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目的调查肺淤血在腹膜透析(腹透)患者的发生率及分析其发病的危险因素,探讨肺超声在腹透患者容量评估中的应用价值。方法将98例腹透患者按B线数目分两组,无或轻度肺淤血组(B线≤15)和中重度肺淤血组(B线>15),比较两组间临床指标的差异,二分类logistic回归分析影响肺淤血发生的危险因素。X~2检验比较以肺超声及下肢水肿评估容量的一致性。Spearman相关分析B线数目和血B型尿钠肽水平的相关性。结果肺淤血发生率52.0%,中重度者达37.8%。与无或轻度肺淤血组相比,中重度肺淤血组糖尿病、肺动脉高压和NYHAⅢ~Ⅳ级者较多,而血白蛋白、钙磷乘积较低(P均<0.01)。多因素分析显示糖尿病、低白蛋白血症及肺动脉高压是肺淤血发生的独立危险因素(P均<0.05)。下肢水肿者83.3%存在肺淤血,而肺淤血者仅39.2%存在下肢水肿(Kappa<0.4,P<0.01)。B线数目和血B型尿钠肽水平显著相关(r=0.692,P<0.01)。结论腹透患者肺淤血发生率高。肺淤血的发生与糖尿病、低白蛋白血症及肺动脉高压有关。下肢水肿预测肺淤血准确度低。肺超声或有助指导容量超负荷的早期诊断与干预。
Objective To investigate the incidence of pulmonary congestion in peritoneal dialysis (PD) patients and analyze the risk factors for the pathogenesis of pulmonary ultrasonography in evaluating the capacity of peritoneal dialysis patients. Methods 98 cases of peritoneal dialysis patients were divided into two groups according to the number of B line, no or mild pulmonary congestion group (B line≤15) and moderate to severe pulmonary congestion group (B line> 15) Binary logistic regression analysis of risk factors affecting the occurrence of pulmonary congestion. X ~ 2 test to compare the capacity of lung ultrasound and lower limb edema consistency assessment. Spearman correlation analysis of the number of B lines and serum B-type natriuretic peptide levels. Results The incidence of pulmonary congestion 52.0%, 37.8% of moderate and severe. Compared with no or mild pulmonary congestion group, moderate to severe pulmonary congestion group had more diabetes mellitus, pulmonary hypertension and NYHA Ⅲ ~ Ⅳ, while the albumin and calcium phosphorus had a lower product (all P <0.01). Multivariate analysis showed that diabetes mellitus, hypoalbuminemia and pulmonary hypertension were independent risk factors of pulmonary congestion (P <0.05). Lower extremity edema, 83.3% of pulmonary congestion, while only 39.2% of pulmonary congestion were lower extremity edema (Kappa <0.4, P <0.01). There was a significant correlation between the number of B line and blood B-type natriuretic peptide (r = 0.692, P <0.01). Conclusion Peritoneal dialysis patients with high incidence of pulmonary congestion. Pulmonary congestion occurs with diabetes, hypoalbuminemia and pulmonary hypertension. Lower extremity edema prediction of pulmonary congestion is low accuracy. Pulmonary ultrasound or early diagnosis and intervention to help guide capacity overload.