Evaluation Of Volume Status Of Dialysis Patients By Common Carotid Artery And Inferior Vena Cava Ultrasound

Objective:This study intends to evaluate the value of common carotid artery and inferior vena cava ultrasonography in evaluating the volume state of patients with chronic kidney disease during stage 5 dialysis.Methods:As a prospective study,a total of 85 people with chronic kidney disease 5 were singled out from the hemodialysis room of the Department of Nephrology of the sixth affiliated Hospital of Kunming Medical University from October 2019 to October 2020 through upper limb arteriovenous fistula.After the patients and their families signed the informed consent.All patients’ sex,age,diagnosis of basic diseases in outpatient clinic and ultrafiltration volume of this dialysis were recorded.During the experiment,the heart rate,systolic blood pressure,diastolic blood pressure,common carotid artery diameter(R),continuous common carotid artery velocity time integral(VTI),three consecutive common carotid arteryone cycle time(CT),systolic time(ST),maximum diameter of inferior vena cava(IVCmax)and minimum diameter(IVCmin)were collected before and after passive leg lifting test before and after dialysis,semireclining position of before and after dialysis.The mean arterial pressure(MAP),corrected blood flow time(CFT),common carotid artery blood flow(CBF)and inferior vena cava variability(VIVC)were calculated.After the data were sorted out.The data were analyzed and processed by SPSS 25.0,and the measured data were tested normally.Before and after passive leg lifting test before dialysis,before and after passive leg lifting test after dialysis,and before and after half-lying dialysis of heart rate,mean arterial pressure and CFT1、CFT2、CBF、VIVC were analyzed.Analyze the correlation between hemodialysis dehydration volume and CFT1、CFT1、CBF change before and after half-lying dialysis.On this basis,the ROC curve was used to determine the evaluation value of the changes of the CFT1、CFT2、CBF before and after the passive leg lifting test before dialysis,before and after the passive leg lifting test after dialysis,and before and after the semi-lying position dialysis.Results:1.Compared with before the passive leg lifting test before dialysis,the CFT1、CFT2、CBF of after the passive leg lifting test before dialysis increased.Compared with before the passive leg lifting test after dialysis,the CFT1、CFT2、CBF of after the passive leg lifting test after dialysis increased,and compared with the semi-lying position before dialysis,the CFT1、CFT2、CBF decreased and the VIVC increased.2.Grouping the amount of dehydration,the CBF value increases with the increase of the amount of dehydration.3.CFT1、CFT2 changes before and after dialysis in semi-lying position did not increase with the increase of dehydration.4.Significant correlation between CFT1、CFT2 value before and after passive leg lift test and before and after dialysis.5.By drawing the ROC curve of CFT1 change value before and after half-lying position dialysis and before and after passive leg lifting test after dialysis,and calculating its area before and after passive leg lifting test,the same method draws the ROC curve about CFT2、CBF and determines the change of CFT1、CFT2、CBF before and after half-lying position dialysis.the change value before and after passive leg lifting test can be used to evaluate the capacity state of dialysis patients.△CFT1 before and after dialysis(AUC=0.618),Its diagnostic critical value is 27.56(sensitivity 42.4%,specificity 85.9%);△CFT2 before and after dialysis(AUC=0.672),Critical value 33.08(sensitivity 49.4%),specificity(87.1%);△CBF before and after dialysis(AUC=0.839),Critical value 385.027(sensitivity 82.4%),specificity(78.8%);△CBF before and after PLR(AUC=0.846),Critical value 229.823,specificity of 72.9%).Conclusions:1.The corrected blood flow time of common carotid artery and blood flow of common carotid artery can be used as indexes to evaluate the volume state of dialysis patients.Moreover,the volume state of patients can be evaluated by calculating the change of corrected blood flow time,common carotid artery blood flow of common carotid artery before and after dialysis and before and after passive leg lifting test to guide Chronic Kidney Disease 5 patients fluid replacement therapy.2.VIVC is not suitable for evaluating the volume status of patients for dialysis patients with spontaneous respiration.3.The passive leg lifting test combined with CFT1,CFT2 and CBFcan be used to evaluate the volume state of dialysis patients,and guide treatment.