Ross R D, Bollinger R O, Pinsky W W
Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit.
Pediatr Cardiol. 1992 Apr;13(2):72-5. doi: 10.1007/BF00798207.
To determine which variables most accurately define congestive heart failure (CHF) in infants, 41 patients (median age 2.5 months) were graded by four pediatric cardiologists for the presence and severity of CHF based on the following variables: amount of formula consumed per feeding, feeding time, history of diaphoresis or tachypnea, growth parameters, respiratory and heart rates, respiratory pattern, perfusion, presence of edema, diastolic filling sounds, and hepatomegaly. There were 19 patients graded as having no CHF, nine as mild, seven moderate, and six severe CHF. The most sensitive and specific variables (p less than 0.0001) for the presence of CHF were a history of less than 3.5 oz/feed, respiratory rate greater than 50/min, an abnormal respiratory pattern, diastolic filling sounds, and hepatomegaly. Moderate to severe CHF was present when patients took less than 3 oz/feed or greater than 40 min/feed, had an abnormal respiratory pattern with a resting respiratory rate greater than 60/min, and had a diastolic filling sound and moderate hepatomegaly. Severe CHF was accompanied by a heart rate greater than 170/min, decreased perfusion, and severe hepatomegaly. Thus, the grading of the severity of CHF in infants should include an accurate description of these historical and clinical variables.
为了确定哪些变量能最准确地界定婴儿充血性心力衰竭（CHF），41名患者（中位年龄2.5个月）由四位儿科心脏病专家根据以下变量对CHF的存在及严重程度进行分级：每次喂养摄入的配方奶量、喂养时间、出汗或呼吸急促史、生长参数、呼吸和心率、呼吸模式、灌注情况、水肿的存在、舒张期充盈音以及肝肿大。有19名患者被分级为无CHF，9名轻度，7名中度，6名重度CHF。对于CHF存在最敏感和特异的变量（p小于0.0001）是每次喂养少于3.5盎司、呼吸频率大于50次/分钟、异常呼吸模式、舒张期充盈音以及肝肿大。当患者每次喂养少于3盎司或超过40分钟、静息呼吸频率大于60次/分钟且有异常呼吸模式、有舒张期充盈音和中度肝肿大时，存在中度至重度CHF。重度CHF伴有心率大于170次/分钟、灌注减少以及重度肝肿大。因此，婴儿CHF严重程度的分级应包括对这些病史和临床变量的准确描述。
