Dupont Matthias, Mullens Wilfried, Tang W H Wilson
Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Curr Heart Fail Rep. 2011 Dec;8(4):233-41. doi: 10.1007/s11897-011-0071-7.
Systemic venous congestion is one of the hallmarks of the syndrome of heart failure that results from activation of different deleterious neurohormonal pathways. Apart from contributing to patients' symptoms and hospital admissions, growing evidence suggests that congestion itself drives further heart failure progression. In addition, systemic venous congestion exerts detrimental effects on other organs (such as kidneys and liver) due to ineffective organ perfusion. Endothelial cell activation, altered ventricular geometry, and functional mitral insufficiency are among the proposed mechanisms. Diuretics and vasodilators remain the mainstay of treatment options, mostly because of poor understanding of the underlying cardiorenal mechanisms involved. Recently, ultrafiltration has emerged as an invasive treatment option in the setting of diuretic resistance. Congestion ideally should be prevented, often initially through water and salt restriction. Early detection, possibly with the help of novel implantable sensor technology, may allow for early detection and intervention long before overt congestion is established.
体循环静脉淤血是心力衰竭综合征的特征之一，其由不同有害神经激素途径的激活所致。除了导致患者出现症状和住院外，越来越多的证据表明，淤血本身会推动心力衰竭的进一步发展。此外，由于器官灌注不足，体循环静脉淤血会对其他器官（如肾脏和肝脏）产生有害影响。内皮细胞激活、心室几何形状改变和功能性二尖瓣关闭不全是提出的机制之一。利尿剂和血管扩张剂仍然是主要的治疗选择，主要是因为对所涉及的潜在心肾机制了解不足。最近，超滤已成为利尿剂抵抗情况下的一种侵入性治疗选择。理想情况下，应经常通过限制水和盐的摄入来预防淤血。借助新型可植入传感器技术进行早期检测，可能会在明显淤血形成之前很久就实现早期检测和干预。
