Analysis On The Clinical Application Value Of Pulmonary Ultrasound In The Assessment Of Volume Status Of Hemodialysis Patients

Objective:B-line in lung ultrasound was used to evaluate lung water before and after dialysis in hemodialysis(HD)patients,and the correlation between B-line and intravascular water,cardiac function indexes,ultrafiltration volume,etc.To explore the value of lung ultrasound in the assessment of volume status of HD patients.Methods:In this study,40 patients with chronic HD at the dialysis center from January to June 2019 were selected.Assessment of lung water status using a28-segment lung ultrasound scan,expressed as a B-line score.Echocardiography measured left ventricular end diastolic diameter(LVEDD),diastolic mitral valve flow rate(E peak,A peak),and left ventricular ejection fraction(LVEF)before and after dialysis.Maximum diameter of inferior vena cava(IVC)measured under the xiphoid process.Compare the changes of these measurement parameters before and after dialysis.Analyze the correlation between B-line and IVC diameter,LVEDD,E / A,LVEF and other parameters before and after dialysis,and analyze the correlation between B-line score and body mass index(BMI)and dyspnea symptoms before dialysis.The ultrafiltration volume after dialysis was recorded.The linear regression analysis was used to analyze the relationship between B-line score,IVC inner diameter,LVEF change rate,and ultrafiltration volume.Results:1.B-line score,IVC inner diameter,LVEDD,E peak,and A peak all decreased after dialysis,and LVEF increased after dialysis.The differences before and after dialysis were statistically significant(P<0.001).2.Before dialysis,the B-line score had a good positive correlation with the inner diameter of IVC(r=0.428,P<0.05),LVEDD(r =0.421,P<0.05),and E / A(r = 0.524,P=0.001),and Good negative correlation with LVEF(r=-0.519,P=0.001).Afterdialysis,the correlation between B-line score and IVC diameter disappeared(P=0.57),and the correlation with LVEDD(r=0.457,P<0.05)E/A(r=0.689,P<0.001)and LVEF(r=-0.604,P<0.001)was still the same as before dialysis,and the correlation coefficient between B-line score and LVEF and E/A increased.In addition,the B-line score before dialysis had a good negative correlation with BMI(r =-0.502,P = 0.001),and had no significant correlation with dyspnea symptoms(P> 0.05).3.The change rate of B-line score before and after dialysis(?=-0.405,P<0.001)has a good negative correlation with the amount of ultrafiltration,while the change in LVEF(? =0.059,P=0.048)shows only a weak correlation with the amount of ultrafiltration.IVC changes before and after dialysis were not significantly related to ultrafiltration volume(P> 0.05).Conclusion:The B-line of pulmonary ultrasound decreased significantly after dialysis,indicating that B-line was sensitive to the response to volume.The B-line score before dialysis was well correlated with the indexes of vascular water and cardiac function,while B-line residual after dialysis was mainly related to cardiac function.In the course of dialysis,B-line,as a marker of pulmonary water,is most closely related to the change of ultrafiltration volume.Thus,pulmonary ultrasound can be used as an effective tool to evaluate the capacity,monitor the capacity change,and provide more valuable information for the clinic.