Hollerbach S, Schultze K, Muscholl M, Schölmerich J
Medizinische Universitätsklinik, Knappschaftskrankenhaus, Klinikum der Ruhr-Universität Bochum.
Dtsch Med Wochenschr. 2001 Feb 9;126(6):129-33. doi: 10.1055/s-2001-11047.
This prospective clinical study investigated whether the relatively simple and cost-effective ultrasonography of the inferior vena cava (IVC) represents a valid clinical tool to assess the effectiveness of diuretic therapy in patients with chronic congestive heart failure (CHF).
Measurement of the resting and inspiratory diameter of the VCI repeatedly during diuretic therapy in 23 consecutive patients (11 women, 70 +/- 10 years) with CHF and comparing the results to the daily measured body weight and serum creatinine in these patients. Results were compared with the IVC diameter obtained in 33 healthy controls (16 women, 42 +/- 15 years). In addition, the IVC collapse index was calculated to assess inspiratory movements of the IVC in patients on day 1 and 10 of therapy.
The IVC diameter at rest was 2.4 +/- 0.6 cm and decreased to 2.0 +/- 0.7 cm at inspiration, which was significantly greater than in healthy controls (1.4 +/- 0.4 cm at rest and 1.05 +/- 0.5 cm at inspiration; p = 0.008 and p = 0.01, respectively). The IVC diameter decreased continuously and significantly (p < 0.003) from day 1 to day 10 during diuretic therapy without a concomitant rise in serum creatinine. At beginning of therapy, the collapse-index of the IVC was significantly greater in patients than in controls. However, after 10 days of therapy this index reached similar values to those observed in controls.
Ultrasonographic measurements of IVC diameter and inspiratory movements are a quantifiable and reliable approach to assess the hypervolemia associated with CHF. Normalization of inspiratory IVC collapse movement correlates with successful diuretic therapy and can be reliably used for bedside assessment and monitoring treatment in CHF patients.
这项前瞻性临床研究调查了相对简单且经济高效的下腔静脉（IVC）超声检查是否是评估慢性充血性心力衰竭（CHF）患者利尿治疗效果的有效临床工具。
在23例连续的CHF患者（11名女性，年龄70±10岁）利尿治疗期间反复测量IVC的静息和吸气直径，并将结果与这些患者每日测量的体重和血清肌酐进行比较。结果与33名健康对照者（16名女性，年龄42±15岁）的IVC直径进行比较。此外，计算IVC塌陷指数以评估治疗第1天和第10天患者IVC的吸气运动。
IVC静息直径为2.4±0.6 cm，吸气时降至2.0±0.7 cm，显著大于健康对照者（静息时为1.4±0.4 cm，吸气时为1.05±0.5 cm；p分别为0.008和0.01）。在利尿治疗期间，从第1天到第10天，IVC直径持续显著下降（p<0.003），而血清肌酐没有相应升高。治疗开始时，患者的IVC塌陷指数显著高于对照者。然而，治疗10天后，该指数达到与对照者相似的值。
IVC直径和吸气运动的超声测量是评估与CHF相关的血容量过多的可量化且可靠的方法。吸气时IVC塌陷运动的正常化与利尿治疗成功相关，可可靠地用于CHF患者的床边评估和治疗监测。
