联合心肺超声对透析间期急性肺水肿发生的危险因素分析  

Analysis of Risk Factors of Acute Pulmonary Edema in Patients During Dialysis Interval by Combined Cardio-lung Ultrasound

作　　者：赵浩天[1] 王泽凯 赵鹏 龙玲[3] 薛红元[1] Zhao Haotian;Wang Zekai;Zhao Peng;Long Ling;Xue Hongyuan(Department of Ultrasound,Hebei Provincial People s Hospital,Shijiazhuang 050000,China;Nephrology,Hebei Provincial People s Hospital,Shijiazhuang 050000,China;Critical Care Medicine,Hebei Provincial People s Hospital,Shijiazhuang 050000,China)

机构地区：[1]河北省人民医院超声科,石家庄市050000 [2]河北省人民医院肾内科,石家庄市050000 [3]河北省人民医院重症医学科,石家庄市050000

出　　处：《中国超声医学杂志》2022年第1期30-34,共5页Chinese Journal of Ultrasound in Medicine

基　　金：河北省科技计划项目(No.152777137);河北省医学科学研究课题计划项目(No.20200714)。

摘　　要：目的探究联合心肺超声技术对透析间期患者发生急性肺水肿的危险因素分析。方法纳入处于透析间期的慢性肾脏病的患者56例,根据透析间期是否发生急性肺水肿将患者分为肺水肿阳性组和肺水肿阴性组。对所有患者均进行联合心肺超声检查。使用十二分区肺超声评分(LUS)量化肺水肿程度。监测左心结构与功能指标,如左房内径(LAD)、左房面积(LAA)、左室舒张末期内径(LVEDD);测量左室收缩与舒张功能,包括左室射血分数(LVEF)、二尖瓣舒张早期血流峰速度(E)和二尖瓣环运动速度(e′),并计算E/e′和左心房面积变化率(v-LAA)。对两组数据进行对比分析。结果肺水肿阳性组的LAD、LAA、E/e′、前胸壁LUS和整体LUS均高于阴性组,LVEF和v-LAA均低于阴性组(P<0.05)。多因素Logistic回归分析显示v-LAA(OR=1.165,P=0.007)和前胸壁LUS(OR=0.344,P=0.021)是透析间期急性肺水肿发生的独立影响因素。结论联合心肺超声对透析间期患者进行心肺功能监测具有实用价值,其中左心房面积变化率和前胸壁肺超声评分与急性肺水肿发生高度相关。Objective To explore the risk factors of acute pulmonary edema in patients during dialysis interval by cardio-lung ultrasound. Methods 56 patients with chronic kidney disease during dialysis interval were included in this study. According to the occurrence of acute pulmonary edema during dialysis interval, the patients were divided into pulmonary edema positive group and pulmonary edema negative group. All patients were examined by combined cardio-lung ultrasound. Twelve zone lung ultrasound score(LUS) was used to quantify the degree of pulmonary edema. The indexes of structure and function of left heart, such as left atrial diameter(LAD), left atrial area(LAA), left ventricular end-diastolic diameter(LVEDD) were measured;left ventricular systolic and diastolic function, including left ventricular ejection fraction(LVEF), mitral early diastolic peak velocity(E), and mitral annular velocity(e′) were monitored. E/e′ and the variation of LAA(v-LAA) were calculated. The two groups of data were analyzed. Results The LAD, LAA, E/e′, anterior chest wall LUS and total LUS in the pulmonary edema positive group were higher than those in the negative group, the LVEF and v-LAA were lower than those in the negative group(P<0.05). Multivariate logistic regression analysis showed that v-LAA(OR=1.165, P=0.007) and anterior chest wall LUS(OR=0.344, P=0.021) were the independent risk factors of acute pulmonary edema during dialysis interval. Conclusions Combined cardio-lung ultrasound has practical value in monitoring cardiac and pulmonary function in patients during dialysis interval. Variation of left atrial area and anterior chest wall lung ultrasound score are highly correlated with acute pulmonary edema.

关 键 词：肺超声评分 急性肺水肿 透析间期 左心室充盈压力 左心室舒张功能 

分 类 号：R445.1[医药卫生—影像医学与核医学] R563[医药卫生—诊断学]