overloaded, which warrants proper intervention for detection and dialysis management. POCUS is a useful and easily performed technique to assess the volume status.

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